Prevention Grantees
National Organizations
Research
International Activities
Recommendations

Prevention Grantees

The Perinatal HIV Prevention grantees are 15 state and local health departments that have been awarded supplemental funding to conduct perinatal HIV prevention activities.

Funds have been provided through a supplement to Program Announcement 04012 (HIV Prevention Projects) since 1999. The goals of the Perinatal Prevention Program are:

• To ensure that health care providers promote routine, universal HIV screening to all their pregnant patients early in pregnancy;
• To promote routine, universal HIV screening directly to pregnant women, including women who are at high risk for acquiring HIV, women who do not receive prenatal care, and women who arrive at labor and delivery without documented HIV status. These strategies should incorporate rapid HIV testing when possible;
• To ensure that pregnant women infected with or at high risk for HIV infection receive appropriate prenatal care; and
• To collaborate with organizations and institutions involved in prenatal and postnatal care for HIV-infected women to ensure that these women and their infants have access to appropriate prevention interventions to reduce perinatal HIV transmission, and that HIV-infected women have access to comprehensive treatment services.

Specifically, most of the perinatal prevention programs accomplish these goals through a combination of five program types:

• Provider training
• Outreach
• Perinatal case management
• Social marketing
• Rapid HIV testing

Below is a table showing the programs conducted with CDC perinatal HIV prevention funding in the various perinatal prevention sites. For more information about these programs, how they are conducted, and resources for replication, please contact CDC.

View table in PDF

The perinatal prevention grantees, together with the perinatal surveillance grantees (Enhanced Perinatal Surveillance) and the national organizations, have periodic meetings to share programs, learn new skills, and increase collaborations.  Materials from past meetings can be accessed by clicking here.

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National Organizations

The national organizations are important resources and collaborators implementing perinatal HIV prevention programs. The following organizations were funded by CDC for perinatal HIV prevention beginning in September 2007. Each of these organizations can offer technical assistance and program materials to health departments and other organizations with an interest in perinatal HIV prevention. Planned programmatic activities for each organization are described below:

American College of Obstetricians and Gynecologists (ACOG)
ACOG promotes state laws/regulations that are consistent with national/federal guidelines for universal HIV testing as a routine component of prenatal care, including third trimester and labor & delivery testing as appropriate. ACOG published recent (November 2004) guidelines on HIV screening for pregnant women, and they have developed educational materials for both providers and patients. They distribute a legislative toolkit to assist legislators when crafting new or revised perinatal HIV legislation. ACOG is also working to develop state-specific materials on HIV testing requirements for pregnant women, as well as develop continuing medical education materials for providers. For more information or to receive these materials, visit ACOG’s perinatal HIV website at http://www.acog.org/goto/pHIV.

ACOG is also collaborating on the FHPP program (see CityMatCH, below).

CityMatCH
CityMatCH focuses on improving maternal and child health in urban communities. They are collaborating with ACOG to develop, implement, and evaluate a modified Fetal and Infant Mortality Review (FIMR) program to investigate and address barriers to further reduction of perinatal HIV transmission in communities. A pilot phase of the FIMR-HIV Pilot Project (FHPP) is underway in three communities, and in the future CityMatCH plans to work to disseminate the outcomes and lessons learned from this activity. For more information, contact  Chad Abresch.

François-Xavier Bagnoud Center (FXBC)
FXBC has expertise in provider training for perinatal HIV prevention in a wide variety of settings, but particularly for physicians and nurses. They are working to complete a series of strategic planning meetings designed to assist hospitals in developing rapid HIV testing programs in their labor and delivery units and emergency departments; a follow-up evaluation of participating hospitals will be conducted. Future plans include training and technical assistance to hospitals and healthcare providers to increase their knowledge and expertise in preventing perinatal HIV transmission in the US. They also plan to develop recommendations on strategies to improve inter-conceptual care through the integration of HIV management and reproductive health and family planning services for women with HIV infection. For more information, contact Carolyn Burr or Elaine Gross.

Health Research and Educational Trust (HRET)
HRET, the research and educational affiliate of the American Hospital Association, promotes the availability of HIV testing and preventive interventions to their membership, and particularly promotes recommending HIV testing to women who arrive at labor and delivery without a documented HIV test as the standard of care. They are distributing a toolkit for all U.S. birth hospitals to promote perinatal prevention, with emphasis on rapid HIV testing in labor and delivery units. HRET is also planning a series of workshops for clinicians in hospital labor and delivery units, nurseries, laboratories, and pharmacies to assist in the implementation of rapid HIV testing in labor and delivery. They will also provide direct technical assistance to hospitals. For more information, contact Francie Margolin.

