Evaluation of prenatal HIV testing among pregnant Medicaid enrollees in Michigan following new legislation.
Jill Diesel (CDC Field Epidemiologist)
The goal of this intervention was to evaluate annual HIV testing in accordance with new legislation requiring providers to screen pregnant persons during the first and third trimester for HIV, syphilis and hepatitis B (Michigan House Bill 6022, passed December 2018). We used data from Michigan Medicaid enrollees who had a date of delivery during 2017 through 2022.
Please provide specific outcomes if possible, such as # or people served, # or % of reaching XYZ outcome, etc.
Of the 179,320 pregnant Michigan Medicaid enrollees who met eligibility criteria and had deliveries between 2017 and 2022, 92.8% were screened at any point during pregnancy, 53.6% were screened during the first trimester and 50.6% were screened during the third trimester. Over time, the percentage of eligible enrollees tested in the first trimester increased 3.8 percentage points (2017: 47.6% (N=13,752); 2022: 51.4% (N=16,591)) and the percentage screened in the third trimester increased 15.5 percentage points (2017: 42.3% (N=12,235); 2022: 57.8% (N=18,675)).
Required a data sharing agreement with Michigan Medicaid and direct access to a specialized data platform (Data Warehouse) and software (BIQuery)..
The Michigan Medicaid data we have used has been a good source of STI screening data as this payer/insurer has a broad reach (paid for ~42% of all birth in Michigan in 2017). We have build a strong working relationship Michigan Medicaid's third party data steward (Optum) which has helped us think through and build robust datasets to answer public health evaluation questions.
If this is not applicable to your health department, type NA.
*testing in the jails started November 2021, only for the Wayne County Jail -- other counties do not test at this capacity
It is important to build relationships with healthcare, security, and program staff. Many incarceration facilities across the nation are now either completely privatized or their healthcare systems are privatized which comes with it's own set of challenges in regards to relationship building. Braiding multiple streams of funding will ensure long-term sustainability. Due to lack of STI funding this type of work is frequently funded by HIV-specific grants (Prevention, EHE) which means that syphilis data is often times lacking because HIV grants were not designed to study STI/syphilis, leading to inherent data issues. It is important to think about the data collection component and the challenges that will come with that. Flexibility in testing times (i.e., weekends, evenings, etc.) will yield higher number of tests. Ensuring confidentiality when clients are tested/screened/assessed for intake, it is extremely challenging to collect accurate historical data in corrections facilities. Having a private space, away from general population, with minimal involvement of required security personnel is an important component in providing confidentiality during this process -- this has been one of our biggest challenges. Working with the medical provider to streamline the treatment process, considering release process of incarcerated individuals (many jail facilities conduct unannounced releases dependent on severity of charges -- even unknown to the medical provider). Utilizing bicillin over doxycycline as much as possible, currently a challenge due to supply shortages. These are just a list of key highlights, but each of these items has a great deal of nuance -- we would recommend reaching out to counties who have done this work for additional discussion and guidance.