Prevention of Perinatal Transmission

Perinatal HIV Prevention Program (PHPP)

Program Description

The Perinatal HIV Prevention Program (PHPP) is designed to reduce perinatal HIV transmission through education, technical assistance, monitoring, and regulatory action, when indicated. The goal of the program is to ensure that all pregnant women have access to HIV counseling and testing and that those who test positive have access to antiretroviral (ARV) medications for their own health and to prevent HIV transmission to their babies. A three-part regime of ARV, administered to the mother during pregnancy, labor, and delivery, and to the newborn immediately after birth, is optimal. However, studies conducted by the New York State Department of Health (NYSDOH) have suggested that partial regimens of ARV prophylaxis, initiated during the intrapartum and newborn periods, can significantly reduce the risk of perinatal transmission.

The major components of this program are set forth in NYSDOH regulations which require that all women in prenatal care in regulated facilities receive HIV counseling with testing presented as a clinical recommendation. The program also requires that all babies born in New York hospitals or birthing centers be routinely tested for HIV with the results reported to their mothers. In August 1999, as a result of medical and scientific advances in the prevention of perinatal HIV transmission, the PHPP was expanded to require expedited HIV testing of women presenting for delivery whose HIV status is unknown, or of their newborn infants. Informed consent is required for testing the mother. This program allows HIV counseling, testing and the initiation of ARV prophylaxis during labor and delivery, if possible, or to the newborn during the first hours of life, when ARV prophylaxis is most effective.

PHPP program staff carry out the following activities:

  • monitoring facility compliance with the regulation requiring HIV counseling of all women in prenatal care;
  • monitoring and reporting birth facility compliance with the regulation requiring expedited testing of women presenting for delivery who have no medical record documentation of HIV testing in the prenatal period or of their newborns;
  • investigating "missed opportunities," that is, those cases in which HIV exposure is first identified through Newborn Screening and an undetected/untreated exposure of a newborn to HIV has occurred;
  • providing education and technical assistance on all of the above, delivered on site, in writing or by telephone; and
  • issuing Statements of Deficiency when facilities show a persistent lack of compliance, or when the actions (or inactions) of a birth facility result in the undetected/untreated exposure of an infant to HIV.

Outcomes

By providing program oversight, and with the collective efforts of facilities across the state, the Department has noted significant improvement in perinatal HIV testing rates and a marked decrease in mother-to-child HIV transmission rates:

  • The prenatal HIV testing rate has greatly improved from 64 percent when expedited testing in the delivery setting was implemented in August 1999, to 95 percent in 2004; and
  • The perinatal HIV transmission rate has dropped sharply - from 10.9 percent in 1997 to 2.8 percent for the year 2004.*

Health Alert: Steps to Further Reduce Mother-to-Child HIV Transmission in New York State

Mother-to-Child HIV Transmission (MTCT) has been dramatically reduced in New York State. The purpose of this Alert is to highlight important strategies to continue reducing MTCT in New York.

Contact:

Perinatal HIV Prevention Program
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 486-6048
PHPP@health.state.ny.us

*Data for 2004 are preliminary

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Prenatal Care Providers Training Project (PreCARE)

Program Description

The Prenatal Care Providers Training Project (PreCARE) is designed to reduce perinatal HIV transmission by increasing the number of pregnant women in New York State who receive HIV counseling and testing during pregnancy. Since May 2000, PreCARE has targeted technical assistance to hospital obstetrics departments with low rates of prenatal testing among women presenting for delivery. In 2004, the statewide rate for prenatal testing was 95 percent; the rates at target hospitals ranged from 85 percent to 90 percent.

PreCARE consultations begin with a survey designed to identify barriers to HIV testing in the prenatal setting, including an analysis of the types of providers whose patients deliver at the hospital and systems for transferring records from prenatal care to delivery. The PreCARE training and technical assistance strategy is based on the results of the survey and is tailored to the specific needs of the site. Interventions generally include training of prenatal providers but may also focus on improving the transfer of medical records from the prenatal program to the delivery site or developing consumer education strategies for ethnic groups with low prenatal testing rates.

As appropriate, training may be conducted at community-based clinics, managed care organizations, or group practices that provide prenatal care and refer patients to deliver at target hospitals. Follow up occurs six months after all proposed interventions are completed. Sites that do not show an improvement in HIV testing receive a second wave of technical assistance, including a reassessment survey to identify new or unresolved barriers and additional training as needed. Since 2000, PreCARE has trained more than 2,600 health care professionals to provide HIV counseling and testing to women in prenatal care.

Funding

The PreCARE Program is supported by federal funding from the Center for Disease Control. The PreCARE contractor is the State University of New York (SUNY) Downstate Medical Center.

Contact:

Perinatal HIV Prevention Program
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 486-6048
PHPP@health.state.ny.us

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Community Action for Prenatal Care Initiative (CAPC)

Program Description

The New York Task Force for the Prevention of Perinatal HIV Transmission is a multi-level partnership between the New York State Department of Health, the New York City Department of Health and Mental Hygiene, and the New York State Office of Alcoholism and Substance Abuse Services. One of the major projects of the Task Force is the Community Action for Prenatal Care (CAPC) Initiative. The CAPC Initiative supports the development of community coalitions dedicated to the reduction of perinatal HIV transmission through the recruitment of high-risk pregnant women into prenatal care in targeted zip codes of the South Bronx, Central Brooklyn, Northern Manhattan, and Buffalo. The New York Task Force selected the following lead agencies, experienced in community organization, in each of the target areas: Bronx Lebanon Hospital Center, the Alliance for Family Education Care and Treatment, the Northern Manhattan Perinatal Partnership, Inc., and the Buffalo Prenatal-Perinatal Network. Lead agencies are responsible for coordinating the activities of their local community coalitions, including implementation of a comprehensive model to reach high risk pregnant women who are not in prenatal care. The basic elements of the comprehensive model are:

  • local planning;
  • recruitment/referrals including a social marketing campaign; a 24 hour a day/7 day a week, confidential, free hotline; direct outreach by specially trained outreach workers, and referrals from agencies serving high-risk women;
  • intake and transitional case management;
  • user-friendly prenatal systems including clinical consultations to providers; and
  • case management/advocacy.

In 2004, a Prenatal Care Linkage Specialist, employed by Prison Health Services, began outreaching and engaging pregnant women at Rikers Island and linking them to community services upon their release.

Funding

The Community Action for Prenatal Care Initiative is supported by $260,000 in Ryan White funding and $1,667,635 in federal funding from the Centers for Disease Control.

Contact:

Community Action for Prenatal Care Initiative
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-8427

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