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									    1.        Background on the Strategic Planning Workshops
              for Hospitals

    Overview                                                            transmission in the U.S. — one of the agency's
                                                                        top priorities articulated in the Advancing
    The Centers for Disease Control and Prevention's                    HIV Prevention (AHP) Initiative. An important
    (CDC) Division of HIV/AIDS Prevention sponsored                     population that still needs to be reached for HIV
    a series of eight regional workshops across the                     testing is pregnant women whose HIV status
    country to increase the capacity of hospitals and                   is unknown when they present in labor. HIV
    healthcare providers to further decrease perinatal                  transmission risk from mother to infant can
    HIV transmission in the U.S. The workshops                          be decreased to approximately ten percent if
    focused on building the capacity of hospitals to                    antiretroviral prophylaxis is initiated during labor.
    offer rapid HIV testing to women in labor whose                     More information is available about the AHP
    HIV serostatus is unknown. The primary goal                         Initiative at
    of this initiative was to reduce the number of
    perinatally acquired HIV infections, by increasing                  Role of CDC Partners
    rapid HIV testing in labor and delivery (RT in L&D)
    settings.                                                           CDC collaborated with the François-Xavier
                                                                        Bagnoud Center (FXBC) at the University of
    The strategic planning workshops were effective                     Medicine & Dentistry of New Jersey and the
    in increasing hospitals’ capacity to offer rapid HIV                Academy for Educational Development (AED) to
    testing to women in labor with undocumented HIV                     develop and conduct these workshops. All three
    status. Nearly 90% of the hospitals who participated                agencies were responsible for coordinating and
    in the follow-up study had formally decided to offer                conducting the workshops.
    RT in L&D.
                                                                        CDC and FXBC developed the format and content
    This document will provide guidance to CDC, state                   of the workshops, which focused on contributing
    health departments, and other organizations that                    to a broad understanding of issues related to
    would like to replicate these strategic planning                    implementation of a science-based protocol for RT
    meetings for hospitals. The approach presented in                   in L&D settings. The content was also designed to
    this document could be tailored, for example, for                   share information with the target audience on how
    meetings focusing on rapid testing in emergency                     the recommended protocol could be effectively
    department settings.                                                applied to their local clinical setting. In conjunction
                                                                        with CDC, FXBC developed the pilot workshop
    Relationship to Advancing HIV                                       which served as the model for subsequent
    Prevention Initiative                                               workshops. With input from CDC, FXBC was
                                                                        responsible for identifying hospitals to invite to the
    The workshop series was a component of the                          workshops; recruiting hospital staff and observers
    CDC initiative to further decrease perinatal HIV                    to attend the workshops; identifying and preparing

4     Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide
the presenters for the workshops; and facilitating                           L&D. The workshops were conducted to provide
and speaking during the workshops.                                           hospitals the opportunity to consider the process
                                                                             for and feasibility of initiating RT in L&D at their
AED was responsible for managing many aspects
of the workshop execution, including planning the
agenda; securing meeting space; arranging lodging
                                                                             Workshop Activities
and travel for participants; renting audiovisual
equipment; reproducing all materials for the                                 The activities conducted during the workshops
workshops; shipping materials and supplies to the                            included:
workshop sites; producing the evaluation forms                               • Two plenary presentations by CDC experts
that measured participant satisfaction (and later                              describing the scientific rationale and
developing evaluation reports); facilitating during                            implementation considerations for offering RT
the workshops; handling onsite logistics; reimbursing                          to women in labor with unknown HIV status,
travelers; transcribing SWOT analysis and action                               and providing a technical overview of the
plans for hospitals; and modifying the agenda for                              performance characteristics of the available FDA-
future workshops.                                                              approved rapid HIV tests;
The three agencies communicated via conference                               • A "lessons from the field" panel during which
call at least once every two weeks and more                                    clinicians who had implemented RT in L&D
frequently if needed. Major decisions regarding the                            settings in their hospitals answered key questions
workshops were made during these conference calls                              regarding RT in L&D; and
or via e-mail.                                                               • Small group interactive sessions on 1) performing
                                                                               rapid testing, 2) offering the test and giving results
Workshop Goals                                                                 to woman in labor, and ) providing follow-up for
The primary goal of the one and one-half                                       mother and baby.
day workshops was to provide hospitals with                                  An important component in each workshop was
information, resources and support to develop a                              time during which each hospital team worked
strategic plan for implementing RT in L&D settings.                          together to develop an implementation plan to
Additional workshop goals included:                                          initiate the use of RT in L&D at their hospital.
• Providing hospital leaders with current                                    Teams spent an hour doing a SWOT analysis1
  information on the science and technology of RT                            of their hospital’s readiness to implement RT in
  in L&D for women with unknown/undocumented                                 L&D. They identified strengths (S), weaknesses
  HIV status;                                                                (W), opportunities (O), and threats (T) that could
                                                                             impact on their hospital’s implementation of RT in
• Creating a workshop environment where hospital
                                                                             L&D. On the second day, teams spent two hours
  leaders can develop the skills that they and their
                                                                             developing an Action Plan for implementation of
  staff need to implement RT in L&D;
                                                                             RT in L&D in their hospital that addressed four
• Supporting hospitals with model policies,                                  key areas important to implementation. Prior
  educational materials, and other materials needed                          to attending the workshops, each team was
  to move from planning to implementing RT in                                encouraged to conduct some data gathering in
  L&D; and                                                                   advance to inform the workshop activities.
• Facilitating hospitals' development of an action
                                                                             For additional background information on these
  plan to implement RT in L&D within a timeframe
                                                                             meetings, see
  determined by the hospital team.
                                                                             training.htm and Appendix A.
Attendance at the workshops did not require a
commitment from the hospitals to initiate RT in
1   Mind Tools. SWOT Analysis. Available at

                                Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide     5
    2.           Selection of Hospitals and Recruitment

