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13th International AIDS ConferenceDurban, South Africa - July 9-July 14, 2000 |
Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrB180)
Shannon M, Canales J, Dahud S
M. Shannon, University of California, San Francisco, Bay Area Perinatal AIDS Center, San Francisco General Hospital, Box 0110, NH 6D4, San Francisco, CA 94110, United States, Tel.: +1 415 661 49 49, Fax: +1 415 661 90 45, E-mail: shannon@itsa.ucsf.edu
ISSUES: Perinatal care for HIV infected women requires complex management of pregnancy, maternal and fetal health. Since 1989, the Bay Area Perinatal AIDS Center has provided care to HIV-infected pregnant women, perinatally exposed infants, research access, and counseling /testing of family members in a service model utilizing certified nurse-midwives (CNM's) and nurse practitioners (NP's) as the principal care providers. Physicians consult at weekly conferences and as needed.
DESCRIPTION: Of 156 pregnant women cared for since 1989 43% are African American, 31% white, 15% Hispanic; 28% had used injection drugs and 39% experienced domestic violence. Prior to routine AZT use in 1994, perinatal transmission was 16%. From 1995-99 a Ryan White perinatal care contract allowed us to provide ongoing clinical care. In this cohort of 73 women 98% of those in care received anti-retrovirals, 59% had combination therapy and 57% participated in research. The mean number of prenatal visits was 10; 86% received > 3 visits. CNM/NPs were the care providers in 91% of visits; 7 women had >2 prenatal care visits by a physician. The perinatal transmission rate for 63 women with >3 prenatal visits was >2%. Of 10 women with >3 visits, 1 transmission is documented. CNM/NP's provided clinical care to 93% of postpartum women and their infants.
CONCLUSION: Regimens to control HIV in pregnancy are complex and challenging as many women face psychosocial morbidity making adherence to care plans difficult. In our setting care is delivered primarily by nurse clinicians, and is associated with low perinatal HIV transmission and excellent maternal/neonatal outcomes. Given the growing number of HIV infected women world wide, the use of CNM/NP's with physician consultation as needed, has the potential to optimize access to care while limiting medical expense.
Copyright © 2000 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.
