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News
You Can Use for Ryan White Title IV Grantees
University of Miami
This publication was made possible by the HRSA HIV/AIDS Bureau Award No. 1 U69 HA 00048-01 from the Training and Technical Assistance Cooperative Agreement Targeting Ryan White CARE Act Title IV Grantees. Views expressed here do not necessarily represent the official views of the Training and Technical Assistance Cooperative Agreement. This publication is compiled and edited by Alina Orozco; questions and comments may be directed to the Editor at bmurray@med.miami.edu. CHANGES AT THE
DIVISION OF COMMUNITY BASED PROGRAMS
DCBP is responsible for the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Title III Early Intervention Services program, Title III Planning and Capacity Building Grants, Title IV Comprehensive Family Services Program, Title IV Youth Services Initiatives, and the Part F Dental Reimbursement and Community Based Dental Partnership Program.
As of November 1,
2002, the overall leadership and direction for Title III, Title IV, and
Dental Programs was elevated to the Division Office level. DCBP’s three program branches were organized by region. Jose Morales, M.D. was appointed to be the Deputy Director for Clinical Issues for DCBP to further enhance the Division’s clinical component.
Title III Early Intervention Services, Planning and Capacity Building Grants, Title IV Comprehensive Family Services, Youth Services, and Community Based Dental Partnership Programs are now managed by three geographically defined branches:
The Northeastern Region is composed of HRSA regions I, II, and III. The Northeastern Regional Branch’s Acting Chief is Maria del Carmen Rios, M.D., and she may be reached at (301) 443-3995.
The Southern Region is composed of HRSA regions IV, and VI. The Southern Regional Branch’s Acting Branch Chief is Ray Goldstine, and he may be reached at (301) 443-0735.
The Western Region
is composed of HRSA regions V, VII, VIII, IX, and X. The Western Regional
Branch’s Acting Branch Chief is Sylvia Trent-Adams, R.N., and she
may be reached at (301) 443-2177. UPDATED PERINATAL
HIV GUIDELINES Your News You Can Use for Ryan White Title IV Grantees Welcome to the first issue of News You Can Use. This is your newsletter and as such we encourage you to send us information on model programs or other interesting work that you may want to share with other grantees. If there are topics/issues that you would like to see featured in an article please let us know. Please send your material to Ms. Brandy Murray at bmurray@med.miami.edu. We look forward to your submissions and feedback on this newsletter. RESEARCH UPDATE Prepared by the National Resource Center at the François-Xavier Bagnoud Center for Comprehensive Family Services Branch Compiled by Linda S. Podhurst, Ph.D.
Children –
About Adherence
Study Participants: N=87 women who were participating in a larger study of perinatal transmission at 3 inner-city New York City hospitals.
Study Method: The women were interviewed 2 to 6 weeks postpartum to assess:
The study also analyzed blood samples of 45 of the infants to measure the level of medication (ZDV) in their systems.
Study Findings: 71% of the women reported administering all of the prescribed 4 daily ZDV doses in the previous week; self-reported adherence was not associated with any maternal characteristics. The investigators measured plasma serum levels of ZDV in the infants. Poor adherence, with lower plasma ZDV levels, was associated with asymptomatic HIV illness in the mother and having 2 or more other children. Good adherence, higher ZDV plasma levels, was associated with the presence of a maternal social support network, disclosure of HIV infection, and mothers’ adherence to their own ZDV regimens during pregnancy.
Lessons Learned:
Women who do not have symptoms of HIV and lack a social support network
are more likely not to
Source: Demas, PA, Webber MP, Schoenbaum EE, Weedon J, McWayne J, Enriquez E, Bamji M, Lambert G and Thea DM. (2002) Maternal adherence to the zidovudine regimen for HIV-exposed infants to prevent HIV infection: a preliminary study. Pediatrics, 110(3):e35,Sep.
Children –
About Cardiovascular Disease
Study Participants: N=600 infants born to women living with HIV infection. The study included 93 infants infected with HIV, 463 uninfected infants, and a comparison group of 195 healthy children born to mothers who were not infected with HIV.
Study Methods: Measurement of cardiovascular function every 4-6 months for up to 5 years.
Study Findings: As expected, HIV-infection is associated with persistent cardiovascular abnormalities that can be identified shortly after birth. In addition, infants born to women with HIV, irrespective of their HIV status, have significantly worse cardiac function than other infants. The data from this study also indicate that the uterine environment has an important role in postnatal cardiovascular abnormalities. A related study by the same authors described the 5-year cumulative incidence of cardiac dysfunction in children living with HIV infection. Cardiac dysfunction occurred in 18% to 39% of HIV-infected children and was associated with an increased risk of death.
Lessons Learned: This study and two other studies (Ensing 2002 and Starc et al 2002) support routine, repeated echocardiograms for children vertically infected with HIV.