    Workshop Schedule and                                               AED conducted a cost analysis to compare travel
                                                                        and lodging costs between the potential workshop
                                                                        locations in the northeast, southeast, and southern
    CDC/AED/FXBC convened eight regional, one                           regions. After reviewing cost information, it was
    and one-half day strategic planning workshops.                      decided that the workshops would be held in the
    CDC's intention was to offer the capacity-building                  following regional locations: 1) Baltimore, MD; 2)
    workshops to regions within the U.S. that had the                   Miami, FL; ) Los Angeles, CA; 4) Houston, TX; 5)
    highest perinatal infection rates. The original list of             Raleigh, NC; 6) Providence, RI; and 7) Cincinnati,
    potential cities to host the workshops included: 1)                 OH. Surplus funds left after hosting seven
    Baltimore, MD; 2) Miami, FL; ) Los Angeles, CA; 4)                 workshops allowed the coordination of an eighth
    either Houston, TX, or New Orleans, LA; 5) either                   workshop in San Juan, PR and a pilot workshop to
    Charleston, SC, Charlotte, NC, Chattanooga, TN,                     implement RT in emergency departments.
    or Raleigh, NC; 6) either Boston, MA, Newark, NJ,
    or Providence, RI; and 7) Indianapolis, IN or                       Below is a table that outlines the workshop
    Cincinnati, OH.                                                     schedule, host cities, and cities represented by the
                                                                        hospitals that attended the workshops.

     Workshop Dates              Host Cities         City Hospitals Represented
     June 29–0, 2004            Baltimore,          Baltimore, MD; Dover, DE; Philadelphia, PA; Salisbury, MD;
                                 Maryland            Washington, DC
     December 2–, 2004          Miami, Florida      Christiansted, USVI; Daytona Beach, FL; Ft. Lauderdale, FL; Lakeland,
                                                     FL; Miami, FL; Pensacola, FL; Ponce, PR; San Juan, PR; St. Petersburg,
                                                     FL; St. Thomas, USVI; Winter Haven, FL; Yabucoa, PR

     January 6–7, 2005           Los Angeles,        Berkeley, CA; Las Vegas, NV; Los Angeles, CA; Oakland, CA; Phoenix,
                                 California          AZ; Portland, OR; Reno, NV; Sylmar, CA
     January 20–21, 2005         Houston,            Alexandria, LA; Baton Rouge, LA; Dallas, TX; Hattiesburg, MS;
                                 Texas               Houston, TX; New Orleans, LA
     February 10–11, 2005        Providence,         Boston, MA; Farmington, CT; Hartford, CT; Jersey City, NJ; Paterson,
                                 Rhode Island        NJ; Providence, RI; Shrewsbury, MA; Springfield, MA; Stamford, CT

6     Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide
 Workshop Dates              Host Cities          City Hospitals Represented
 March 10–11, 2005           Raleigh, North       Atlanta, GA; Augusta, GA; Charleston, SC; Columbia, SC; Durham,
                             Carolina             NC; Greenville, NC; Memphis, TN; Nashville, TN
 April 12–1, 2005           Cincinnati, Ohio     Cincinnati, OH; East Chicago, IN; Flint, MI; Green Bay, WI;
                                                  Indianapolis, IN; Kansas City, MO; St. Paul, MN
 June 1–2, 2005              San Juan, Puerto     Aricebo, PR; Bayamon, PR; Carolina, PR; Manati, PR; San Juan, PR;
                             Rico                 St.John, USVI; Yabucoa, PR

Hospitals were not invited from states or cities that               Hospitals were considered for invitation to the
had an existing program to facilitate RT in L&D (e.g.               workshop if they met the following criteria:
IL and NY). The workshop schedule was developed                     1. Rapid HIV testing was not routinely offered to all
in an effort to avoid major religious and secular                      women in labor with undocumented HIV status;
holidays, avoid major meetings and conferences,
                                                                    2. Had at least 500 births per year; and
allow for two days plus a travel day prior within
each scheduled block, and leave enough time                         . Met at least one of the following additional
between workshops to complete follow-up activities                     criteria:
for the completed workshop while preparing for                      • > 5% of women who delivered had no prenatal
the next one.                                                         care;
                                                                    • HIV prevalence >0.5% among its patient
                                                                      population; and/or
Hospitals Identified to Invite to
                                                                    • Identified as an obstetric practice leader in the
the Workshops                                                         community (i.e., an academic institution or has a
The list of hospitals to recruit for the workshops                    very high number of deliveries).
was developed in a variety of ways. CDC reviewed
pediatric HIV and AIDS data, as well as state and                   See Appendix B for the template created for
local public health efforts, to determine the general               contacted individuals to complete for selection
areas to focus recruitment efforts in the various                   criteria.
regions where the workshops were held. FXBC and
AED then consulted with contacts from Ryan White                    Hospitals that met the above criteria (or were the
Title IV projects, state health departments including               best fit from the state), based on the input of key
HIV and maternal child health staff, CDC perinatal                  informants and key hospital contacts, were invited
HIV prevention grantees, regional AIDS Education                    to send a team of decision-makers to the meeting.
and Training Centers (AETC), state hospital
associations, and others for their suggestions on
which hospitals to invite to the workshops.                         Invitation Process
                                                                    FXBC and AED were jointly responsible for
The individuals approached were also asked to
                                                                    recruitment of hospital staff and observers to
identify key contacts at hospitals who would be
                                                                    attend the workshops.
helpful in facilitating their hospital's participation
in the workshop and identifying staff to attend the
                                                                    FXBC and AED initially called and/or e-mailed the
                                                                    key contact(s) at the hospitals to inform them about

