Preventing Perinatal HIV Transmission Newsletter: Field Update Banner Logo

Overview

Welcome to the fifth issue of Preventing Perinatal HIV Transmission: Field Update. You are receiving this newsletter because you expressed an interest in perinatal HIV prevention in hospitals or have signed up to receive it. 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 website.

 

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

 

November 17: CDC Satellite Broadcast/Web cast on Revised Recommendations for HIV Screening
CDC and the Public Health Training Network will present a satellite broadcast and Web cast, "Revised Recommendations for HIV Screening of Adults, Adolescents and Pregnant Women in Health Care Settings," on Thursday, November 17, 2005, beginning at 1 p.m. EST.  The 2-hour forum will cover the rationale for expanded HIV screening in health care settings, alternative procedures for normalizing screening in various health care settings, and practices that facilitate routine screening.  A panel of experts will answer viewers' questions, which can be sent via fax during the broadcast or by e-mail after the broadcast.

 

Additional information is available here and through the CDC Fax Information System, telephone 888-232-3299, by entering document number 130042 and a return fax number. Organizations are responsible for setting up their own viewing locations and are encouraged to register their locations as soon as possible so that persons who wish to view the broadcast can access information online. Directions for establishing and registering a viewing location are available here. The broadcast can also be viewed live or later on computers with Internet and RealPlayer® capability here. Videotapes and video CD-ROMs of the broadcast can be ordered by telephone at 800-458-5231.

 

HRET Presents Poster on Preventing Perinatal HIV Transmission at APHA’s Annual Meeting

The American Public Health Association will be holding its annual meeting in Philadelphia from December 10-14.  HRET staff member Jeanette Lyons will be presenting a poster entitled “Hospital policies for preventing perinatal HIV transmission: Relationship to disease prevalence” on Wednesday, December 14 at 8:30 a.m. as part of session #5014.0, “Topics in HIV/AIDS Prevention and Care.”  To view the poster, click here. 

 

ACOG Releases Translated “HIV and Other Important Pregnancy Tests” Tear-off Notepads

In order to increase HIV testing among pregnant patients who do not speak English, ACOG recently released revised tear-off notepads of the "HIV and Other Important Pregnancy Tests."  These tear-off notepads have been translated into Spanish, French, Russian, and Chinese.  Each tear sheet offers patients a summary of common prenatal blood tests, answers frequently asked questions about HIV testing, and provides resources for information.  If you have not received these tear-off notepads and would like to order some, please contact Rebecca Carlson at rcarlson@acog.org. 

 

Also keep an eye out on ACOG’s perinatal HIV site to be relaunched in the near future.

 

CityMatCH Publishes “Profiles of Perinatal HIV Prevention”

This past September, CityMatCH released the document “Profiles of Perinatal HIV Prevention” to preserve and recognize the work of urban communities which have fought to prevent and eliminate perinatal HIV transmission.  The profiles in this document aim to facilitate access to community-wide, systemic approaches to perinatal HIV prevention.  The most affected communities contribute to the larger CityMatCH network of urban members and partners, offering insights, strategies, and tools that can be used to implement proven perinatal HIV prevention initiatives.  If you would like to order a copy of this document, please contact Chad Abresch at cabresch@unmc.edu.

 

Oregon Passes “Opt-Out” Legislation

During the 2005 legislative session, Oregon became the latest state to pass “opt-out” legislation for pregnant women. Framing the issue as an “administrative housekeeping item” needed to bring Oregon law in line with standard of care, proponents convinced legislators that “opt-out” was good for moms and babies.

 

Oregon law already requires maternity care providers to test pregnant women for infectious conditions and offer them the opportunity to decline. However Oregon law also required special informed consent for HIV testing, making it illegal to include HIV in the routine prenatal laboratory panel. House Bill 2706 simply exempts pregnant from the special informed consent requirements for HIV testing so that HIV can be included in the routine group of prenatal labs. The law preserves the voluntary nature of the test as well as the confidentiality protections currently provided to HIV test results. The bill passed the Oregon House 55-1 and passed the Senate unanimously. It goes into effect January 1, 2006.

 

Oregon Department of Human Services, HIV/STD/TB Division is currently in the process of formalizing the Administrative Rules that will clarify the procedure regarding notification of HIV testing. In order to normalize HIV testing, the goal is to ensure that women are informed of ALL infectious disease tests recommended and that they are offered the opportunity to decline any of them.

 

HB 2706 can be found here.

 

Study Reveals Racial Disparities in Prenatal HIV Testing
D.N. Perlman and colleagues investigated within-group and between-group variations in prenatal HIV testing in a sample of low-income pregnant and recently postpartum women. The scientists used multivariable linear regression to estimate proportional differences in prenatal HIV testing for the total sample and stratified by race. "In bivariate analyses," the study said, "race and site of care jointly affected the probability of being tested."

