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Overview

Welcome to the fourth issue of Preventing Perinatal HIV Transmission: Field Update. You are receiving this newsletter because you expressed an interest in perinatal HIV prevention in hospitals, have signed up to receive it, or attended the 2005 Perinatal Grantees' Meeting in Atlanta in June. This free, quarterly email newsletter connects its subscribers to news updates, trends, statistics, prevention programs, policy initiatives, tools, and useful practices relating to perinatal HIV prevention in U.S. hospitals.  The dramatic reduction of perinatal HIV transmission in the U.S. stands as one of the great public health successes in U.S. history.  But in spite of this success, there are still women – and babies – who slip through the cracks.  Our nation’s hospitals stand in a unique position to implement practices and policies that can make a real difference in the lives of these women and babies.  The Health Research and Educational Trust (HRET), with support from the Centers for Disease Control and Prevention (CDC), launched this newsletter as a forum for information dissemination and for communication among and between hospital staff, HIV experts, and researchers.  

 

For more information on HRET’s Perinatal HIV Prevention project, please visit their web site.

 

If you have comments or suggestions for future issues of this newsletter, please contact Jennifer Reiter at jreiter2@aha.org.

 

From the HRET Hospital Perinatal HIV Testing Survey

In last summer’s HRET survey of hospitals on policies and practices relating to prevention of perinatal HIV transmission, we asked about HIV testing for women in labor and delivery (L&D). Of 1,250 respondents, 1,079, or 86%, indicated that HIV testing is available in L&D, but where testing is performed varied with the number of births performed annually and the type of community (a related but not identical descriptor). Hospitals with a smaller number of births were more likely to have tests performed at point of care, while hospitals performing more births were more likely to use either the hospital laboratory or an off-site lab. Similarly, hospitals in non-metropolitan areas were more likely to use point-of-care testing, and hospitals in metro areas were more likely to use the hospital lab.

 

U.S. Preventive Services Task Force Recommends Voluntary HIV Testing for All Pregnant Women

The U.S. Preventive Services Task Force, an independent panel of U.S. health experts, has recommended that all pregnant women be offered an HIV test to further reduce mother-to-child transmission of the virus, according to a report in the July 5 issue of the Annals of Internal Medicine. The task force's recommendations say that the current strategy of offering tests only to pregnant women deemed to be at "high risk" of being HIV-positive is missing opportunities to prevent vertical transmission. The task force recommended that the tests be voluntary for pregnant women and the task force noted that recent scientific advances have proven that testing all pregnant women for HIV is beneficial. The panel's 1996 recommendation had said there was insufficient evidence that testing all pregnant women had any benefit. Providing combination drug therapies, offering caesarean-section delivery and advising HIV-positive women to avoid breastfeeding can reduce the risk of vertical HIV transmission from about 25% to less than 2%.

 

To read the recommendation from the U.S. Preventive Services Task Force for the screening of HIV, click here.

 

Perinatal Hotline helps clinicians treat HIV-infected pregnant women

As reported in the February 2005 Field Update, a Perinatal Hotline (888-448-8765) is now providing free 24-hour consultation about management of HIV in pregnant women, HIV testing in pregnancy, and care of HIV-exposed infants. The Perinatal Hotline is staffed by HIV experts who can also refer callers to local clinicians for co-management or referral of these patients. Early identification of HIV-infected pregnant women and advances in antiretroviral therapies has led to a decrease in mother-to-child transmission.

 

“Since the Hotline started in December 2004, we have helped hundreds of clinicians offer the most up-to-date therapies to their patients.  With proper treatment, we can reduce mother-to-child HIV transmission to less than 1 percent, but health care providers need information and support to meet this goal,” says Jess Fogler, MD, Assistant Director of the Perinatal Hotline.

 

The hotline, based at UCSF/San Francisco General Hospital, is part of the National HIV/AIDS Clinicians’ Consultation Center of the Health Resources and Services Administration, in partnership with the Centers for Disease Control and Prevention.  For more information about the Perinatal Hotline, including Bulletins featuring clinical case studies taken from actual calls, and corresponding recommendations given by NCCC clinical faculty, please visit their web site.

 

Hospitals and Health Networks Editorial on Reducing Mother-to-Child HIV Transmission

On June 28, 2005, Hospitals and Health Networks published online an editorial written by Francie Margolin, HRET’s Vice President of Operations.  This article concerning the feminization of HIV discussed how HIV transmission is growing in women of child-bearing age, but that with proper care, the rate of transmission from mothers to their babies can be reduced to less than two percent. 

 

To read the full article, click here.

 

Drug To Block Mother-To-Child HIV Transmission Induces Resistance More Often Than Previously Thought

From the Journal of Infectious Diseases: Three studies in the July 1, 2005 issue show that drug resistance associated with single-dose nevirapine -- which is used to prevent mother-to-child HIV transmission -- might be "substantially higher" than previously thought, particularly among patients infected with HIV subtype C, according to a JID release. Two studies -- one study led by Jeffrey Johnson of CDC and another study led by Susan Eshleman of Johns Hopkins University -- assessed resistance to nevirapine using laboratory tests more sensitive than standard genotype assays. A third study, also led by Eshleman, assessed how the rate of nevirapine resistance differs in patients infected with various subtypes (JID release, 6/1).

 

CDC-Funded National Organizations Meet in Atlanta

The national organizations funded by CDC to help eliminate perinatal HIV transmission were out in force at the June HIV prevention meeting in Atlanta. Representatives from American College of Obstetricians & Gynecologists (ACOG), Association of Maternal & Child Health Programs (AMCHP), CityMatCH, François-Xavier Bagnoud Center (FXB), and Health Research and Education Trust (HRET) attended not only the main conference but also the meeting of the CDC Perinatal HIV Prevention and Surveillance grantees. Carolyn Burr of FXB and Francie Margolin of HRET were part of a panel on rapid HIV testing. In addition to their individual projects, the national organizations are also collaborating to “get the word out” more broadly about preventing perinatal HIV transmission.

 

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