                           Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide   7
    the upcoming workshop and to determine whether                      with other major hospital commitments such as an
    or not they were already doing RT in L&D and if                     accreditation visit.
    the hospital could benefit from the workshop. If key
    contacts were not given for the hospitals, FXBC                     See Appendix C for a sample invitation letter,
    and AED called the hospital switchboard and asked                   Appendix D for a sample agenda, Appendix E for a
    to speak with either the Nurse Manager for L&D, a                   sample registration form, and Appendix F for sample
    Perinatologist, or the Director for Women's Services.               travel and hotel instructions.
    It was assumed that these were the key people to
    contact about the workshops because they are often
    hospital decision-makers and have the authority to                  Composition of Hospital Teams
    assemble a team of staff to attend.
                                                                        Included in the invitation letters to the hospitals
                                                                        was information about the desired composition
    Subsequent contact with these individuals depended
                                                                        of hospital teams to send to the workshops.
    upon their commitment to sending a hospital team
                                                                        Each hospital was asked to send a team of four
    to the workshop or their progress in obtaining
                                                                        professionals, including a representative from the
    approval to attend. FXBC and AED followed up by
                                                                        obstetric medical staff, laboratory services, nursing
    phone and e-mail after the initial invitation package
                                                                        management of maternity services, and hospital
    was sent in order to register participants in a timely
                                                                        administration or risk management. They were
                                                                        also encouraged to include an HIV provider as an
                                                                        alternate for the team in the event that one of the
    As anticipated, some of the invited hospitals
                                                                        other representatives was not available for the
    declined participation in the workshops. Several
                                                                        workshop. The hospital was asked to designate one
    hospitals that initially were reluctant to attend
                                                                        member of the team as the team leader.
    were persuaded to send a team. For example, one
    hospital currently doing expedited EIA testing in
                                                                        When working with the key contacts at the
    labor and delivery was reluctant to send a team
                                                                        hospitals, emphasis was placed on selecting
    if doing so committed them to change to rapid
                                                                        individuals who could impact policy and practice
    testing. They were persuaded to attend for the
                                                                        at their hospitals. Teams composed of individuals
    opportunity to critically compare their present
                                                                        in leadership positions from multiple hospital
    practices to that of rapid testing. Several reluctant
                                                                        departments would be better positioned to develop
    hospitals with rapid testing available, but with
                                                                        and implement comprehensive strategic plans.
    inconsistent or unwritten policies were persuaded
    that the workshop would give them the opportunity
                                                                        Most of the hospitals sent teams of two to five
    to develop a quality assurance plan for their policy
                                                                        representatives. Observation of the early workshops
    and procedures. Overall, 105 hospitals were invited
                                                                        showed that hospital teams composed of at least
    to attend and 4 declined.
                                                                        –4 members with authority to make or influence
                                                                        key decisions were better able to develop more
    Hospitals declined to participate for a variety of
                                                                        complete strategic plans. Smaller teams and those
    reasons. Some hospital contacts did not think the
                                                                        with less influential members often expressed
    HIV prevalence in their area warranted a hospital-
                                                                        concern that they would face challenges with
    wide response. Others were not able to assemble
                                                                        implementation when returning to their hospitals.
    a team in the time available prior to the workshop.
    Other hospitals were interested but declined
                                                                        The number of hospitals participating in each
    because the timing of the workshop conflicted
                                                                        workshop varied based on the region, interest of

8     Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide
hospitals, lead time for invitations, and recruitment                      When contacted about recommendations for
support from local colleagues. The number of                               hospitals to invite, several individuals from Ryan
participating hospitals in each workshop ranged                            White Title IV projects, health department staff,
from 8–12 to facilitate interaction among                                  CDC perinatal grantees, maternal child health
participants and with presenters.                                          programs, AIDS Education and Training Centers
                                                                           (AETC), and other organizations, expressed interest
                                                                           in attending the workshops. These individuals were
Hospital Preparation for                                                   invited to participate as observers or as facilitators
                                                                           for the hospital team activities, although their travel
                                                                           costs were not covered (see Section 4. Conducting
Approximately two weeks before the workshops,                              the Strategic Planning Workshops for Hospitals
AED e-mailed or faxed materials to the registered                          for more information on these activities). State
participants. Materials included: a confirmation                           health department representatives and AETC staff
letter, logistical information about the workshop,                         also served as resources for state-specific laws and
a draft agenda, the CDC Model Protocol2, a                                 regulations. In addition, these resource persons
questionnaire assessing hospital readiness, and                            were later available to provide support to the
travel expense reimbursement instructions.                                 hospitals during the implementation process.
The Model Protocol was sent to participants to
review as it served as the basis for much of the
discussion during the workshops. Participants were
encouraged to complete the hospital readiness
assessment because the answers would help them
develop strategic plans during the workshop.

See Appendix G for the sample pre-meeting
letter and Appendix H for the hospital readiness

Recruitment Logs
Throughout the recruitment process, FXBC and
AED kept detailed notes about their contacts
with hospital staff and the conversations and
communication that ensued. These logs were kept
to facilitate the provision of technical assistance and
administration of the outcome evaluation after the
workshops concluded.

Role of Workshop Observers

2 Centers for Disease Control and Prevention. Rapid HIV-1 Antibody Testing During Labor and Delivery for Women of Unknown HIV Status: A
Practical Guide and Model Protocol. January 2004.

                              Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide         9
     3.             Preparing for the Strategic Planning Workshops
                    for Hospitals

     Meeting Logistics                                                      AED also worked with the hotel to select a menu
                                                                            for the workshops and provided the rooming list to
     Once invited (see Section 2. Selection of Hospitals                    the hotel contact.
     and Recruitment for an account of the invitation
     process), hospital team members e-mailed or faxed
     their registration forms to AED. AED recorded the
     registration information electronically for later use
                                                                            Materials Preparation and
     in developing participant lists, name badges, and                      Distribution
     table tents. Participants also provided information                    Name badges identified each participant and
     on their need for a hotel reservation that was later                   observer and their affiliation. Table tents with the
     provided to the hotel as a rooming list.                               hospital names identified where the team should sit.

     Participants received information on making their                      "Get" Cards were printed for distribution at the
     travel arrangements with the invitation package.                       workshops. The "Get" Cards provided participants
     They contacted the travel agent directly. The agent                    with a convenient means of requesting follow-up
     e-mailed the itinerary to AED for authorization                        materials, technical assistance, or other information
     of the expense and then e-mailed the electronic                        from the workshop sponsors, organizers, and
     tickets to the participants.                                           speakers. The "Get" Cards were available on the
                                                                            tables throughout the workshop. See Appendix J for
                                                                            a sample "Get" Card.
     Hotel Identification
     & Instructions                                                         Binders containing all of the slide presentations for
                                                                            the workshop, descriptions of the SWOT analysis
     Hotels were identified in the workshop cities                          and strategic planning activities, and background
     based on recommendations from others who had                           materials on RT in L&D, as well as sample hospital
     held meetings there. Hotels were contacted to                          policies and procedures were prepared for each
     determine their willingness to provide government                      participant. See Appendix K for a list of the binder
     rate lodging to guests; availability of lodging and                    contents. Along with their binder, workshop
     meeting space on dates requested, size of meeting                      participants received the CDC Model Protocol for
     rooms, and cost.                                                       Rapid HIV Testing in Labor and Delivery as well as
                                                                            AGOG's new Perinatal HIV Guidelines when they
     See Appendix I for a sample e-mail sent to a hotel                     registered onsite for the workshop.
     outlining these requests.
             College of Obstetricians and Gynecologists. Prenatal and Perinatal Human Immunodeficiency. Virus Testing: Expanded
     Recommendations. ACOG Committee Opinion No. 304. November 2004.

