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ACOG

HIV is spread from mother to child by:. PregnancyDeliveryBreastfeeding. ACOG's professional/patient education on perinatal HIV. 076 Committee OpinionHIV Technical Bulletin1994 AAP/ACOG Policy Statement1999 Revised AAP/ACOG Policy StatementGuidelines provider reference books1999 Cesarean Deliv

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ACOG

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    1. ACOG American College of Obstetricians and Gynecologists Medical specialty society Women’s health mission >44,000 members >95% board-certified ob-gyns in US 85% of deliveries in US

    2. HIV is spread from mother to child by: Pregnancy Delivery Breastfeeding

    3. ACOG’s professional/patient education on perinatal HIV 076 Committee Opinion HIV Technical Bulletin 1994 AAP/ACOG Policy Statement 1999 Revised AAP/ACOG Policy Statement Guidelines provider reference books 1999 Cesarean Delivery Committee Opinion 1999-2000 CDC grant Survey of State HIV consent laws

    4. RESULTS Role for obstetric providers Significant decline in pediatric AIDS cases

    5. Dramatic reduction in perinatal HIV transmission Prenatal HIV treatment + Low viral load + Cesarean delivery = 0-2% transmission rate

    6. CDC estimates (2000) 280-370 HIV-infected infants born 62% diagnosed before birth 9% diagnosed at birth 29% diagnosed after birth

    7. ISSUES 1/3 HIV-infected infants: mother’s status unknown to ob provider 1/3 HIV-infected mothers not treated in labor and delivery

    8. ISSUES Late/no prenatal care prenatal HIV testing? Prenatal HIV treatment? Rapid testing?

    9. ACOG NATIONAL SURVEYS (2000,2001) >90% ob-gyns test pregnant patients Same in high/low prevalence areas “More aggressive” in high prevalence “More awareness” of HIV materials/state laws “More barriers” in low prevalence Workplace policies increase testing

    10. BARRIERS TO TESTING Language Late prenatal care Low risk Consent/Counseling/Time Offend patient

    11. ACOG’S CDC GRANT (1999-2000) Routinize prenatal testing Broad dissemination MD/Pt materials Innovative tools Postgraduate education Annual meeting Media

    12. Continued, Grassroots leadership ACOG/CDC websites State-specific Providers Partnership (CT, NC) Collaboration (AAP, AMCHP etc)

    13. ACOG MATERIALS PACKET (CDC) Routine prenatal/HIV test tear pad (Spanish) Laminated MD reference card AAP/ACOG Testing Policy Cesarean Delivery Committee Opinion Pt ed pamphlet (Spanish) Video “Important HIV News” mailing/flyer

    14. MAILED TO: All ob-gyns in US (33,000) Other ob professions (FP, CNM, NP, NN) State AIDS/health/MCH directors APHA state affiliates

    15. STATES INITIATIVES/FOLLOWUP Several state-wide mailings of “purple folder” (FL, MI) to all ob-gyns, FPs, CNMs by CNMs, public health Used AAP/ACOG policy statement to change state prenatal HIV testing regulations (PA DOH)

    16. EVALUATION Random sample 1,000 ob-gyns Testing practices Risk perception Testing barriers Pre/post materials Increased awareness of ACOG’s testing policy Decrease reimbursement barrier

    17. MATERIALS EVALUATION Greatest awareness of professional association (ACOG) materials over CDC/state materials High recognition “purple folder”

    18. RECOMMENDATIONS 1. Routinize HIV/prenatal testing 2. Reduce barriers (language, care) 3. Professional association materials (ACOG)

    19. FUTURE DIRECTIONS ACOG, CDC + STATES 1. Model consent/Pt ed 2. Model prenatal form 3. Model PP form 4. > Languages 5. Public/private partnerships 1. NYS, ACOG tear pad 2. ACOG’s antepartum 3. ACOG’s PP record 4. ACOG’s tear pad 5. ACOG’s Provider Partnership grant

    20. DISCUSSION Effective local/state/national efforts? Major gaps/needs materials? Outreach? (esp women not in care) Public/private linkages? Changes in state HIV test consent laws?

    21. ACOG’S PERINATAL HIV ACTIVITIES American College of Obstetricians and Gynecologists Washington, DC

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