Overview
Welcome to this issue of Preventing Perinatal HIV Transmission: Field Update. You are receiving this newsletter because you have attended one of HRET’s workshops on implementing rapid HIV testing, expressed an interest in perinatal HIV prevention in hospitals, or have signed up to receive it. This 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 Health Research & Educational Trust (HRET), with support from the Centers for Disease Control and Prevention (CDC), produces 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 our Web site.

If you have comments or suggestions for future issues of this newsletter, please contact Cindy Greising at cgreising@aha.org.

Free CEU Workshop on Eliminating Perinatal HIV Transmission

Clinicians’ Guide to States’ Perinatal HIV Testing Laws Available Online

The NCCC has published the Perinatal Quick Reference Guide: A Guide to States’ Perinatal HIV Testing Laws for Clinicians. A subset of the Compendium of State HIV Testing Laws, the quick reference guide summarizes states’ key laws, which are unique to each state and have been revised or supplemented in some cases. The compendium more fully characterizes the individual state profiles. Both the compendium and the quick reference guide are designed to help clinicians understand HIV testing laws and implement sound HIV testing policies. Click here for more information.

The NCCC (National HIV/AIDS Clinicians’ Consultation Center) provides clinical consultation for health care providers as part of the HRSA AIDS Education and Training Centers (AETC) Program and is based at San Francisco General Hospital, University of California, San Francisco.

To join the NCCC community on Facebook: Search “National HIV/AIDS Clinicians’ Consultation Center” and click “Become a fan.”

Article Highlights Positive Effects of Early Antiretroviral Therapy on Infants

In HIV-1 vertically infected infants, starting antiretroviral therapy before the age of three months significantly reduces progression to AIDS and death. These findings are presented in “Effect of Early Antiretroviral Therapy on the Risk of AIDS/Death in HIV-infected Infants” by Guetghebuer and others published in the March 13, 2009, issue of AIDS.

HIV and Pregnancy: Prevention and Care – Knowledge Pretest and Posttest

A new training tool for hospital staff working to eliminate perinatal HIV transmission is available from the HRET Web site. The 10-question knowledge pretest/posttest, “HIV and Pregnancy: Prevention and Care,” was developed by the François-Xavier Bagnoud (FXB) Center, School of Nursing, University of Medicine and Dentistry, New Jersey.

Report Released on Reducing HIV Transmission and Elizabeth Glaser Foundation

A recent article reviews an almost seven-year initiative in developing countries by the Elizabeth Glaser Pediatric AIDS Foundation to prevent mother-to-child transmission (PMTCT) of the HIV virus. Among the authors’ conclusions are that “opt-out testing, supplying mothers with medication at time of diagnosis, and providing the infant dose early have measurably improved program efficiency. PMTCT should be viewed as an achievable paradigm and an essential part of the continuum of care." The article “Preventing Mother-to-Child Transmission of HIV in Resource-Limited Settings: The Elizabeth Glaser Pediatric AIDS Foundation Experience,” by Allison Spensley, Tabitha Sripipatana, Abigail Norris Turner, Chuck Hoblitzelle, Joanna Robinson, and Catherine Wilfert, is published in the April 2009 issue of American Journal of Public Health.

Report: No Treatment for Majority of HIV-Positive Women in Developing Countries

A new study reports that in 2007 only 33 percent of pregnant women in developing countries received drugs to block transmission of the HIV virus to their children. Though global coverage of HIV rose from 9 percent in 2004 to 33 percent in 2007, at least three-fourths of HIV-positive women in 61 countries, including Cameroon, Ethiopia, India, and Nigeria, still do not receive any drugs for PMTCT. The report “Failing Women, Failing Children: HIV, Vertical Transmission, and Women’s Health” was released in May 2009 by the International Treatment Preparedness Coalition (ITPC).

The study’s authors cite several causes for the failure to reach many HIV-positive women, including the emphasis in many countries on providing antiretroviral prophylaxis to prevent transmission to newborns and not on preventing, counseling, caring for, and treating women; lack of funding; and lack of consistent and coordinated efforts by donors, agencies, and governments.

Updated Pediatric HIV/AIDS Surveillance Slides Now Available

CDC has updated and released pediatric HIV/AIDS surveillance slides through 2007. You can access the slides from the CDC or HRET Web sites.