Sources: Lipshultz
SE, Easley KA, Orav EJ, Kaplan S, Starc TJ, Bricker JT, Lai WW, Moodie
DS, Sopko G, Schluchter MD and Colan SD. (2002). Cardiovascular status
of infants and children of women infected with HIV-1 (P(2)C(2) HIV): a
cohort study.
Ensing G. (2002). Cardiac complications with vertically transmitted HIV infection. Comments. Lancet, 360(9330):350-51, Aug 3.
Starc TJ, Lipshultz SE, Easley KA, Kaplan S, Bricker JT, Colan SD, Lai WW, Gersony WM, Sopko G, Moodie DS and Schluchter MD. (2002). Incidence of cardiac abnormalities in children with human immunodeficiency virus infection. Journal of Pediatrics, 141(3):327-34, Sep. WW, Moodie DS, Sopko G, Schluchter MD and Colan SD. (2002). Cardiovascular status of infants and children of women infected with HIV-1 (P(2)C(2) HIV): a cohort study. Lancet, 360(9330):368-73, Aug 3. Ensing G. (2002). Cardiac complications with vertically transmitted HIV infection. Comments. Lancet, 360(9330):350-51, Aug 3. Starc TJ, Lipshultz
SE, Easley KA, Kaplan S, Bricker JT, Colan SD, Lai WW, Gersony WM, Sopko
G, Moodie DS and Schluchter MD. (2002). Incidence of cardiac abnormalities
in children with human immunodeficiency virus infection. Journal of Pediatrics,
141(3):327-34, Sep.
Adolescents –
About Safe Sex
Study Participants: N = 522 sexually active adolescent females.
Study Method: Information on STD history and current sexual behaviors (within the last 30 days) was collected in face-to-face interviews. Less sensitive topics, such as STD prevention knowledge, attitudes about condom use, and perceived barriers to condom use were collected in a written survey.
Study Findings: Although past STD diagnosis was associated with increased STD prevention knowledge, it was not associated with increased motivation to use condoms. Compared with adolescents who had never had an STD, adolescents with a history of diagnosed STD were more likely to report:
Among this sample of female adolescents, past STD diagnosis was an indicator of current high-risk sexual activity and increased risk for gonorrhea and trichomoniasis.
Lessons Learned: Although adolescents may gain factual knowledge from the experience of having an STD diagnosed, they are not motivated to increase use of condoms and remain at risk for subsequent STD infection. The findings suggest that there is a need to intensify clinic-based prevention efforts directed toward adolescents with a history of STDs. Source: Diclemente
RJ, Wingood GM, Adolescents -
About Care and Treatment Study Participants: N = 80 parent-child dyads participating in clinical studies of the Pediatric HIV Working Group of the HIV/AIDS Malignancy Branch at the National Cancer Institute. Average age of participants was 11.8 years at time 1; 56% were male, racial composition was 72% white, 14% African-American, 7% Hispanic, and 7% other; 39% contracted HIV perinatally, 35% through a hemophilia related transfusions, and 26% through another type of transfusion. Study Method: Children and their caregivers were interviewed and completed written reports 3 times, approximately 12 months apart. Study Findings: Disclosure was positively related to social support, self-competence, and decreased problem behavior, except in the case of public disclosure, which was negatively associated with global self-competence. Adolescents with social support were much less likely to have problem behavior. Participants aged 18 years and older were less likely to complete their academic education than their healthy peers (national norms). Adolescents who lost a parent were more likely to have suffered from depression during their lifetime. Lessons Learned: Social support and open communication about the diagnosis are essential, particularly at an age at which decisions about relationships, sexual activity, drug use, and plans for the future are the focus of adolescent development and individuation. With advances in medical treatment, HIV-infected children are more likely to survive into adolescence and beyond and their psychosocial needs are changing to more closely resemble the needs of the chronically ill individual, rather than the terminally ill. Families of HIV-infected children should seriously consider preparation for independent living. Source: Battles HB and Wiener LS. (2002). From adolescence through young adulthood: psychosocial adjustment associated with long-term survival of HIV. Journal of Adolescent Health, 30(3):161-8, Mar. Women – About
Adherence and
Safer Sex
Study Participants: N = 2,115 women attending a public STD clinic in San Francisco from October 1996 to March 1997. Data were analyzed for a subgroup of 409 female patients who reported recent male sexual partners.
Study Method: Patients attending a public STD clinic in San Francisco were given a written survey to complete. The survey asked about STD history, sexual risk behaviors, partner violence history, partner characteristics and demographics.
Study Findings: Intimate partner violence is common among female STD patients and is associated with risk behaviors and partner factors that increase patients' risk of contracting HIV. Of the 409 women who reported recent male sexual partners, 11% had experienced intimate partner violence in the past 12 months and 24% had a history of intimate partner violence. This history was also associated with:
Lessons Learned: Women attending STD clinics should be routinely screened and referred for intimate partner violence.
