February 15, 2011

Preventing Perinatal HIV Transmission Newsletter: Field Update Banner Logo

New Resources:

Free Online Toolkit Helps Providers Maximize Reimbursement, Calculate Costs

The Health Research & Educational Trust developed a free online toolkit to assist hospitals, physicians and clinics in calculating their costs and reimbursement for HIV testing and screening. The package includes a cost calculator and a summary of key issues and resources to consider when starting or expanding an HIV testing program.

Access the toolkit at www.hret.org/hiv-cost. For more information, contact Joan Miller at jmiller@aha.org or 312-422-2619.

Updated HIV Testing CPT Coding Guide Developed by AAHIVM and AMA

The American Academy of HIV Medicine and the American Medical Association, along with contributions from other organizations, recently updated an HIV Testing CPT Coding Guide used for reporting of outpatient services. Because hospitals use these codes for any type of outpatient services for all payers, using them fits in with hospitals’ goals to prevent perinatal HIV transmission

To view the guide, click here.

Kaiser Issues Resources on Health Reform and Women

The Kaiser Family Foundation released a new narrated-slide tutorial and an updated issue brief that examine the implications of the new health reform law for women and their health and health care. The resources feature information on HIV testing and reproductive health..

In the KaiserEDU.org tutorial Health Reform: Impact on Women’s Health Coverage and Access to Care, vice president, Kaiser Family Foundation and director of the Women’s Health Policy project, Alina Salganicoff, Ph.D., reviews how the Patient Protection and Affordable Care Act is expected to impact access to care and affordability of health coverage for women.

The tutorial also explains the provisions in the new law related to preventive screening services, reproductive health, maternity care and women on Medicare. Much of the same ground is covered in greater detail in the updated issue brief Impact of Health Reform On Women’s Access to Coverage and Care which includes national and state-level estimates of the percentage of uninsured women ages 18-64 who are likely to qualify for federal help under the law and a summary of key coverage and benefits provisions in the law that affect women.

The foundation also updated two fact sheets on women’s health insurance coverage, reflecting the latest data from the U.S. Census Bureau. One fact sheet, revised to reflect major issues in health reform implementation, provides statistics on health coverage and describes the major sources of health insurance for women ages 18-64. The other provides detailed state-level coverage information for the 50 states and the District of Columbia.

New Updates:

Michigan Streamlines HIV Consent and Testing Laws

The state of Michigan passed a new law (PA 320 of 2010) that allow providers to incorporate consent for HIV testing into the general consent for medical care, and provide pre-test information verbally beginning January 1, 2011. The new legislation circumvents previous requirements to provide separate, written consent.

This legislation is in line with the national trend to normalize HIV testing by incorporating it into other routine care.

For more information, see this memo to health providers or go to the Michigan Department of Community Health website at http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_2982---,00.html.

OraSure Extends OraQuick Rapid HIV Test Shelf Life

OraSure Technologies announced that U.S. regulators approved extending the shelf life of the OraQuick ADVANCE Rapid HIV-1/2 Antibody Test test to 24 months, up from 18 months.

Manufacturing improvements in the product resulted in its longer shelf life, said OraSure officials. Using oral fluid or blood samples, the OraQuick HIV test yields results in about 20 minutes. OraSure now is seeking Food and Drug Administration approval for over-the-counter sales of OraQuick, which currently is used in clinics and hospitals.

For more information, go to http://www.orasure.com/.

U.S. Women With HIV Develop Worse Outcomes Than Men

Women with HIV had worse outcomes than men, despite favorable clinical parameters on enrollment, according to a 1997-2007 study of recently and acutely infected patients, published in the Journal of Infectious Diseases. The study was based on 2,277 HIV seroconverters, including 124 women, enrolled in the Acute Infection and Early Disease Research Program.

Among the study findings:

  • Initially, women averaged .40 log10 fewer copies/mL of HIV-1 RNA (P<.001) and 66 more CD4+ T cells/µL (P=.006) than men, after controlling for age and race.
  • Nonwhite men and women were less likely to initiate antiretroviral therapy (ART) at any time than white men (P<.005).
  • Patients in the US South were less likely to initiate ART compared with those in other regions (P=.047).
  • Women were 2.17-fold more likely than men to experience at least one HIV/AIDS-related illness (P<.001), and nonwhite women were most likely compared to all others (P<.035), adjusting for IV drug use and ART.
  • Eight years after diagnosis, 78 percent of nonwhite and 37 percent of white patients in the South had reported at least one HIV/AIDS-related illness, compared with 24 percent of whites and 17 percent of nonwhites from other regions (P<.001).

The full study, "Sex, Race, and Geographic Region Influence Clinical Outcomes Following Primary HIV-1 Infection," was published in the Journal of Infectious Diseases (2011;203(4):442-451).

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

Sharing Breast Milk Continues, Despite Government Warning of HIV Risk

For the first time, Food and Drug Administration advisers met in December to collect information and seek public comment on formal human-milk banking. Though casual milk sharing among mothers was not on the meeting agenda, it is a concern to FDA, according to the FDA website.

The FDA warned "against feeding your baby breast milk acquired directly from individuals or through the Internet" due to the risk of infectious diseases like HIV and contaminants, including illegal drugs.

According FDA data, the chances of transmitting hepatitis B or C through breast milk are "negligible." However, there is a 42 percent risk of transmitting HIV and a 76 percent chance of passing along cytomegalovirus. "Flash pasteurization" - heating milk at 144 degrees Fahrenheit (62 degrees Celsius) for 30 minutes - kills most germs.

Study Explores Influences of Unintended Pregnancy on Reproductive Control

Unintended pregnancy is commonly used as a proxy measure for reproductive control, a concept that refers to an individual's ability to control his or her own reproduction, according to an article in Sexual Health.

In the study, the researchers used unintended pregnancy as a proxy measure for reproductive control by analyzing data on 4,521 heterosexually active female participants in the National Survey of Family Growth, Cycle 6. Self-reported pregnancy intention was used to group women into four categories: women reporting one unintended pregnancy; women reporting two or more unintended pregnancies; women reporting intentionally having no pregnancies; and women reporting that all their pregnancies were intentional (reference category). Polytomous logistic regression, weighted for the complex sampling design, provided estimates of odds ratios (OR) and 95 percent confidence intervals (CI).

The results showed that 51 percent of women who reported one unintentional pregnancy went on to report at least one more such pregnancy. The following were found to significantly predict multiple unintended pregnancies: being black, Hispanic, born to a mother younger than 18 at first birth, having multiple partners, and age of first sexual debut (consensual or non-consensual).

Relative to those reporting sexual debut after age 18, women who reported sexual debut before age 15 were at increased risk of multiple unintended pregnancies (adjusted OR, reported as consensual: 6.96; 95 percent CI: 4.26 to 11.39) (adjusted OR, reported as non-consensual: 27.10; 95 percent CI: 11.03-66.57).

"Efforts to delay sexual debut and to protect girls from non-consensual sex are sorely needed to prevent a lifelong trajectory of lack of reproductive control," the authors concluded.

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