10      Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide
AED burned CD-ROMs with all the binder
materials, excluding the articles in the binder's
Resources section (for copyright reasons), for
distribution to the hospital team leaders and
anyone else interested in accessing the materials

Folders prepared for all Planning Committee
members (CDC/FXBC/AED) and facilitators
included an annotated agenda that assigned point
people to staff each agenda activity, a list of
facilitators and their corresponding hospitals, a
facilitator guide for the SWOT analysis and action
planning activities, and state-specific data compiled
by CDC.

                          Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide   11
     4.           Conducting the Strategic Planning Workshops
                  for Hospitals

     See Appendix D for a sample workshop agenda.                        locations; a description of the color-coded star
                                                                         system for the name badges and its purpose; and
                                                                         an overview of housekeeping items. An icebreaker
     Day One                                                             activity was conducted, entitled "Stand Up and
                                                                         Be Counted,” that helped participants learn a
     Registration, Welcome, and
                                                                         little about their colleagues. See Appendix L for a
                                                                         description of the icebreaker.
     FXBC, AED, and CDC staff greeted the participants
     and gave them their name badges and binders.                        Plenary Presentation
     Participants were asked to select one or more
                                                                         A plenary presentation on perinatal HIV opened the
     colored star stickers for their name badge to
                                                                         content portion of the workshop. Dr. Carolyn Burr
     identify their specialty area. The stars represented:
                                                                         (FXBC) provided a brief overview on perinatal HIV
     HIV Services, Hospital Administration/Risk
                                                                         prevention and then moderated the session for the
     Management, Laboratory Services, Nursing
                                                                         two presenters — Dr. Bernard Branson and Ms.
     Management for Maternity Services, Obstetric
                                                                         Margaret Lampe (CDC). See Appendix M for Dr.
     Medical Staff, and Other.
                                                                         Burr's introductory presentation.

     Participants sat with their team at the table
                                                                         Dr. Branson and Ms. Lampe were selected for this
     identified with the hospital's name on the table tent.
                                                                         plenary because of their recognized expertise in
     Observers, speakers, diagnostics representatives,
                                                                         the field of perinatal HIV prevention and rapid HIV
     and Planning Committee members sat at the tables
                                                                         testing. Dr. Branson is responsible for coordinating
     towards the rear of the meeting room. Facilitators
                                                                         CDC's activities surrounding new technologies for
     sat with their hospital teams.
                                                                         HIV testing, including rapid HIV tests and tests for
                                                                         HIV incidence. He is currently Associate Director
     The "Welcome" was delivered by Margaret Lampe
                                                                         for Laboratory Diagnostics in the Divisions of HIV/
     (CDC) and Carolyn Burr (FXBC). They welcomed
                                                                         AIDS Prevention at CDC, where he also conducts
     participants to the workshop and described the
                                                                         research into HIV prevention strategies. Ms. Lampe
     intent of the two days. Lunch was then served as
                                                                         has worked in the area of perinatal HIV prevention
     the registration process continued for latecomers.
                                                                         for over 10 years and is currently a Health
                                                                         Education Specialist for the Divisions of HIV/AIDS
     The "Introductions" were conducted by moderators
                                                                         Prevention at CDC. She has been an investigator in
     from FXBC or AED and included a review of
                                                                         several perinatal HIV prevention research studies,
     the hospitals attending the workshop and their
                                                                         including the Mother-Infant Rapid Intervention

12     Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide
at Delivery (MIRIAD) study, and she convened                      describe the panel format, and answer any of the
an expert workgroup to author the CDC Model                       presenters' questions. Whenever possible, the
Protocol, which serves as guidance for national                   panel presenters were selected to offer diverse and
implementation of rapid HIV testing for women                     unique perspectives (e.g., the panel composition
in labor with unknown HIV status. For more                        might have included an obstetrician, a perinatal or
information on the MIRIAD study, see: Bulterys,                   an infection control nurse leader, program manager,
Jamieson, O’Sullivan, Cohen, Maupin, Nesheim,                     laboratorian, etc.).
et al. 2004. Rapid HIV-1 testing during labor: a
                                                                  The panel format included eleven questions,
multicenter study. JAMA, 292, 219–22.
                                                                  developed by CDC, FXBC, and AED, that were
Their presentations focused on the technology and                 posed by a moderator. See Appendix P for a list
science of rapid HIV testing, its role in labor and               of the questions. After the panel presentation, the
delivery, and its relationship to CDC's "Advancing                moderator opened up the session for discussion
HIV Prevention" initiative begun in 200. Dr.                     and additional questions from the participants.
Branson's presentation was titled "Rapid HIV
                                                                  Strengths, Weaknesses, Opportunities,
Testing — Advancing HIV Prevention in the U.S."
                                                                  and Threats (SWOT) Analysis
and can be found in Appendix N. Ms. Lampe's
presentation entitled "Perinatal HIV Prevention:                  Each hospital team then met to conduct a SWOT
Translating Science to Practice" can be found in                  analysis of their hospital's readiness to implement
Appendix O. Sufficient time was allowed for a                     RT in L&D. A SWOT analysis is an established
question and answer period with the audience.                     management technique designed to help an
While most questions were reserved for the time                   organization identify strengths (S), weaknesses
following both presentations, the informal format of              (W), opportunities (O), and threats (T) as the
the plenary allowed for participants to ask questions             organization is planning for new initiatives or
throughout the presentations as well.                             problem solving. Strengths and weaknesses within
                                                                  the organization are identified including resources
Lessons from the Field Panel                                      and experiences. Opportunities and threats are
Presentation                                                      identified that are external to the organization.
A panel of healthcare providers from the region,                  These may be from the local community, regulatory
with experience in implementing rapid HIV testing                 bodies, or the larger society.
in labor and delivery, provided "Lessons from
                                                                  The SWOT analysis was designed to help set
the Field" and responded to questions from the
                                                                  the stage for the action planning activity on Day
participants. The goal of this panel presentation was
                                                                  Two (described below) by helping hospital teams
to discuss the issues that hospitals had addressed
                                                                  identify positive forces and potential barriers
as they implement RT in L&D and to provide
                                                                  that could impact their action plan. With the
local examples of how implementation could be
                                                                  guidance of a facilitator, hospital teams identified
facilitated. Presenters for the panel were identified
                                                                  the strengths and weaknesses of their institution,
by FXBC with assistance from CDC. At least one
                                                                  such as staff openness to new ideas or the
speaker was selected who had implemented RT
                                                                  laboratory’s reluctance to implement a new test,
in L&D at more than one site, including several
                                                                  and the opportunities and threats in their larger
individuals that worked on the MIRIAD study.
                                                                  community such as positive media coverage of
FXBC held a conference call with the presenters in
                                                                  pregnant women’s need to know their HIV status
advance of the workshops to review the questions,
                                                                  or the community’s perception that HIV was not a

