phases (prenatal, intrapartum, and postnatal/newborn) and also provides follow-up data on outcome. STEP data for the state indicate that between 1993 and 1996, ZDV use during pregnancy increased from 7.6% to 47%; use during delivery increased from 2% to 35%; and use in neonates increased from less than 1% in 1993 to 64% in 1996. Overall, the proportion of women/neonates who received ZDV during pregnancy, delivery, or the neonatal period increased from 8% in 1993 to 67% in 1996.

Since a significant proportion of HIV-infected women still do not receive ZDV in pregnancy, two surveys were undertaken to determine the reasons. A provider survey of eligible physician members of the Academy of Medicine of New Jersey (52% response rate) indicates that 94% of respondents offer HIV testing to all or almost all of their patients, 90% discuss the benefits of testing, and 77% offer counseling. Overall, only 59% offer all three components. Respondents were more likely to offer counseling if they felt: it fit into the office routine; it resulted in better outcomes; it was easy; they were confident in counseling; the patients appreciated it; it was the standard of care; or it had been actively promoted by the medical community. Dr. Paul noted that findings from the provider survey lead to the conclusion that improved diffusion and implementation of HIV counseling and testing among obstetrician—gynecologists could be accomplished through peer education.

A survey of pregnant women also focused on factors associated with ZDV use. Among a convenience sample of largely young, African-American and Hispanic pregnant women, 57% said they would use ZDV, 41% were unsure, and only 2% indicated they would not use ZDV. Among the factors associated with intention to use ZDV to prevent HIV transmission are positive beliefs about ZDV; recommendation by a doctor or nurse; access to ZDV through the clinic or doctor; and sufficient information to make an informed decision. Evaluators found that conspiracy theories about ZDV were not associated with respondents' reported intention to take ZDV. Based on these findings, Dr. Paul and her colleagues concluded that pregnant women are willing to consider ZDV use if they are given adequate, accurate information.

Dr. Paul summarized as follows: (1) there has been a marked improvement in efforts to prevent perinatal HIV transmission in New Jersey; (2) physicians do offer counseling and testing; (3) pregnant women are willing to use ZDV; (4) surveillance and seroepidemiology studies have documented ZDV use; and (5) mandatory counseling and voluntary testing appear to be working in New Jersey.

Health Care Financing Administration

Theresa Rubin, a regional AIDS coordinator for the Health Care Financing Administration (HCFA) presented information on implementation and evaluation efforts undertaken by the agency.



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