Source: Bauer HM, Gibson P, Hernandez M, Kent C, Klausner J and Bolan G. (2002). Intimate partner violence and high-risk sexual behaviors among female patients with sexually transmitted diseases. Sexually Transmitted Diseases, 29(7):411-6, Jul.
Women – About
Care and
Treatment
Study Participants: N = 1,054 HIV positive women participating in the Women's Interagency HIV Study (WIHS), a large multi-center study of disease progression in women living with HIV/AIDS.
Study Method: Data from a prospective cohort study were analyzed for 1054 HIV-infected women; median follow-up was 3.4 years.
Study Findings: Progression to AIDS and death was predicted by pre-HAART values of less than 200 CD4(+) cells and greater than 50,000 HIV-1 RNA copies (viral load). Women with CD4 (+) counts in the 200-350 range had similar rates of progression.
Lessons Learned: It is a valid clinical management strategy for HIV-1 to delay starting HAART until the CD4(+) cell count is between 350 and 200.
Source: Anastos K, Barron Y, Miotti P, Weiser B, Young M, Hessol N, Greenblatt RM, Cohen M, Augenbraun M, Levine A and Munoz A. (2002). Women's Interagency HIV Study Collaborative Study Group. Risk of progression to AIDS and death in women infected with HIV-1 initiating highly active antiretroviral treatment at different stages of disease. Archives of Internal Medicine. 162(17):1973-80, Sep 23.
Pregnant Women
– About Care
and Treatment
Study Participants: Thirteen maternal-cord blood sample pairs.
Study Method: High-performance liquid chromatography was used to determine drug levels in blood samples simultaneously collected from a peripheral maternal vein and the umbilical cord at delivery.
Study Findings: Protease inhibitors do not cross the placenta to an appreciable extent and consequently cannot be expected to exert a direct antiviral activity in-utero during the whole dosing interval. In contrast, nevirapine readily crosses the placental barrier.
Lessons Learned: This information may support treatment decisions in pregnant women.
Source: Marzolini C, Rudin C, Decosterd LA, Telenti A, Schreyer A, Biollaz J and Buclin T. (2002). Transplacental passage of protease inhibitors at delivery. AIDS,16(6):889-93, Apr 12.
Pregnant Women–
About Hepatitis
C and HIV
Study Participants: Reports of mother-to-infant transmission of HCV have been based on small numbers of patients, with differing disease definitions, followed with different study designs and using different virological assays. These reports tended to be heterogeneous and conflicting. Factors that promote mother-to-infant transmission and the outcome of chronic HCV infection acquired by this route still require clarification. This report is a meta-analysis of existing data.
Study Method: This
article is a critical
Study Findings: Mother-to-infant transmission of Hepatitis C virus (HCV) is comparatively uncommon. The rate of mother-to-infant transmission is 4% to 7% per pregnancy in women with HCV viremia. Co-infection with HIV increases the rate of transmission 4 to 5 fold. The actual time and mode of transmission are not known.
Lessons Learned: Elective Cesarean section is not recommended for women who only have chronic HCV infection. The role of treatment to prevent transmission is limited by the fetal toxicity of currently available medications for Hepatitis C. Pregnant women at high risk for HCV infection should be screened for anti-HCV, and HCV RNA testing should be performed if anti-HCV is positive. Infants of women with Hepatitis C should be tested for HCV RNA on two occasions, between the ages of 2 and 6 months and again at 18 to 24 months, along with serum anti-HCV. The natural history of mother-to-infant Hepatitis C remains uncertain, especially the course in the first year of life when some infants appear to have spontaneous resolution.
Source: Roberts EA and Yeung L. (2002) Maternal-infant transmission of Hepatitis C virus infection. Hepatology, 36(5 Suppl 1):S106-13, Nov.
Reports of Note
Study Participants: N = 2,647 patients at the CORE Center, Chicago 1997-1998. Study Method: Retrospective analysis of clinical data sets to investigate the relationship between four support services:
and access to and retention in HIV primary care in an inner city public hospital clinic.
Study Findings: Patients who received each of these services were significantly more likely to receive any care, regular care and had more visits than patients with no services, and retention increased by 15-18%. There was a substantial need for all services and this need was significantly greater in women. Outcomes improved to the greatest extent among patients who needed and received each service.
Lessons Learned: Support services significantly increased access to and retention in HIV primary care.
Source: Sherer R, Stieglitz K, Narra J, Jasek J, Green L, Moore B, Shott S and Cohen M. (2002). HIV multidisciplinary teams work: support services improve access to and retention in HIV primary care. AIDS Care, 14 Suppl 1:S31-44, Aug |
