sites and primary care, ensuring access to care, offering ZDV prophylaxis, and maintaining women and infants in care.

Acceptance of Counseling and Voluntary Testing

Findings from a range of HRSA-funded project sites indicate there is a high testing acceptance rate among women in prenatal care. A small survey of obstetricians and gynecologists in New Orleans found that more than three-fourths of providers reported at least 90% acceptance of HIV testing. Of all women who received pre-test counseling through SPNS adolescent care projects, 91% accepted testing, and 94% of pregnant women accepted testing. At one Cook County site, a 1996 survey indicated that 70% of prenatal and postpartum women were offered HIV testing. Of those offered pre-test counseling, 82% accepted testing, compared to 61% acceptance among those without prior counseling.

Access to HIV Care

Successful models of care funded by HRSA include: one-stop shopping models in St. Louis, Missouri and Miami, Florida; co-location of a birthing center and a comprehensive care center in New York City; and a publicly funded case management program in northern Virginia that allows women to receive care in a private provider setting.

Offering ZDV

All HRSA-supported programs are expected to routinely offer ZDV prophylaxis to pregnant women living with HIV. In one rural Wisconsin project, 100% of women receiving prenatal case management accepted and received ZDV.

Maintaining Women and Infants in Care

Post-delivery care maintenance is essential both for the mother and for the infant. Some successful strategies include home visits by nurses or case managers, family appointments that allow mother and infant to get care at the same time or place, transportation assistance (bus tokens, cab vouchers, rail passes), and the use of peer advocates to help negotiate the care system.

Reaching Providers

Even if universal access to care is achieved, much would still depend on the provider. HRSA has therefore focused considerable resources on provider preparedness, including provider training and technical assistance, and dissemination

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