Early Treatment in Children with HIV Preserves Normal Vaccine Response

Infants who acquire HIV from their mothers may respond normally to childhood vaccines if they receive highly active antiretroviral therapy (HAART) in their first year of life, according to a new report. Researchers concluded that early initiation of HAART preserves a normal immune response in infants with HIV, as they maintained normal levels of antibody-producing cells. For infants receiving no treatment or treatment later in life, low levels of antibody-producing cells were observed. The report “Timing of HAART Defines the Integrity of Memory B Cells and the Longevity of Humoral Responses in HIV-1 Vertically-Infected Children” by Pensieroso and others was published in the May 12, 2009, issue of Proceedings of the National Academy of Sciences.

Free Conference on HIV and Violence Against Women

Designed to promote and enhance understanding of women’s health and well-being as influenced by HIV/AIDS and violence against women, HIV and Violence Against Women: A National Conference will be held on Saturday, August 27, 2009, at the Loudermilk Conference Center in Atlanta, GA. Registration is free. Sponsored by the DHHS, Office of Women’s Health, CDC, and Southeast AIDS Training and Education Center, Emory University School of Medicine, the conference is scheduled one day before the National HIV Prevention Conference.

CDC Convenes Meeting to Explore Routine HIV Screening in Hospitals

CDC, HRET, and the François-Xavier Bagnoud (FXB) Center, School of Nursing, University of Medicine and Dentistry, New Jersey, hosted Consultation on Implementation of Routine HIV Screening at Hospital Admission in June in Chicago. This one-day meeting brought together representatives from specific disciplines involved in establishing hospital HIV screening programs, such as hospital administrators, laboratory scientists, health policy professionals, hospitalists, nurses, internal medicine and infectious disease physicians, risk managers, admissions managers, and payer groups. Participants helped identify barriers and facilitators to initiating routine HIV screening at hospital admission.

HRET to Survey Hospitals on HIV Testing and Treatment Practices

To better understand the opportunities and challenges the nation faces in identifying and treating individuals who are HIV-positive, HRET, in partnership with the CDC, is surveying 1,000 hospitals on their current practices of HIV testing and treatment. The survey will be distributed to the field in June. Geared for hospital infection control professionals, the survey includes questions about where and when HIV tests are conducted and about HIV testing protocols for various hospital units. To access HRET’s operational guide on implementing or expanding ED-based HIV testing, go to http://www.edhivtestguide.org/.

Public Health Reports Article Provides Baseline for Newer CDC Guidelines

The May/June 2009 issue of Public Health Reports highlights research that benchmarks HIV testing availability prior to CDC’s 2006 revised recommendations. This research is discussed in “HIV Testing and Referral to Care in U.S. Hospitals Prior to 2006: Results from a National Survey,” by Gretchen Williams Torres, former director, research, HRET; Juliet Yonek, director, program evaluation, HRET; Jeremy Pickreigh; Heidi Whitmore; and Romana Hasnain-Wynia, former vice president, research, HRET.

HIV-Positive People at Increased Risk with New Flu Strain

The H1N1 flu strain poses an increased risk of hospitalization for HIV-positive individuals, according to the World Health Organization (WHO). Individuals with immodeficiency diseases such as HIV/AIDS are more likely to be “among high-risk groups for complications and premature deaths from seasonal influenza and are among the targeted groups for yearly influenza vaccination.” WHO has posted recommendations for using antiviral drugs against the influenza A (H1N1) virus. On June 11, WHO raised the pandemic alert level to Phase 6, due to spread of the H1N1 virus to over 70 countries; the severity of the illness caused by the virus remains moderate for most individuals.

Report: Most Americans Support Increased HIV/AIDS Funding

A report released in May indicates that most Americans support increased funding in the United Sates for HIV/AIDS. For “Impressions of HIV/AIDS in America: A report on conversations with people throughout the country,” researchers conducted focus groups, interviewing a cross-section of Americans from urban, suburban, and rural areas. Most interviewees expressed support for increased domestic funding for HIV/AIDS programs, particularly for education/awareness, prevention, and vaccine research.

Researchers also found that HIV/AIDS was “off the radar” for most participants but that nearly all were sympathetic to HIV-positive people. In addition, the report indicates that some people still attach a stigma to HIV and have misconceptions about how the virus is transmitted. The report was prepared for the National AIDS Coordinating Committee with support from the MAC AIDS Fund.

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