This panel included presentations from Massachusetts, North Carolina, and New Jersey and from the federal Health Care Financing Administration (HCFA).
Deborah Allen, from the state's Title V program, reported on the Massachusetts experience.
The State of Massachusetts has used a variety of interventions to educate providers and promote counseling, testing, and the use of ZDV for HIV-infected pregnant women: (1) soon after ACTG 076 results were published, the state sent a clinical advisory to obstetric, pediatric, and women's health providers; (2) a pocket guide on counseling and testing has been disseminated; (3) provider training has been undertaken statewide; and (4) a media campaign has also been launched. Provider materials are currently being revised to include additional therapies and to promote a model of specialized HIV care for pregnant women (previously, a primary care model was promoted). The Department of Public Health currently provides HIV counseling and testing to 20,000 to 25,000 pregnant women per year.
Data for 1992 to 1995 indicate two related but separate trends in Massachusetts: (1) the number of HIV exposed infants dropped approximately 44%; and (2) the decline in the number of HIV-infected infants was even greater—approximately 75%. These trends reflect more women knowing that they are HIV-positive, accompanied by a move among HIV-infected women to forgo or delay pregnancy; and the use of ZDV in pregnancy. Despite these gains, challenges remain in the state: (1) in 1995, 15 HIV-infected babies were born in Massachusetts; (2) it is estimated that eight of their mothers did not know their status; and (3) there may be an emerging trend of women opting to become pregnant or to continue pregnancies now that therapies are available.
Ms. Allen reported the following findings from a 1996 survey of obstetric and midwife practices in Massachusetts. (1) On average, these providers reported