Transcript TexasHIVPerinatal - Texas Department of State Health Services

Texas HIV Perinatal Program
Jenny R. McFarlane
Texas Dept State Health Services
HIV/STD Prevention Services Group
Field Operations Team Leader
[email protected]
Outline
 Background
 Texas
Laws/CDC Guidance
 Texas’ program
 Future activities
 What programs can do
Background
Perinatal HIV Transmission
Accounts for nearly all pediatric AIDS cases. HIV
transmission from mother to child during pregnancy, labor
and delivery or by breast feeding accounted for
approximately 91% of all AIDS cases reported among U.S.
children between 1985 and 2004 (1).
Can be prevented. Data indicate that when appropriate
antiretroviral medications are given during pregnancy, labor
and delivery and after birth, the risk of transmission can be
reduced to less than 2% (2) compared with approximately
25% when no interventions are given (3).
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1.
2.
3.
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2004. Atlanta: US Department of Health and Human Services
2004.
Cooper ER, Charurat M, Mofenson LM, Hanson IC, Pitt J, Diaz C, et al. Combination antiretroviral strategies for the treatment of pregnant
HIV-1-infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr. 2002;29(5):484-94.
Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O'Sullivan MJ, et al. Reduction of maternal-infant transmission of human
immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med. 1994;331(18):1173-80
HIV, Syphilis, and Hepatitis B Serologic Testing in
Pregnant Women
and Safety Code, §81.090
 Texas Administrative Code, RULE §97.135
 OPT-OUT: verbally notify the woman that an HIV
test will be performed if the patient does not object
and note on the medical records that verbal
notification was given and printed materials were
distributed (required).
 Test is confidential, not anonymous. If woman
objects, must be referred to anonymous test site.
 Health
2006 CDC HIV Testing Recommendations for
Pregnant Women
 Opt-Out Approach
 Test
at first prenatal care visit
 2nd Test during third trimester <36 weeks
 Opt-Out rapid test at L&D if no history of test
 Immediate initiation of ART prophylaxis
recommended to women on basis of reactive rapid
test result without waiting for confirmatory
Formative Audience Research

Sherry Mathews Advocacy Marketing -Formative Audience
Research: 4/01/02 – 8/31/02
Location: Lufkin, Nacogdoches, Houston
Audience: HIV positive women of CBA, women of CBA at risk of
HIV infection, key informants working in health care and related fields
Process and Outcomes: Thirty face to face interviews with HIV
positive or at risk women of CBA, two focus groups with 13 residents
of a facility for homeless HIV positive women and their children, 13
health care staff key informant interviews, recommended strategies
based on findings and a literature review.
 Formative
audience research 4/1/02-8/31/02
indicates:
 Women
underestimate their risk of HIV infection
 Most women do not know that perinatal transmission
can be prevented through medication during pregnancy.
 Focus group respondent, “The president needs to
announce that!”
In the beginning….
In 1999, through the HIV Prevention Cooperative
Agreement the CDC earmarked $400,375 for HIV
perinatal prevention activities.
 Funds may only be used for activities to prevent
the perinatal transmission of HIV.
 Funds may not be used for medical care, including
medications.
 DSHS initially allocated all of the funds to City of
Houston Health and Human Services due to the
large number of exposed infants in the Houston
area.
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In 2002, funds were redistributed to regions in East
Texas that were identified as high HIV morbidity areas
for women of childbearing age. 9% of HIV positive women
giving birth in Texas come from PHRs 4/5N but only 5% of total Texas 2000
births (363,325) are from PHRs 4/5N
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Fewer resources available in the area.
Three current HIV prevention and services CBOs were
allocated funds in 2002.
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Special Health Resources, Longview
Triangle AIDS Network, Beaumont
Health Horizons, Nacogdoches
The funds were added to CBOs’ existing federal HIV
prevention grants.
All of the programs perform specialized case
management to women who are HIV positive and
pregnant.
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Specialized case management:
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Provide assistance with HIV medications adherence,
attending HIV medical appointments, prenatal care
appointments and postpartum care for the woman and
the infant.
Other targeted interventions:

Include prevention case management to women of
childbearing age at risk of HIV infection and HIV
infected women of childbearing age, SISTA, HIV
counseling and testing, pregnancy testing and education
on HIV perinatal transmission and prevention, and
reproductive choices education.
 Programs
developed social marketing
campaigns that emphasize:

the importance of HIV testing when pregnant,
prenatal care, and treatment for women who are
living with HIV. Billboards, radio, and
television spots.
 Programs
either perform provider education
themselves, collaborate with AETC or
contract with other clinicians.
 Education
includes HIV perinatal transmission,
the law for testing pregnant women, and
treatment guidelines for HIV positive pregnant
women.
Process Measures 2001-2005
 189
HIV positive pregnant women receive
specialized case management
 55 provider trainings - 1880 attendants
 194 tv/radio public information spots
 Multiple billboards for rotating cycles
 Outreach to 6,132 high risk child bearing age
women
Next Steps
 Implement
HIV rapid testing in labor and
delivery sites.
 Improve EPS data
 Distribute Four Sisters Four Stories and
Cuatro Mujeres Cuatro Historias Booklets
 Statewide social marketing campaign
 Collaborate with RW, Maternal Health and
HBV nurse Case Managers
What to do?

Assess your population
Identify your HIV + women of cba
 Educate clients on HIV perinatal issues
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Transmission
 Medication
 Reproductive choices
 Partner Services
 Peer advocacy
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Staff need to know:
Reporting requirements
 Testing law for pregnant women
 New CDC HIV testing recommendations for pregnant women
 Links for prenatal care
 Referral Networks – HIV/STD Prev, RW (Parts A, B, C, D)

What to do?
 Case
Mangers role:
 Discuss
pregnancy status with clients/partners
 Follow up on referrals (ob, pedi, HIV)– obtain consent
 Medications adherence
 Know delivery status
 Hospital pedi meds
 Follow infant status
 Follow mom’s post delivery care
 Report case, work with surveillance on EPS
What to do?

HIV/STD Prevention Staff
Assess pregnancy status of client and partners
 Educate on HIV perinatal issues
 Build referral resources
 Follow up on referrals
 Partner services
 Integrate perinatal issues into activities – SISTA, screenings
 Collaborate with HIV/DIS on no shows
 Report case, work with surveillance on EPS
 HIV c/t objective 90% HIV+ pregnant women successfully
linked into prenatal care
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Links
 Perinatal
Hotline (888)448-8765
 www.cdc.gov/hiv/topics/perinatal/index.htm
 www.hret.org/hret/programs/hivtransm.html
 www.cdc.gov/hiv/topics/testing/healthcare/

http://aidsinfo.nih.gov/ContentFiles/Perinatal_FS_en.pdf

http://aidsinfo.nih.gov/Guidelines/GuidelineDetail.aspx?MenuItem=Guidelines&
Search=Off&GuidelineID=9&ClassID=2
Contact
Jenny R. McFarlane
512-533-3094
[email protected]
1100 W. 49th Street
Austin, Texas 78756