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Perinatal HIV Prevention in Michigan CitiMatCH Conference September 13 th , 2004

Perinatal HIV Prevention in Michigan CitiMatCH Conference September 13 th , 2004. Hollie Malamud-Price, MPH Maternal Child HIV/AIDS Program Michigan Department of Community Health. So…What Are We Talking About Today?. Michigan Public Health Code Epidemiological Data

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Perinatal HIV Prevention in Michigan CitiMatCH Conference September 13 th , 2004

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  1. Perinatal HIV Prevention in MichiganCitiMatCH Conference September 13th, 2004 Hollie Malamud-Price, MPH Maternal Child HIV/AIDS Program Michigan Department of Community Health

  2. So…What Are We Talking About Today? • Michigan Public Health Code • Epidemiological Data • The Michigan Department of Community Health (MDCH) perinatal prevention activities

  3. So, What is the Problem? Health Care Professionals (HCP) are not consistently complying with Michigan Public Health Code (PHC) 333.5123.

  4. What is Michigan Public Health Code 333.5123? • Requires pregnant women to be tested for HIV at initial prenatal care visit, at the time of labor and delivery, and/or immediate post partum if the mother’s HIV status is unknown or undocumented. • The Michigan Department of Community Health (MDCH) also recommends retesting in the third trimester.

  5. Michigan Public Health Code 333.5123, cont… • Michigan by written law appears to be an “opt-out” state. • In practice functions as an “opt-in” state due to HIV counseling requirements and signature of consent or declination of testing required by law.

  6. Why Is Michigan PHC 333.5123 Not Working the Way It Should? • Possible HCP confusion about the law • Possible confusion by women if they test positive-children may be taken • Women do not know it is the law to be offered HIV testing • HCP perceived notion at who is at risk • Difficult for MDCH to monitor compliance • Difficult for MDCH to enforce

  7. Why Is It a Problem that HCP Are Not Complying With Michigan PHC 333.5123? • 82% of all HIV positive children in Michigan have been infected via Mother to Child Transmission (MTCT). • Women do not have the opportunity to make informed decisions about their health and that of their child’s health. • Undue burden on the medical system.

  8. Michigan’s Basic Epidemiological Data •In 2002, there were 129,518 live births to Michigan women. • White women delivered 78 percent of the live births, • African American women 17 percent, and • Hispanic women, American Indian, Asian and Pacific Islander and Arabic women comprise the remaining 5 percent of live births.

  9. Michigan’s Basic HIV/AIDS Epidemiological Data • As on July 1, 2004 there were an estimated prevalence of 16,200 living with HIV, including 3,660 (23%) women. • Estimated prevalence rate of 163 and 72 per 100,000 for women. • 1,142 (20%) women reported living with AIDS. • 1,461 (25%)women reported living with HIV.

  10. Michigan’s Basic HIV/AIDS Epidemiological Data, cont.. • As on July 1, 2004 the counties with the highest estimated prevalence rate • Ingham = 161.1 • Kent = 149.7 • Oakland = 146.5 • Washtenaw = 164.1 • Kalamazoo = 146.7 • Wayne = 143.3 City of Detroit = 735.9

  11. Confirmed Infection Status Among Infants Born to HIV-Infected Mothers 1995-2003* July 1, 2004 *2003 incomplete

  12. Confirmed Infection Status Among Infants Born to HIV-Infected Mothers 1995-2003 • 44 HIV-infected children • 556 HIV-infected women gave birth • 8% (44/556) perinatally infected children • 2003 incomplete

  13. Mother’s Mode of HIV Transmission Among Perinatally HIV-Infected Infants by Geographic Area 11 Percent 15 9 5 2 1 Geographic Area

  14. Mother’s Race among Perinatally HIV-Infected Infants by Geographic Area 21 Percent 8 5 5 2 1 1 Geographic Area

  15. Birth Hospital, Among 42 Perinatally HIV-Infected Children • 8 (19%) Main Detroit Hospital • 6 (14%) Other Detroit Hospitals • 23 other Michigan hospitals had 1-2 births each • 1 home birth • 1 out of state

