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Promising Strategies in Perinatal HIV Prevention

Promising Strategies in Perinatal HIV Prevention. Chan McDermott Texas Department of State Health Services Title V and Health Resources Development Office. Some Texas HIV statistics. 10,159 females, age 13-49, were living w/ HIV/AIDS at the end of 2004

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Promising Strategies in Perinatal HIV Prevention

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  1. Promising Strategies in Perinatal HIV Prevention Chan McDermott Texas Department of State Health Services Title V and Health Resources Development Office

  2. Some Texas HIV statistics • 10,159 females, age 13-49, were living w/ HIV/AIDS at the end of 2004 • 372,369 residents gave birth in Texas in 2002 • Infants born in 2002: • 391 exposed infants • 17 confirmed HIV positive • 191 confirmed HIV-uninfected • 183 unconfirmed

  3. Texas pHIV transmission rate, 2002 17 infected ------------------------------------ = 4.3% (17 infected + 191 confirmed uninfected + 183 unconfirmed)

  4. Texas legislation – Health & Safety Code • Pregnant women tested at first prenatal and again at delivery for HIV, syphilis and Hepatitis B. • If a woman refuses, she is referred for anonymous testing • Printed materials given on HIV, syphilis and Hepatitis B

  5. Survey of Texas private Ob/Gyn providers (1997) • 99% of practices offered prenatal HIV testing to all their pregnant patients • More than 95% of practices reported that 10% or less of the women refused the test when offered it; 73% had no refusals in the past 6 months • N = 617

  6. Birth Certificate Data (2002) • HIV test done prenatally • Yes 341,945 (91.8%) • No 23,058 • Unknown 7,366 • HIV test done at delivery • Yes 316,956 (85%) • No 50,754 • Unknown 4,659 • HIV test done prenatally and at delivery • 295,322 (79%)

  7. HIV testing, 2002 • Total tested for HIV: 360,310 (96.8%) • Total known not tested at all: 4,389 (1.2%) • Total unknown: 4,355 (1.2%)

  8. Quick overview: travel team • Staff from the Bureaus of Women’s Health and HIV/STD (Titles V, X, XIX and XX)* • One from Public Health Region 4/5N (Tyler area)* • One practicing physician (ACOG/Title IV) *Some travel funds paid by Title X

  9. Quick overview: home team • +/-22 people (28 invited) • DSHS programs: Case Management, Social Work, WIC, Adolescent Health, Data, etc • Community based organizations: AHEC, Healthy Start, March of Dimes, Rural Health, TO-AETC • Other state agencies: MH/MR, TX Youth Commission, TX Dept. of Criminal Justice, TX Commission on Alcohol and Drug Abuse • Consumers, Advocates

  10. Three projects • Data Assessment & Reorganization • Social Marketing Campaign • Consultation Network

  11. 1.Data Assessment & Reorganization Goals: • Reorganize existing data • Identify gaps in data • Complete data needs assessment

  12. Data Assessment & Reorganization • Steps: • Inventory current data • Develop & complete a template for data source list • Identify gaps in data • Develop/identify plans to address gaps • Develop & complete a template for data summaries

  13. Develop distribution plan for provision of data to public health regions and stakeholders • Distribute data summaries to public health regions and stakeholders

  14. Survey of Childbearing Women • Database is compiled from a CDC funded Family of Survey (HFS) Study component (1988 through 1995) and state funding in 1997. The SCBW is an HIV prevalence survey of resident Texas women who delivered a live birth within a given sampling period. Data fields: • Health Department Use: Record Identification number, state identification number

  15. Demographics: county of hospital, zip code of residence, state of hospital, zip code of hospital, mother’s age group, mother’s county, infants birth date (MM/YY), mother’s race • Status: Mother’s HIV status known at child’s birth, Infant’s HIV exposure known at birth • Facility of Dx: County of hospital, state of hospital, zip code of hospital • Mode of Exposure: N/A  • Patient/Maternal Hx: Infant’s biological mother’s infection status known

  16. Birth Hx (Perinatal Only): N/A  • Maternal Demographics: Race, mother’s age group, zip code of residence • Tx/Referrals: N/A • Lab Data: Elisa, Western Blot • Clinical Status: N/A

  17. Strengthsand Weaknesses of SCBW data: • Strengths: Largest and least biased of all HIV surveys conducted in Texas because it includes women of all races, ethnicities, and socioeconomic strata. Includes women of all races, ethnicities, and socioeconomic strata. • Weaknesses:HIV prevalence among all females not representative: only women of childbearing age, who delivered a live birth during the survey interval tested. Smaller sample sizes in later years reduced the number of HIV-positives identified resulting in some areas and groups indicating no positives.

