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.
|
Provider training |
Outreach |
Case management |
Social marketing |
Rapid HIV testing |
Training for medical providers or CBO outreach staff |
Outreach to high-risk pregnant women |
Case management for HIV+ pregnant women and/or high risk HIV- women and their infants |
Messages to encourage HIV testing among women of childbearing age |
Working with hospitals to implement rapid HIV testing in labor and delivery units |
California |
|
|
|
|
X |
Connecticut |
|
|
|
|
X |
Delaware |
|
X |
X |
|
|
Florida |
X |
|
X |
|
|
Georgia |
X |
|
|
X |
X |
Illinois |
X |
X |
X |
|
X |
Louisiana |
X |
|
X |
|
X |
Maryland |
|
X |
|
|
X |
New Jersey |
X |
|
|
|
X |
New York |
X |
X |
X |
X |
|
Philadelphia |
X |
X |
X |
|
X |
Puerto Rico |
X |
X |
X |
X |
X |
South Carolina |
|
|
X |
|
|
Texas |
|
X |
X |
X |
X |
Washington, DC |
X |
X |
|
|
X |
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. Go to Top
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