The study found that predictors of prenatal testing differed by race. Hispanic women had the highest probability of being tested in public-practice settings. Relative to white women, black women had a higher probability of being tested in public and private practices. Receiving prenatal care in a community health center or hospital outpatient clinic increased the probability of testing for Hispanics, the authors reported, while being a recent victim of intimate partner violence was associated with less frequent testing for blacks. "Positive beliefs about HIV screening, while significant for blacks and Hispanics, was the only factor associated with testing for whites," the study found.

"Our data suggest that racial biases may be influencing providers' approach to testing, rather than CDC's 2001 guidelines for HIV screening of pregnant women. Study findings are being used to modify social marketing campaigns and improve provider trainings regarding prenatal HIV testing," the researchers concluded.

The report, "Disparities in Prenatal HIV Testing: Evidence for Improving Implementation of CDC Screening Guidelines," appeared in the Journal of the National Medical Association (2005;97(7 Suppl):44S-51S).

 

Day Care Center for HIV-Positive Children in Texas Closes Because of Lack of Need

The Anne Simon Reeves Center for HIV-positive children run by Catholic Charities in Fort Worth, Texas, closed in late October because it is no longer needed. Indicative of the plummeting number of mother-to-baby transmissions in Tarrant, Johnson, Parker and Hood counties, the last HIV-positive child enrolled at the center left to begin kindergarten this year and no other children were waiting to take her place. "[W]e are closing our doors for a really, really good reason," Francesca Pinto, the center's director, said. Dania Lee, a spokesperson for the Catholic Charities Diocese of Fort Worth, said a sister program has done so well at preventing mother-to-child HIV transmission that there is no need to continue running the day care. The center opened in 1991 and enrolled several hundred children, some of whom did not live to reach kindergarten.

Besides better medical treatment, another key to the center’s success was making sure pregnant women received medical care and education on how to prevent transmission.  Catholic Charities, with federal funding, started a pediatric and family HIV project in the four counties at the same time it opened the center.  Since 2000, case managers in the program have worked with 82 HIV-positive women who have delivered 86 babies, and every baby has been born HIV-negative, Pinto said.

The number of babies born with HIV because their mothers transmitted the disease to them has dropped significantly in Texas. The state Health Department's Web site shows the following numbers through 2001.

1991 – 41
1992 – 61
1995 – 41
1998 – 27
2000 – 16
2001 -- 8


Maternal Mortality, AIDS Leading Causes of Death for Women Worldwide, UNFPA Report Says

More than 500,000 women died from complications related to pregnancy or childbirth in 2000, but 99% of those maternal deaths were preventable, according to the U.N. Population Fund's "State of World Population 2005" report recently released, BBC News reports (BBC News, 10/12). Reproductive health problems, including HIV/AIDS, are the leading cause of death among women ages 15 to 44 and are responsible for approximately 250 million years of productive life lost annually, the report says (Lawless, AP/ABC News, 10/12). About half of the approximately 40 million HIV-positive people worldwide are women, and prevalence is rising among women, especially young women, according to the report (Daily Mail, 10/12). Women ages 15 to 24 are 1.6 times as likely to be HIV-positive as their male counterparts, the report says (BBC News, 10/12).

 

According to the report, improving gender equality and investing in the health and education of women and youth could lead to lower HIV prevalence rates, smaller families, and healthier, more literate children. "It is time to call for action to free women from discrimination, violence and poor health they face in their daily lives," UNFPA Executive Director Thoraya Obaid said, adding, "If we don't invest in women's education and health and their ability to plan their family, we are not allowing them to be able to contribute to the economic sector" (Reaney, Reuters, 10/12). The estimated cost of achieving the U.N. Millennium Development Goals -- which include stemming the HIV/AIDS pandemic, halving extreme poverty, promoting gender equality and reducing maternal mortality -- would be $135 billion in 2006, rising to $195 billion in 2015 (AP/ABC News, 10/12). Providing social infrastructure alone will not solve the problem, Steve Kraus, head of the HIV/AIDS branch of UNFPA, said, adding, "When we benefit women in a just and free society, all of society benefits. When we suppress women, society loses" (Cheong-won, Korea Times, 10/12). (Kaisernetwork.org Daily HIV/AIDS Report, 10/13)

 

The Latest From the HRET Hospital Perinatal HIV Testing Survey Documentation of HIV testing in a woman's hospital medical record is almost universal, according to results of the HRET Perinatal HIV Testing Survey. More than 95% of survey respondents say that documentation of testing in prenatal care is required by their hospital's policy; the figure is 92% for documentation of testing in labor and delivery. However, while documentation of some sort is widespread, the requirements for specific items to be recorded are spottier. For example, just over half of hospitals (53% in prenatal care, 54% in L&D) require documentation of a patient's acceptance of testing; somewhat more (62% prenatal care, 61% L&D) require documentation of refusal. And only two-thirds of hospitals require documentation of test results in prenatal care; 71% require test results to be documented in labor and delivery. HRET's tools for hospitals instituting universal testing of women who present to L&D with undocumented HIV status will include suggestions for policies and sample forms for testing documentation.

 

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