                         Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide   1
     problem in their community. They recorded their                     Day One Closing and Networking
     ideas on newsprint paper. The team selected one or                  Reception
     two issues in each category that they considered                    The moderators provided a short closing to
     most important and highlighted these in a "report                   Day One, highlighted the action planning activity
     out" to the entire workshop group. By sharing their                 that would occur on Day Two, and reviewed the
     SWOT analysis with the other hospital teams, teams                  concurrent sessions that would be offered in the
     were able to identify similar issues and common                     afternoon. They emphasized the importance of
     concerns. This peer-to-peer learning also provided                  hospital teams having a participant at each of the
     the opportunity for hospitals to identify additional                three sessions and suggested that they determine
     factors that could impact their ability to implement                beforehand which team members would attend each
     RT in L&D at their institution. See Appendix Q for                  session. They also reminded participants about the
     a description of the SWOT analysis activity. See                    networking reception. The closing of the workshop
     Appendix R for the FXBC presentation describing                     led immediately into the networking reception so as
     the SWOT analysis and the benefit of conducting                     to entice more people to attend.
                                                                         The networking reception provided an informal
     Each hospital team was assigned a facilitator for                   opportunity for the four diagnostics companies
     the SWOT analysis and the action planning activity.                 to display their products, distribute literature,
     The facilitators were identified from the pool                      and answer participants' questions. This cost was
     of observers, speakers, and Planning Committee                      considered to be their registration/exhibition fee
     members attending the workshop. Facilitators                        to demonstrate their products at the workshops.
     were knowledgeable about the clinical issues and                    The networking reception also gave participants the
     comfortable in guiding group process. Observers                     opportunity to interact with other hospitals, health
     and speakers were asked to facilitate when they                     department staff, diagnostics representatives, and
     registered for the workshops and were then sent a                   the workshop sponsors.
     facilitator guide and instructions for conducting the
     SWOT analysis and action planning activities. Onsite,
     FXBC met with each facilitator to review their                      Day Two
     role and answer any questions they had related to
     facilitating activities with the hospital teams.                    Opening and Action Planning
     See Appendix S for the facilitator guide.                           FXBC greeted participants and described the
                                                                         purpose of the action planning activity — for
     AIDS Education and Training Center                                  hospital teams to assess where they are in the
     (AETC) Presentation                                                 process of providing RT in L&D and to develop very
     Before the workshops, FXBC and AED identified                       specific action steps that they can implement when
     representatives from the AETC(s) in the region to                   they return to their institutions. The newsprint
     attend as observers and to provide an overview of                   paper used for the SWOT analysis remained on
     the technical assistance and training the AETC could                the walls throughout this activity so that hospitals
     provide to hospitals. Many of the hospital team                     could refer to their responses and record additional
     members were not familiar with AETC services                        thoughts. The facilitators assigned to hospitals for
     and noted in their evaluations that they were glad                  the SWOT analysis helped guide the same hospital
     to have learned about this important resource and                   through the action planning activity.
     would use it in the future.

14     Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide
The Action Planning Tool was developed to                         address an overall timeframe and their goals for
complement the CDC Model Protocol for RT in                       implementation of RT in L&D. The hospitals were
L&D. The tool directed teams to examine four areas                informed that FXBC would like to follow up with
critical in the implementation of RT in L&D:                      them to see how they were progressing toward
• Making the decision to offer rapid HIV testing                  providing RT in L&D. The suggested follow-up time
  in labor, including information on their patient                was three to six months. During the report, each
  population and HIV testing in prenatal care;                    hospital was asked to select a key contact person
                                                                  and decide when they would like to be contacted
• Developing a hospital policy on RT in L&D, the
                                                                  by FXBC for follow-up. FXBC also offered to
  stakeholders involved and the process required;
                                                                  provide technical assistance, answer questions, or
• Making the rapid HIV test available in labor                    direct the hospitals to existing resources following
  including deciding whether the test would be                    the workshop.
  done in the lab or in L&D, selecting a test, and
  assuring quality control, and                                   Hospital teams documented their action plan on
• Preparing staff to offer RT in L&D including staff              either newsprint paper and/or directly on the
  training and planning for follow-up of identified               Action Planning Tool. Participants were asked to
  mothers and infants.                                            leave their SWOT analysis and action planning
In each area, the teams were asked to consider:                   notes with the organizers and they would receive
                                                                  them electronically after the workshop. If the team
• What action, if any, needs to be taken?
                                                                  members preferred to have a hard copy immediately,
• Who will take responsibility?                                   the facilitators or Planning Committee members
• What is the time frame or target date?                          photocopied the materials.

