Texas HIV Perinatal Program

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Texas HIV Perinatal Program

• Jenny R. McFarlane
• Texas Dept State Health Services
• HIV/STD Prevention Services Group
• Field Operations Team Leader
• jenny.mcfarlane_at_dshs.state.tx.us

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Outline

• Background
• Texas Laws/CDC Guidance
• Texas program
• Future activities
• What programs can do

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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).
• 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.
  200229(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. 1994331(18)1173-80

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HIV, Syphilis, and Hepatitis B Serologic Testing
in Pregnant Women

• Health 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.
  

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2006 CDC HIV Testing Recommendations for Pregnant
Women

• Opt-Out Approach
• Test at first prenatal care visit
• 2nd Test during third trimester lt36 weeks
• Opt-Out rapid test at LD if no history of test
• Immediate initiation of ART prophylaxis
  recommended to women on basis of reactive rapid
  test result without waiting for confirmatory

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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.

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• 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!

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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
• Fewer resources available in the area.
• Three current HIV prevention and services CBOs
  were allocated funds in 2002.
• 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
• 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.

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• 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.

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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

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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

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What to do?

• Assess your population
• Identify your HIV women of cba
• Educate clients on HIV perinatal issues
• Transmission
• Medication
• Reproductive choices
• Partner Services
• Peer advocacy
• 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)

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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 moms post delivery care
• Report case, work with surveillance on EPS

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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 [phone]
• 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?MenuItemGuidelinesSearchOffGuidelineID9
  ClassID2

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Contact

• Jenny R. McFarlane
• 512-533-3094
• jenny.mcfarlane_at_dshs.state.tx.us
• 1100 W. 49th Street
• Austin, Texas 78756