  16. Hospital of HIV Diagnosis, Among 40 Perinatally HIV-Infected Children • 22 (55%) Children’s Hospital of Michigan • 1 (3%) Other DMC Hospital • 11 other Michigan hospitals made 1-3 diagnoses each • 1 out of state

  17. Expanded Perinatal Surveillance Data among 264 HIV-Infected Women Giving Birth 2000-2003 • When Mom Diagnosed as HIV-infected • Mom’s HIV status in prenatal care records • Mom’s HIV status in L&D records • Mom’s HIV status in infant’s birth record • Was child breastfed

  18. When Mother was Diagnosed as HIV-Infected 6% 5% 53% 35%

  19. Mom’s HIV Status in Prenatal Care Records 10% 13% 72% 5%

  20. Mom’s HIV Status in L&D Records 4% 8% 88%

  21. Mom’s HIV Status in Infant’s Birth Record 9% 3% 88%

  22. Was Child Breastfed? 2% 4% 94%

  23. Now, What is the Michigan Department of Community Health Doing?

  24. MDCH Activities • Perinatal HIV Prevention Working Group (PPWG) • Staff from: • Maternal Child HIV/AIDS Program, • Title X, • Women Infants and Children, • HIV/AIDS Prevention and Intervention Section, • HIV, STD and Bloodborne Infections Section, (Surveillance) • Office of Drug Control Policy

  25. PPWG Mission Eliminate perinatal HIV and other perinatal infectious disease transmission and keep HIV positive women and women with high-risk behavior healthy throughout their pregnancy.

  26. PPWG Goals •Collaborate with other health care initiatives to include information on and strategies toward further elimination of perinatal HIV and other perinatal infectious disease transmission and improve women’s health. •Address perinatal prevention failures with individualized intervention strategies. •Update and, if necessary, create perinatal HIV and other perinatal infectious diseases clinical and service related educational materials.

  27. PPWG Goals, cont. • Education to Women/Children service providers (CBOs, Head Start, etc) and General Public, including: •It is the law to be offered HIV C & T •Know and disclose HIV and other infectious disease status to providers •Treatment is available during pregnancy and for baby to reduce HIV transmission •Educate women to test children (siblings) if HIV status is unknown • Educate HIV negative women how to maintain negative status

  28. Addressing Prevention Failures:Missed Opportunity vs. Prevention Failures-Define What You Mean • Missed Opportunity-The child is not perinatally infected, although the health care provider did not comply with Public Health Code 333.5123 • Prevention Failure-A child becomes infected due to lack of a health care provider’s compliance with Public Health Code 333.5123.

  29. Addressing Prevention Failures, cont… •Missed Opportunity Working Group (MOWG) •Reviews surveillance data (regardless of child’s serostatus) on any reported HIV positive woman that did not receive HIV counseling and testing according to Public Health Code 333.5123. •Letter sent to health care facility asking for a corrective action plan. (CAP) •MDCH site visit

  30. Addressing Prevention Failures, cont… •Documents Developed • Mission Statement and Goals • Corrective Action Plan Protocol • Corrective Action Plan Flow Chart • Site Visit Protocol

  31. Addressing Prevention Failures, cont… •Coalition Building Within and Outside of MDCH • Within-WIC, Maternal and Infant Support Services, Title X, HIV/AIDS Prevention, Healthy Start, CitiMatCH • Outside-MATEC, MSACOG, FQHC, LHD’s, and CitiMatCH

  32. Addressing Prevention Failures, cont… •Current andFuture Activities •Distribution of Improving the Odds • It’s the Law and One Test May Save Your Baby’s Life • Conference Presentations on PMTCT • Participation in AMCHP

  33. Lessons Learned…Know Your P’s and Q’s • Have all players, policies, and protocols in place • Have support from all agencies, departments, and personnel • Define roles and expectations • Set time lines and realistic goals as the “enforcer” of perinatal HIV prevention efforts • Set time lines and realistic goals for the facility where the m.o. or p.f. occurred • Work in partnership, not in a punitive manner

  34. Contact Information: Hollie Malamud-Price 3056 W. Grand Blvd. Suite 3-350 Detroit, MI 48202-3056 (p) 313.456.4365 (f) 313.456.4364 E-mail: MalamudH@michigan.gov

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