• How will the outcome be communicated?
                                                                  Concurrent Sessions
• What evaluation is needed and how will it be                    At the workshops, three concurrent sessions
  done?                                                           were offered. The goal of the concurrent sessions
                                                                  was to offer the opportunity for skills-building for
The Action Planning Tool that FXBC had developed                  implementation of RT in L&D.
for the pilot workshop was utilized throughout the
series of workshops. The hospital teams were given                The objectives of the first session, Performing Rapid
approximately two hours to discuss the RT in L&D                  HIV Tests at the Point-of-Care and Laboratory Settings,
plan. See Appendix T for a more detailed description              included:
of the action planning activity. Appendix U for the               • Identify differences and similarities among FDA-
Action Planning Tool designed for hospitals to use                  approved rapid HIV tests as demonstrated;
to record their plan.                                             • Discuss the advantages and disadvantages of each
                                                                    rapid test product as they pertain to individual
Hospital teams were also asked to decide on the                     hospital circumstances; and
three highest priority action steps to implement                  • Learn details about the pricing and availability of
when they returned to their institutions. A                         the rapid test products.
representative from each hospital team was                        The session was designed to provide in-person
designated as the person to report on these                       demonstrations of each of the available FDA-
three steps to the entire workshop group. During                  approved rapid tests in order to give workshop
the report, the representative was asked to                       participants first-hand exposure to the tests.

                         Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide   15
     Prior to each workshop, the four diagnostics                        the skills necessary to offer RT in L&D and to think
     companies that had FDA-approved rapid HIV                           about the educational needs of their staff.
     tests were invited to send representatives to
     demonstrate their products and participate at                       Elaine Gross (FXBC) presented this session at
     the networking reception. The four companies                        each workshop, often with a co-presenter. Co-
     were: Bio-Rad Laboratories Inc., MedMira Inc.                       presenters included MIRIAD study coordinators
     (accompanied by its sales company, Cardinal Health),
                                                                         or labor and delivery nurses from the meeting
     OraSure Technologies Inc., and Trinity Biotech USA.
                                                                         region with experience in offering rapid testing
     These companies were invited because their rapid
                                                                         to women in labor. This interactive session used
     HIV tests were approved by the Food and Drug
     Administration. The tests they demonstrated were                    case presentations, role play, and discussion. See
     Multispot HIV-1/HIV-2, Reveal G-2, OraQuick and                     Appendix W for the workshop presentation and
     OraQuick Advance, and Uni-Gold Recombigen HIV,                      Appendix X for the handout on case studies and
     respectively.                                                       role plays referenced during the workshop.

     Companies were asked to send technical experts                      The objectives of the third session, Follow-up with
     to these meetings, rather than sales representatives,               Mother and Baby, included:
     so they could effectively demonstrate their product                 • Describe the current standards of care for HIV
     and answer participants' questions.
                                                                           positive postpartum women and their HIV-
                                                                           exposed infants;
     Company representatives received a description of
     the format of their session and an overview of the                  • Discuss the key components of a multidisciplinary
     workshop logistics so they could adequately prepare                   model of care for women living with HIV; and
     for their presentations. See Appendix V for this
                                                                         • Explore the challenges of linking newly identified
                                                                           HIV-positive women and their HIV-exposed
                                                                           infants into primary care and diagnostic and
     The objectives of the second session, Offering HIV
                                                                           treatment services.
     Testing In Labor: Context, Content, and Follow-Up,
     • Discuss the key information about HIV testing                     FXBC identified local speakers to present in the
       that needs to be given to women in labor with                     session that were expert clinicians in women's
       undocumented/unknown HIV status;                                  HIV care and pediatric HIV care. The speakers
                                                                         were often part of Ryan White Title IV projects
     • Describe strategies to insure confidentiality,
       comfort, and consent/assent in discussing HIV                     and included obstetricians, pediatricians, nurse
       rapid testing with women in labor;                                practitioners, and social workers. Presenters
                                                                         discussed national recommendations for follow-up
     • Outline procedures for documenting and
                                                                         and regional resources available to the participants.
       communicating rapid HIV test results;
                                                                         At the majority of the workshops, the speakers
     • Discuss post-test counseling for a preliminary                    used a PowerPoint presentation. Presenters
       positive and negative rapid HIV test; and
                                                                         were encouraged to utilize case discussions and
     • Describe approaches to address educational                        ensure audience participation. See Appendix Y
       needs of hospital staff and medical staff regarding               for two sample Follow-up with Mother and Baby
       rapid HIV testing in labor.                                       presentations.

     The purpose of this session was to give workshop                    The agenda originally offered each session twice,
     participants the opportunity to begin to develop                    but the Planning Committee decided to change

16     Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide
the agenda because of low attendance during the
second round of some sessions. The Performing
Rapid HIV Tests and the Offering HIV Testing sessions
were offered twice and the Follow-Up session was
only offered once.

Day Two Closing
FXBC closed the workshop by reminding hospital
teams that they would be contacted about their
progress in carrying out their action plans and
to ask for their participation in the outcome

                          Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide   17
     5.           Evaluating the Strategic Planning Workshops for

     Participants completed a process evaluation at                      workshops. Thereafter, FXBC ensured this expertise
     each workshop designed to capture participant                       was available at subsequent workshops.
     learning and satisfaction with the workshop. FXBC
     developed and analyzed the evaluation for the pilot                 See Appendix Z for the summary workshop
     and AED analyzed all subsequent evaluations.                        evaluation report.

     Participants were asked to rate how well they were
     able to achieve each workshop objective using a
     four point Likert scale (e.g., Completely, Very Well,
     Fairly Well, Not at All). Participants also rated
     presenters for the plenary and concurrent sessions.
     The evaluation also requested general comments
     on what participants liked most/least about the
     workshop and suggestions for improvement.

     These process evaluations, completed by
     participants at the close of each workshop, were
     very positive. Eighty to one hundred percent of
     participants thought that the workshop objectives
     were achieved "completely" or "very well." With
     the exception of two individuals, all participants
     in the first seven workshops reported that the
     opportunity to work in hospital teams to develop
     an action plan was an "excellent" or "good" activity.
     Participants were asked what they liked most
     and least about the workshop and were asked
     to give suggestions for improving the meeting.
     Many of these comments were then incorporated
     into subsequent workshops. For example,
     the importance of having a resource person
     knowledgeable about state regulations, such as a
     state health department or AETC representative,
     was noted as a strength in the evaluations of early

18     Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide
6.           Outcome Evaluation

