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Quick Facts: Perinatal April 2003 – March 2005 |
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Challenges
- An estimated 6,000 to 7,000 HIV-infected women give birth each year in
the United States, resulting in 280 to 370 new perinatal infections.
- Approximately 40% of mothers whose infants are perinatally infected
have no documentation of HIV status, despite recommendations that all
pregnant women be tested for HIV prenatally.
- About 40% of women of childbearing age are unaware that treatment is
available to prevent perinatal transmission.
- Although the acceptability and feasibility of rapid HIV screening in
labor and delivery have been demonstrated by the CDC-supported MIRIAD
research study (JAMA 2004; 292 219-223), only about 1/3 of U.S.
hospitals have rapid HIV testing available to women in labor, and less
than half of those have policies or protocols to routinely offer rapid
HIV testing to women with undocumented HIV status (CDC unpublished
data).
- Studies show that an opt-out testing approach (i.e., pregnant women
are told that an HIV test will be included in the standard group of
prenatal tests and that they may decline the test) results in higher
testing rates than an opt-in approach (i.e., pregnant women receive
pre-test HIV counseling and must provide HIV test consent.) However,
opt-out testing has not been implemented in many prenatal settings.
Accomplishments
- Developed a national model protocol to promote rapid HIV screening in
labor and delivery when the mother’s HIV status is unknown.
- Created partnerships with the American Academy of Pediatrics, the
American College of Gynecologists, the American College of
Nurse-Midwives, the Health Resources and Services Administration’s
Bureau of Maternal and Child Health, and the Centers for Medicare and
Medicaid Services.
- Collaborated with the American Hospital Association to study perinatal
HIV prevention policies and practices at all U.S. hospitals with at
least 300 births.
- Created materials on opt-out HIV testing, including a newsletter
article, a fact sheet, and questions and answers to distribute to health
departments, professional organizations, and healthcare providers seeing
pregnant women and women with newborns.
- Completed formative research in 5 cities to learn about obstetrical
HIV screening practices by obstetricians/gynecologists and certified
nurse midwives. This was in preparation for a social marketing campaign
for healthcare professionals to promote optout prenatal testing and
rapid testing at labor and delivery.
- Provided technical assistance to 16 perinatal HIV prevention grantee
sites.
- Funded 5 national organizations to help programs and providers achieve
high rates of prenatal HIV testing and to promote rapid HIV testing as
the standard of care for women in labor with undocumented HIV status.
- Conducted Enhanced Perinatal Surveillance (EPS) of transmission rates
and missed opportunities for perinatal HIV prevention from 1999-2003 in
24 states with CDC-funded grantees with high prevalence of HIV/AIDS
among women of childbearing years. During 2004, EPS was conducted as an
evaluation in 10 states. During 2005, EPS data collection continues in 8
states.
- Collaborated with the American College of Obstetricians and
Gynecologists (ACOG) to study obstetricians’ perinatal HIV prevention
practices including opt-out testing during prenatal care and at labor
and delivery.
- Collaborated with the American College of Obstetricians and
Gynecologists on their updated, expanded recommendations for prenatal
and perinatal HIV testing.
- Collaborated with the Francois-Xavier Bagnoud Center and the Academy
for Educational Development to develop and implement 8 regional
strategic planning workshops for hospitals to implement protocols for
rapid testing for women in labor. Hospital teams receive training and
assistance with development of action plans, as well as follow-up
technical assistance.
- Developed an assessment of perinatal HIV testing rates among a
representative sample of delivering women for 14 states, including 12
perinatal HIV prevention grantees.
- Began an evaluation of the opt-out approach to rapid HIV testing for
women in labor within the Mother-Infant Rapid Intervention at Delivery (MIRIAD)
study.
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