National Black Alcoholism and Addictions Council (NBAC)
NBAC plans an intensive examination of the policies and practices of substance abuse treatment services involving access, treatment and referral for HIV positive women in Central Florida, as a sample of current practices. This data will be compared with existing policies and practices in diverse geographical areas to develop a model of national technical guidance to help providers achieve high HIV screening rates for women of reproductive age in substance abuse treatment services. This information will help guide effective perinatal HIV prevention efforts in other areas. We will collaborate with the National Perinatal Project Group in order to maximize the development of best practices and dissemination of the technical guidance. For more information, contact John Robertson.

National HIV/AIDS Clinicians Consultation Center (NCCC) Perinatal Hotline
The NCCC offers three hotlines exclusively for healthcare workers. The Perinatal HIV Hotline (888.448.8765) is a resource that provides free clinical consultation on treating HIV-infected pregnant women and their infants and advice on indications and interpretations of HIV testing in pregnancy. The hotline is available 24/7, and includes access to a Perinatal Referral Network of 250 healthcare professionals that can link patients with primary and specialty care and other essential services nationwide. For more information, contact Shannon Weber. The NCCC’s Warmline (800.933.3413) offers clinical advice on HIV testing, antiretroviral treatment, drug interactions, resistance testing, management of opportunistic infections, and primary care of persons with HIV/AIDS. The PEPline (888.448.4911) provides around-the-clock advice on managing occupational exposures to HIV and hepatitis B and C.

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Research

In addition to prevention programs, CDC sponsors many research projects related to perinatal HIV.

Mother-Infant Rapid Intervention at Delivery (MIRIAD)

The MIRIAD study was a large, multicenter project designed to evaluate the feasibility, acceptability, and accuracy of rapid HIV testing during labor or late in pregnancy.  18 hospitals in 6 cities in the United States participated.  Women without a documented HIV test result during their current pregnancy were asked if they would consent to a rapid HIV test.  HIV-infected women were offered antiretroviral prophylaxis to prevent perinatal transmission and were referred for comprehensive medical care follow-up.  Infected women and their infants were followed by study staff for up to 3 years.

For more information, the following paper discusses the initial reports from the first two years of MIRIAD.

Bulterys M, Jamieson DJ, O'Sullivan MJ, Cohen MH, Maupin R, Nesheim S, Webber MP, Van Dyke R, Wiener J, Branson BM. Rapid HIV-1 testing during labor:  A multicenter study. JAMA 2004;292(2):219-223.

Kesho Bora

Kesho Bora (Kiswahili for “A Better Future”) is a large study conducted over 6 sites in 4 countries in Africa.  Kesho Bora has both a research component and an intervention component, and the goal of the program is to optimize the use of antiretrovirals to reduce mother-to-child transmission of HIV and improve mother's health.

For more information, visit the Kesho Bora website at http://www.who.int/reproductive-health/stis/mtct.htm or the trial registration page at http://www.controlled-trials.com/isrctn/trial/
ISRCTN71468401/0/71468401.html.

Kisumu Breastfeeding Study (KiBS)

KiBS is a Phase II clinical trial being conducted in Kisumu, Kenya, to demonstrate that a regimen using highly active antiretroviral therapy to maximally suppress maternal viral load in the late antenatal period and during the first six months of lactation is safe, effective and can be implemented in resource poor settings in order to reduce the risk of HIV transmission to the infant. For more information, visit the KiBS trial registration page at http://www.clinicaltrials.gov/ct/show/NCT00146380. Preliminary results for the trial can be viewed at http://www.retroconference.org/2005/CD/
PDFs/809.pdf

Post-Exposure Prophylaxis for Infants (PEPI)

PEPI is a clinical trial to evaluate the effectiveness of three different regimens of antiretrovirals given to infants after birth.

For more information, visit the PEPI trial registration page at http://www.clinicaltrials.gov/ct/show/
NCT00115648.

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International Prevention Activities

In addition to US-based prevention programs, CDC also operates many international prevention programs through the Global AIDS Program (GAP).  For more information, visit their website at http://www.cdc.gov/nchstp/od/gap/pa_pmtct.htm.

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Recommendations

As a part of CDC’s prevention activities, periodic recommendations are issued concerning topics that relate to perinatal HIV transmission.  For more information, refer to the Resources section of this website.

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