The outcome evaluation component of the RT in                     Hospitals' progress toward implementation of
L&D Strategic Planning Workshops was initiated                    RT in L&D was the primary outcome measure.
by FXBC in April 2005 and continued throughout                    Participants' perceptions of the impact of the
the 2005–2006 grant year. Each of the hospital                    workshop on their planning process was also
teams that participated in a workshop was asked                   assessed.
to designate an individual to be contacted for
follow-up and to select a time frame in which to                  Participants were informed at the strategic
be contacted for follow-up evaluation, generally six              planning meetings that they would be contacted
to twelve months following the workshop. FXBC                     for follow-up about the training and would be
designed an evaluation plan that was reviewed and                 offered additional support and technical assistance
approved by the UMDNJ Institutional Review Board                  as requested. The purpose and procedures of the
(IRB) in March 2005.                                              program evaluation project were presented. Each
                                                                  hospital team designated an individual as the follow-
The program evaluation research assessed changes                  up contact. The individual named as the follow-up
in hospital policy and procedures regarding RT in                 contact was asked to provide written informed
L&D following participation in the strategic planning             consent to allow information from the follow-up
workshop. The purpose of the evaluation was to:                   questionnaire to be used as part of the project's
1. Assess the relationship of participation in                    formal evaluation. For participants in workshops
   the strategic planning meetings to hospital                    offered after the IRB approval was received,
   implementation of rapid HIV testing in labor and               informed consent was sought at the time of the
   delivery (RT in L&D); and                                      workshop. For participants in earlier workshops,
                                                                  informed consent for the program evaluation was
2. Identify factors that supported or inhibited
                                                                  obtained through a follow-up letter.
   implementation of RT in L&D.

                                                                  Once consent was obtained, FXBC initiated follow-
The program evaluation is a qualitative research                  up by e-mail or phone at a time period specified by
study based on a naturalistic paradigm. As such,                  each hospital team based on their implementation
the study sought to describe and understand the                   plan (approximately 6–12 months after the
phenomena observed and to discover elements                       workshop.) The follow-up contact for each hospital
common among the experience of those in the                       team was asked to participate in a semi-structured
study. No attempt was made to establish causation                 telephone interview lasting about 0 minutes
but rather to describe the experience of those who                with Carolyn Burr or Elaine Gross. Participants
participated in the workshop and then sought to                   received a copy of the interview guide by e-mail or
bring about change in their institution.

                         Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide   19
     fax prior to the interview. It was anticipated that                 to offer RT in L&D. Similarly, barriers or supports
     individuals would need to gather information in                     in the development of hospital policy about RT in
     order to report about the status of implementation                  L&D were analyzed. Analysis focused on identifying
     of RT in L&D at their hospital. They were asked to                  themes and commonalities of experience among
     share copies of policies and procedures that were                   hospitals that had successfully implemented RT in
     developed or modified following the workshop.                       L&D and ones that had not yet done so.
     Interviewers took detailed notes during the
     interview and documented the interview using field                  Preliminary findings of the program evaluation
     notes.                                                              regarding hospitals that have implemented RT in
                                                                         L&D were presented to CDC once the interviews
     Confidentiality of respondents and participating                    were completed. Interviews were analyzed using
     hospitals was carefully protected. Each semi-                       qualitative data analysis techniques looking for
     structured interview was assigned an alpha-numeric                  recurring themes and issues in the interview
     code that indicates the location of the training                    responses. Sixty-six percent of the hospitals (44/70)
     workshop and assigned the hospital a number                         that attended the workshops participated in the
     (e.g. HT01 is Houston workshop, hospital 1). The                    follow-up study. Of those, 89% (9/44) reported
     first page of the interview guide that identifies the               that the hospital had made a formal decision to
     respondent and includes the code was removed                        offer RT in L&D and 87% (4/9) had policies in
     from the interview guide and kept by the Principal                  place or in process. Having RT available elsewhere
     Investigator.                                                       in the hospital (such as employee health), facilitated
                                                                         the decision to offer RT in L&D. Hospitals serving
     Alpha-numeric codes only were used on the pages                     large numbers of pregnant women with no prenatal
     of the semi-structured interview form on which                      care saw the need for RT in L&D. A perceived low
     responses are recorded. Data revealing the identity                 prevalence of HIV in the community and poor HIV
     of the respondent, the hospital, or their location                  knowledge and attitudes among providers were
     were not included. No information that would                        barriers to policy adoption and implementation.
     identify the individual or institution was used in the              At the time of the interview, 69% (27/9) of
     write-up of the program evaluation or subsequent                    hospitals had RT available in L&D. A selection of
     reports or manuscripts.                                             the interviews were used to develop best practices
                                                                         case studies based on the experiences of hospitals
     Responses to the semi-structured interviews                         that have successfully implemented RT in L&D or
     were entered into a qualitative analysis computer                   those that encountered barriers to implementing
     program. Qualitative analysis software was assessed                 RT in L&D. Case studies were blinded and
     and the NVivo program was selected to analyze                       anonymous to protect the identity of the hospital
     the interviews. Data were coded beginning in                        and the respondent. A final report of the program
     September 2005 and were entered as interviews                       evaluation was completed by early 2007.
     were completed.
                                                                         See Appendix AA for the letter to hospitals
     Preliminary analysis was initiated while interviews                 regarding participation in the outcome evaluation.
     were ongoing in order to refine the interview as                    See Appendix BB for the outcome evaluation
     the evaluation was underway. Analysis looked for                    protocol.
     factors that were present prior to and following the
     hospital's participation in the workshop that may
     have facilitated or hindered the hospital's decision

20     Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide
7.           Recommendations and Lessons Learned

Division of Responsibilities                                      Since the workshops were regional, participants
                                                                  were not traveling far distances and some even
It was very helpful to have two contractors                       drove to the workshops. In addition, workshops
conducting the workshops with overall guidance                    were held in cities where one or more local
from CDC. Having one contractor focused on                        hospitals attended, reducing transportation costs
meeting logistics, and the other contractor focused               greatly.
on meeting content, led to a clear delineation of
roles and responsibilities.
                                                                  Hospital Recruitment
                                                                  The most challenging aspect of this project, noted
Record of Decisions and
                                                                  by FXBC and AED, was hospital recruitment. The
Workshop Debrief Sessions                                         ease of the process varied by region and by hospital.
Over the course of the project, meeting and                       In areas with great contacts (e.g., Ryan White Title
conference call notes were recorded and                           IV-funded clinicians, health department staff, CDC
summarized by AED. This created a useful record                   perinatal HIV prevention grantees, maternal child
of decisions made and action item steps to be                     health representatives, AIDS Education and Training
carried out by individuals.                                       Centers, and other individuals and organizations)
                                                                  the process of identifying hospitals to recruit to the
Immediately following the first few workshops,                    workshops was more efficient. The recruitment
CDC/FXBC/AED held a debrief session to discuss                    process went more smoothly when contacts
potential improvements on the workshops. The                      were knowledgeable about decision-makers at
content, agenda, and logistical processes evolved                 the hospitals and provided us with their contact
based on discussions during these debrief sessions.               information. In several cases, our contacts were
Once the format of the workshops was mostly                       not entirely familiar with the hospitals in their area
solidified, the debrief sessions were no longer                   implementing RT in L&D and their client population.
necessary.                                                        This led to recruitment of hospitals that were not
                                                                  the best fit for the workshop.

