Prenatal care and HIV infection

Rapid HIV testing and obstetrical characteristics of women with unknown HIV serostatus at time of labor and delivery

OBJECTIVE

To describe the obstetrical characteristics of women without prenatal care and/or undocumented human immunodeficiency virus (HIV) serostatus who presented for delivery and to assess the usefulness of rapid HIV screening in these women.

MATERIALS AND METHODS

The study design was a retrospective analysis. Demographics, labor, delivery characteristics, and pregnancy outcomes of women without prenatal care and/or unknown HIV serostatus were reviewed.

RESULTS

Three hundred fifty parturients met the inclusion criteria: 15.2% presented at complete cervical dilation, 48.6% with cervical dilation of at least 5 cm, and 43.1% with ruptured membranes. Twenty-two percent of parturients delivered within 1 hour of admission, 47.6% delivered within 4 hours of admission, and 5.5% delivered prior to arrival to the hospital. With the lengthy admission process and procurement of zidovudine from the pharmacy requiring at least 1 hour at best, 27.5% would not have the benefit of intrapartum zidovudine treatment. Single Use Diagnostic System HIV-1 rapid test was reactive and confirmed in 7 women (2.5%).

CONCLUSION

Rapid HIV screening is a useful tool for guiding immediate obstetrical management and coordinated care for the neonate. In some circumstances, the full benefit of rapid HIV detection will not be realized due to advanced labor, ruptured members, or delivery prior to arrival.

Impact of HIV/AIDS on mothers in southern India: a qualitative study

The purpose of this study is to explore the perceptions and needs of mothers living with HIV to gain greater insights into the challenges they face in relation to their health seeking behavior, fears around disclosure, and issues related to stigma and discrimination. This qualitative study utilized focus groups consisting of a sample of 60 HIV-infected mothers recruited from a large maternity hospital and STD clinic in Chennai, India. Discrimination by physicians and other health care workers has been a major impediment expressed by mothers living with HIV in accessing quality health care. Mothers living with HIV are increasingly concerned about how and when to disclose their HIV status to their children and the repercussions which could result from disclosure. The findings of this study call for urgent intervention strategies taking into consideration these various concerns and needs of mothers living with HIV and their children.

Ethnicity and prenatal health promotion content

Prenatal care health promotion education is an important strategy for reducing perinatal health disparities. The purposes of this study were to (a) identify differences between the health promotion content women wanted to discuss and the content women reported discussing and (b) determine whether ethnicity was related to health promotion content. A cross-sectional study used face-to-face interviews to obtain data about 159 Mexican American and African American pregnant women's prenatal experience. Women wanted more health promotion content than they discussed. Despite wanting information about more health promotion topics than African American women. Mexican American women discussed fewer topics. Ethnicity, number of topics women wanted to discuss, whether a woman had a primary provider, and type of prenatal provider model were also related to content.

Zidovudine use during pregnancy among HIV-infected women on Medicaid

OBJECTIVES

This study estimates the rate of zidovudine (ZDV) use during pregnancy among HIV-infected women receiving Medicaid. The rates of ZDV use during pregnancy are compared before (preperiod) and after (postperiod) the 1994 publication of US Public Service Task Force guidelines, recommending use of ZDV during pregnancy. The authors also compare and contrast the correlates of ZDV use during pregnancy in each of the preguideline and postguideline periods.

METHODS

New Jersey AIDS/HIV surveillance data and paid Medicaid claims data between 1992 and 1996 were merged to examine ZDV use during pregnancy. Among ZDV users, the authors also examined persistence of ZDV use during the 3 months preceding delivery. In these analyses, the authors examined care received during pregnancy and differentiated routine medical care from pregnancy-specific care. Correlates of intrapregnancy ZDV use were examined using chi2 analysis and robust regression techniques that correct for correlation among repeated observations.

RESULTS

Use of ZDV during pregnancy steadily increased from 13% in 1992 to 70% in 1996, with the upward trend beginning before the release of the guidelines. Averaged over the full preperiod (1992-1994), the rate was 29%, increasing to 57% during the full postperiod (1995-1996). Women with no health care during pregnancy did not receive any ZDV prophylaxis. Women who had some health care contacts, but did not receive pregnancy-specific care, had low rates of ZDV use that did not increase after the promulgation of the guidelines (21% in preperiod and 27% in postperiod). Women who received pregnancy-specific care, whether from obstetrician-gynecologists (OB-GYNs) or other providers, substantially increased their use of ZDV in the postguideline period (from 37% to 63% for those who saw OB-GYNS, and from 20% to 59% for those who received pregnancy-specific care from other providers). However, among users of ZDV, only a minority (24%) used ZDV persistently during the 3 months preceding delivery. African American women were less likely to be persistent ZDV users, even after controlling for other factors.

CONCLUSIONS

The study highlights the underutilization of ZDV by women who did not receive pregnancy-related care, even after the publication of guidelines. Lack of pregnancy-specific medical care during pregnancy is an important barrier to ZDV prophylaxis. This study confirms that the receipt of prenatal care during pregnancy is a key intervening variable in the real world application of the PHS guidelines and underscores the importance of proactive efforts to provide prenatal care to pregnant women with HIV.

HIV-infected women's experiences and beliefs related to AZT therapy during pregnancy

To explore women's experiences and beliefs concerning zidovudine (AZT) therapy during pregnancy, short-answer and open-ended questions were asked of 322 human immunodeficiency virus (HIV)-infected women at increased risk for pregnancy. Specifically, we examined what women believed they had been told concerning AZT therapy during pregnancy by health care professionals and peers, experiences with taking AZT, how effective they believed AZT therapy to be, and if they would take AZT if they became pregnant. Women in the study were predominately African American (88%), single (79%), with a mean age of 32 years, and had annual incomes less than $10,000 (64%). Although 81.4% of the women had been told to take antiretrovirals, only 69.1% of the women were actually taking HIV-related medicines. Almost three-fourths of the women (70.8%) reported being told that taking AZT during pregnancy would reduce perinatal transmission. Women reported the most frequent reason for their stopping AZT was its side effects. When women who were not presently taking AZT were asked what would make them consider taking it, they most frequently said they would begin AZT if their health deteriorated or based on the advice of health care professionals. A small group of women said nothing would make them take AZT-type medications. More than one-half of the women said they felt AZT was effective in preventing perinatal HIV transmission. However, almost 20% of the women reported believing that their health care provider would not be positive about their taking AZT during pregnancy. Significant relationships were found between intent to take AZT if becoming pregnant and specific AZT-related beliefs and experiences.