  18. Progress • Data Inventory: Complete • Data Source List: Complete • Regional Data Summaries: Complete • Data Distribution: Complete (via internet)

  19. Data Assessment Evaluation • Development of: • Perinatal HIV Data Source Inventory • Perinatal HIV Transmission Data Summaries • Plan to address gaps in data

  20. 2. Social Marketing Campaign (General focus on prenatal care) • Goals: • Funding identified • Survey existing campaigns • Campaign designed (incl. evaluation component) 4. Campaign implemented 5. Complete campaign evaluation

  21. Social marketing campaign • Steps • Secure funding • Identify pilots sites • Conduct pre-campaign market research • Procure or design campaign • Negotiate media • Pilot campaign • Evaluate campaign

  22. Progress • Pilot sites identified: complete (Lufkin/Nacogdoches, Houston) • Pre-campaign research: complete • Design campaign: complete • Remaining steps stalled due changing economy, agency changes. • Work is resuming.

  23. Social Marketing Campaign Evaluation • Various methodologies, possibly including: • tracking calls to referral hotlines from pilot markets during pilot period • pre- and post-survey • interviews with members of target population about impact of campaign

  24. 3. Consultation Network, to include a list of qualified providers (Focus: Leading to phone consultation and telemedicine) • Goals: • Identify list of providers • Identify gaps in providers • Work with TOAETC to develop internet list of providers

  25. Consultation network • Evolved into: Provider identification and training, including development of a list of barriers to care and strategies to overcome barriers.

  26. Steps • Negotiate partnership with TOAETC • Develop lists of providers in targeted area of highest morbidity for HIV disease in HIV+ pregnant women and women of child-bearing age at risk for HIV disease • Survey providers • Conduct key informant interviews with providers

  27. Conduct focus groups with consumers and providers • Analyze data • Develop list of identified barriers and strategies to overcome barriers • Develop training for providers • Evaluate activities • Issue report on findings and recommendations

  28. Progress • Partnership with TOAETC: Complete • Develop lists of providers: Complete • Survey providers/conduct key informant interviews: Complete • Conduct focus groups: Complete • Analyze data: Complete • Identify barriers and strategies: Complete • Develop training: Toolkit developed for general provider training • Evaluate activities: Complete • Issue report: Complete

  29. Consultation Network Evaluation • Various methodologies, possibly including: • development of the barriers list • issuance of the report • review by Bureau of HIV/STD Prevention of contract with TOAETC to assure that all performance measures were met

  30. What’s happening today • In 1999, the CDC earmarked funds for pHIV prevention activities through the HIV Prevention Cooperative Agreement (Texas = $400,375). • In 2002, funds redistributed to regions in east Texas that were identified as high HIV morbidity areas for women of childbearing age.

  31. Three current HIV prevention and services CBOs were allocated funds in 2002 • Services provided: • specialized case management • targeted intervention including prevention case management • HIV & pgy. testing and counseling • education on pHIV transmission/prevention and reproductive choices • incentives for keeping prenatal & HIV medical appointments

  32. Other features • Programs have developed social marketing campaigns that emphasize the importance of HIV testing when pregnant, prenatal care, and treatment for women who are living with HIV. The programs use billboards, radio, and television spots. • Programs perform provider education themselves or contract with other clinicians. Providers are educated on pHIV transmission, the HIV testing law, and treatment guidelines for HIV+ pregnant women.

  33. Information sharing: results of social marketing and TOAETC surveys, key informant interviews and focus groups have been shared with the providers to assist them in developing training and addressing barriers to care.

  34. Triangle AIDS Network (TAN) will offer a luncheon presentation on Tuesday, March 29 from 11:30am-1:30 pm on the topic of prenatal care and HIV prevention for physicians, pharmacists, nurse practitioners and other health care professionals in Jefferson, Hardin and Orange counties.

  35. Perinatal Hotline - 888/448-8765The Perinatal Consultation and Referral Service • Provides free 24-hour clinical consultation and advice on treating HIV-infected pregnant women and their infants as well as indications and interpretations of rapid and standard HIV testing in pregnancy.

  36. Challenges • What if they had a meeting and no one came? • Logistics of consumer participation • Time • Economic constraints • Administrative issues

  37. Successes • Project One: Completed • Project Two: Initiated, stalled, resumed. • Project Three: Completed • Team Spirit Award!

  38. Internal successes • Awareness raised inter- and intra- agency • Awareness raised among providers and consumers • On-going connections • HIV/STD staff representation on PRAMS Steering Committee, Perinatal Health Workgroup, Women’s Health Network

  39. Words of wisdom • Make every meeting meaningful • Try to line up funding sources as early as possible • Leverage resources wherever possible • Maintain communication!

  40. What now? • RECONNECT! • Complete social marketing campaign • Impact of other STIs on Perinatal Health • Look at issue of rapid testing in labor in Texas

  41. Contact info: • Chan McDermott, MPA Perinatal Coordinator Title V and Health Resources Development Office MC: 1920 Texas Department of State Health Services 1100 W. 49th St., M355 Austin, TX 78756 512-458-7111, x. 6663 chan.mcdermott@dshs.state.tx.us

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