December 13, 2010

Preventing Perinatal HIV Transmission Newsletter: Field Update Banner Logo

New Activities:

FIMR/HIV National Resource Center Announces Sites for Second Year Implementation

Ten sites recently applied and were selected to implement the FIMR/HIV Prevention Methodology. These sites include Baltimore; Broward County, FL; Chester, PA; Indianapolis; Newark, NJ; New Orleans; Philadelphia; Washington, DC; the State of Illinois; and the State of Michigan. This project follows a three-year pilot project in three communities (Baton Rouge, LA; Detroit; and Jacksonville, FL).

Participating sites are required to make a one-year commitment to become part of a national-practice community that shares ideas and problem-solves with one another. Sites receive technical assistance from the FIMR/HIV national partners in the form of training calls, in-person trainings and site visits. Additionally, online tools and resources are available to all communities free of charge. These tools are available at http://www.citymatch.org/.

The FIMR/HIV Prevention Methodology is based on the premise that pregnancy of women with HIV infection are sentinel events that warrant review. By collecting comprehensive quantitative and qualitative data via medical record abstraction and maternal interview, this methodology provides an in-depth look at the systems that lead to unintended perinatal HIV exposure or perinatal HIV transmission. This process allows communities to identify missed opportunities for prevention and then develop and implement improvements to systems of care for women who are HIV-positive.

The FIMR/HIV Prevention Methodology is a collaborative project of the Centers of Disease Control and Prevention, CityMatCH, the American College of Obstetricians and Gynecologists, and the National Fetal and Infant Mortality Review Program. For more information, visit http://fimrhiv.citymatch.org/ or contact CityMatCH at (402)561-7500.

Perinatal HIV Hotline Resumes 24/7 Coverage

The National HIV/AIDS Clinicians’ Consultation Center has resumed coverage 24-hours a day, seven-days a week for its perinatal hotline. The hotline provides around-the-clock advice on indications and interpretations of standard and rapid HIV testing in pregnancy, as well as consultation on antiretroviral use in pregnancy, labor and delivery, and the postpartum period. The NCCC Perinatal HIV Consultation and Referral Service also assists clinicians with linking HIV-infected pregnant women with appropriate HIV-specialist care. The hotline’s toll-free number is (888)448-8765.

HIV Testing and Screening Cost and Reimbursement Toolkit

HRET has developed a free online toolkit for cost and reimbursement issues surrounding HIV testing and screening that is available at www.hret.org/hiv-cost. The package includes a downloadable calculator to assist hospitals, clinics and physicians in understanding the cost of HIV testing programs and maximizing reimbursement. Free postcards promoting the resource are also available. The resource was developed in partnership with the Centers for Disease Control and Prevention. For more information, contact Joan Miller at (312) 422-2619 or jmiller@aha.org.

ACOG Releases New Guidelines for HIV-Positive Women

As initially reported in Reuters Health Medical News, the American College of Obstetricians and Gynecologists recently issued guidelines for the routine gynecological care of HIV-positive women.

All women ages 19 to 64 should receive routine HIV screening, the report recommended. While there is no consensus on how often repeat screening should be offered, the guidelines suggested at least annual testing for women at elevated risk, including injection drug users, those whose partners are injection drug users or HIV-positive, and those have had an STD in the previous year.

The guidelines recommend aggressive treatment of STDs, which increase the risk of HIV transmission. CDC recommends annual testing for curable STDs, ACOG noted. HIV-positive women should have cervical screening twice during the first year after HIV diagnosis and annual screening thereafter.

HIV-positive women are at increased risk of bacterial vaginosis and yeast infections, and treatment may take longer than average, the guidelines note. Women with recurrent yeast infections may need long-term medication to forestall future yeast infections, they said.

Condoms, which are recommended for all sexually active HIV-positive persons, plus another method of birth control are recommended to prevent unintended pregnancy among HIV-positive women of child-bearing age. Oral contraceptives are safe for women with HIV, except for women taking certain antiretroviral therapies. The combination may interfere with effectiveness. ACOG notes that IUDs can be a good birth control option for HIV-positive women on antiretroviral therapy.

For HIV-positive women who wish to become pregnant, there are strategies to avoid the risk of vertical transmission. They include reducing the virus to undetectable levels before delivery, not breastfeeding and administering the infant prophylactic antiretrovirals.

HIV-positive women tend to go through menopause about three to four years before other women, according to the guidelines. In the absence of detailed research, the guidelines suggest standard interventions to address the bone loss often seen in menopausal women: increasing physical activity, stopping smoking, and taking vitamin D and calcium supplements.

The full report, "Practice Bulletin No. 117: Gynecologic Care for Women with Human Immunodeficiency Virus," was published in Obstetrics & Gynecology (2010;116(6):1492-1509).


New Resources:

CDC Provides Updated Data on Women and HIV

CDC recently updated its slide sets covering HIV surveillance in women from the 2008 HIV Surveillance Report: Diagnoses of HIV infection and AIDS in the United States and Dependent Areas. The data include information on the number and rates of HIV and AIDS diagnoses among females by race and ethnicity, transmission modes and age of diagnosis, morbidity and mortality. Among the highlights:

• Black/African-American females comprise 14 percent of the population and 67 percent of diagnoses of HIV infection;
• The vast majority of females (some 80 to 90 percent) contract HIV through heterosexual contact.

To access the slide sets, visit HIV Surveillance in Women (Through 2008).

Kaiser Releases New Fact Sheet on Women in U.S. With HIV/AIDS

The Kaiser Family Foundation compiled available data in an updated fact sheet on women with HIV and AIDS in the United States. Among the data cited, most women become infected through heterosexual contact. Other highlights:

• Today, there are approximately 1.1 million people living with HIV/AIDS in the U.S., including nearly 280,000 women.
• In 2006, there were 15,000 new HIV infections and, in 2008, there were 9,813 AIDS diagnoses among women.
• There were 4,802 deaths among women with an AIDS diagnosis in 2007.

The full fact sheet is accessible here.

Journal Highlights Advances in Preventing Mother-to-Child HIV Transmission

The December 2010 issue of Clinics in Perinatology entitled “Perinatal HIV Infection” is a comprehensive review of the biology, epidemiology, and prevention of perinatal HIV transmission, as well as the clinical care and optimal management of the pregnant mother and her exposed or infected infant.

The 12 articles cover such topics as antiretroviral drug strategies, Cesaerean section, breastfeeding, postnatal HIV transmission prevention and care of HIV-infected infants, among others.

To access the journal, go here http://www.perinatology.theclinics.com/current


News Updates:

New York State Law Expected to Improve Screening and Early Diagnosis

New York implemented a new state law in September, in line with the HIV consent approach recommended by the CDC. The streamlined process and linkage to care requirements are expected to decrease the estimated 20 percent of residents with HIV who do not know they are infected and detect infections earlier.

Under the law:
*Consent for HIV testing can be incorporated in general consent to medical care, although opt-out language for HIV testing must be included.
*Consent can be given verbally and noted by the provider in the medical record.
*Prior to testing consent, patients must be provided with information about HIV.
*Providers who offer HIV testing must arrange an appointment for the care and treatment of patients with confirmed HIV-positive results, provided they consent.

For more information about the testing law, visit www.nyhealth.gov/diseases/aids/testing/hiv_testing_law.htm.

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