Investigator(s)

Study Period

Geographic Area

Methods

Results

Comments

Paul SM, Cross H, Costa SJ. et al. IOM workshop presentation, April 1, 1998

1993–1996

New Jersey

SCBW, enhanced pediatric surveillance

Prenatal ZDV use among women known to be HIV-infected increased from 8% to 47% from 1993 to 1996. Known ZDV use in neonates increased from less than 1% in 1993 to 64% in 1996. According to a 1995 SCBW study, women under age 30 were more likely than older women to have used ZDV. Race/ethnicity and volume of HIV + births in hospitals were not correlated to ZDV use

 

Fiscus SA, Adimora AA, Schoenbach VJ, et al. 1996 Published report

1993–1994

North Carolina

SCBW, pediatric surveillance

The proportion of HIV-exposed children in North Carolina who were identified and tested increased from 60% to 82% from 1993 to 1994. After results of ACTG 076, ZDV was given to 75% of HIV+ women who delivered infants in North Carolina

 

without regard to women's experience and perceptions, inadequately tested in women and minorities, promoted for the wrong reasons, and inappropriate while they were feeling well (Siegel and Gorey, 1997). Nevertheless, studies of pregnant women residing in high-prevalence areas suggest that most women would take ZDV if they were to test positive for HIV (Pemberton, 1997; Silverman et al., 1997).

Health Care for HIV-Infected Women

As Chapter 4 shows, HIV-infected women and their babies now have greatly improved chances of survival because of ZDV and other antiretroviral therapy. With prenatal and intrapartum ZDV therapy, the rate of perinatal HIV transmission has been dramatically reduced and new, more complex therapies promise even greater reductions in mother-to-child transmission. High-risk HIV care centers specializing in maternity and postpartum services for HIV-infected women and their babies have been developed in high-incidence areas of the country. These centers continue to test and improve upon therapeutic approaches. Equally important, the centers give the kind of comprehensive care that is essential to reaching the best possible outcomes for HIV-infected mothers and their infants.

While specialty clinics provide a model for quality perinatal HIV care, these services are clearly not uniformly available to infected women and their infants. The committee repeatedly heard testimony about a range of care-related problems women encounter once they have tested positive for HIV. Site visits in Alabama, New York and New Jersey, Florida, and South Texas, as well as testimony by providers and patients from the San Francisco Bay area (see Appendix



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