Overall Budget for Workshops                                      In recruiting the hospitals, the best means of
                                                                  contact was an introductory phone call, followed
The final cost of implementing the seven workshops
                                                                  by an e-mail with the materials included in the
was significantly lower than initial estimates. A main
                                                                  invitation package. Subsequent contacts varied on
reason for the lower cost was due to reduced
                                                                  their commitment to sending a hospital team to the
airfare/train costs of participants.

                         Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide   21
     workshop or their progress in obtaining approval to                 Obtaining Buy-in From Hospitals
                                                                         Following the publication of ACOG's Committee
     Hospitals varied regarding when they responded                      Opinion 4, hospitals were more aware of RT in
     with their intent to attend the workshops and                       L&D and their buy-in regarding the importance of
     registrations of team members. For many hospitals,                  attending the workshops was easier. Including a
     numerous attempts at contacting the key decision-                   copy of the ACOG Committee Opinion with the
     maker(s) were essential in determining whether                      invitation package may have provided hospitals with
     or not the hospital would send a team to the                        more incentive to attend the workshops.
     workshop. Some hospitals did not respond at all to
     FXBC or AED's attempts at contact.                                  Facilitators also found it useful to have a person
                                                                         knowledgeable about state/local regulations attend
     Through recruitment, it was apparent that hospital                  the meeting to address issues specific to the region.
     departments often did not communicate with
     each other. Several L&D nurse managers were
     unaware of the rapid testing technology offered in                  Restructuring/Flexibility of
     their laboratories. In these cases, the laboratorians               Agenda
     informed FXBC or AED about the availability of
                                                                         The order of activities on the agenda changed
     the test after individuals from L&D had already
                                                                         after the pilot training. During subsequent sessions,
     registered for the workshop. Considering the lack of
                                                                         certain segments were reordered and others were
     communication at some hospitals, it may be helpful
                                                                         removed from the agenda or added to the activities
     for the key hospital decision-maker(s) to complete a
                                                                         when appropriate. This helped to ensure that the
     form during the registration process confirming that
                                                                         sessions were relevant to each group that was
     the hospital meets the selection criteria.
     It is ideal to allow at least one month between
     workshops, so that there is sufficient time to
     attend to follow-up activities from one workshop
                                                                         Make-up of Hospital Teams
     before the next one is conducted (i.e., transcribing                When hospital teams attending trainings were
     SWOT analyses and Action Plan tools, creating the                   comprised of a minimum of three people and at
     evaluation report, attending to "Get" card requests,                least one team member in attendance was in a
     and reimbursing participants for their travel                       leadership role at the hospital they represented,
     expenses). These follow-up activities can occur                     the hospitals developed more comprehensive
     simultaneously with recruitment of hospitals for                    action plans and seemed more likely to succeed in
     upcoming workshops.                                                 implementing RT in L&D.

     Alternating hospital recruitment between two                        Facilitators also found that participation and
     agencies was helpful so that one agency is not                      communication between different staff members in
     recruiting for more than one workshop at the same                   the target hospitals was higher when premeeting
     time. Allowing at least one month for recruitment                   assignments were sent to registered participants
     is preferable, although even more time would be                     before they attended the trainings. Having
     considered optimal.                                                 10–15 extra binders available was helpful in case
                                                                         participants wanted extra copies for colleagues that
                                                                         could not attend.

22     Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide
Facilitators                                                       nurses. The writing and approval process for the
                                                                   policy were challenges identified by a number of
The skill and comfort levels of observers who                      hospital. Getting buy-in from physicians and nurses
worked as facilitators during portions of the                      also was challenging for some. Strong leadership
trainings varied. Mailing/e-mailing some background                from senior obstetricians and nurse management
information and a facilitator's guide to facilitators              was central to implementation of RT in L&D, as was
prior to the training helped them to better prepare                leadership from the laboratory. The workshop team
for their roles. Some facilitators required more                   frequently provided ongoing leadership in the policy
guidance than others; it may be helpful to allow                   development and approval process.
time for trainers to speak with individual facilitators
before the sessions start if necessary.                            The hospital strategic planning workshop model
                                                                   was successful in increasing the number of hospitals
                                                                   routinely offering rapid HIV testing in labor and has
Lessons Learned                                                    the potential for adaptation to address other needs.
The strategic planning workshops were an effective
approach to increasing hospitals' capacity to offer
RT in L&D to women with undocumented HIV
status. Nearly 90% of hospitals in the follow-up
study had decided to implement RT in L&D. The
workshop gave hospital teams information on the
science and technology of rapid HIV testing, as well
as on staff education and policy issues they needed
to address. The interactive aspects of the workshop
helped hospital teams, made up of providers who
often did not work together, anticipate and plan
for implementation of RT in L&D in their particular
hospital. The team also learned about community
resources for follow-up of mother and baby with
which they were sometimes unfamiliar. The
process for implementing RT in L&D was often
slower than providers expected, and hospitals had
to overcome a variety of barriers. At the time of
the interviews, however, almost all of the hospitals
had made a formal decision to offer RT in L&D and
over two-thirds had RT available in the labor unit.

Hospitals reported a number of positive
experiences in implementing RT in L&D. Many
discussed the positive impact that implementation
was having on patients and staff. Hospitals also
described an increased sense of teamwork and
improved communication as positive outcomes,
as well as increased knowledge and awareness of
perinatal HIV transmission among physicians and

                          Strategic Planning Workshops for Rapid HIV Testing in Labor and Delivery Units: A Replication Guide   2

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