Prevention of Perinatal Transmission

Maternal-Pediatric HIV Prevention and Care Program (MPHPCP)

Program Description

The Maternal-Pediatric HIV Prevention and Care Program (MPHPCP) is designed to reduce perinatal HIV transmission through education, technical assistance, monitoring and regulatory action, when indicated. The goal of the program is to reduce mother to child transmission (MTCT) to the lowest level possible by ensuring that all pregnant women have access to HIV counseling and testing and that those who test positive have access to antiretroviral (ARV) medications for their own health and to prevent HIV transmission to their babies. A three-part regimen of ARV, administered to the mother during pregnancy, labor, and delivery, and to the newborn immediately after birth, is optimal. However, studies conducted by the New York State Department of Health (NYSDOH) have suggested that partial regimens of ARV prophylaxis, initiated during the intrapartum and newborn periods, can significantly reduce the risk of perinatal transmission.

The major components of this program, set forth in NYSDOH regulations and first issued in 1996, require that all women in prenatal care in regulated facilities receive HIV counseling with testing presented as a clinical recommendation. Routine prenatal HIV counseling with testing recommendation has become a standard of care for all New York State prenatal care providers. The MPHPCP regulations were amended in 1997 to implement routine HIV screening of all infants as part of the NYSDOH’s Newborn Screening Program. In August 1999, as a result of medical and scientific advances in the prevention of perinatal HIV transmission, the regulations for the MPHPCP were again amended to require that expedited HIV testing be done in the obstetrical setting in instances where the mother’s HIV status is unknown at presentation for delivery. Expedited testing in the obstetrical setting is a "safety net" to facilitate late identification of maternal HIV infection so that ARV prophylaxis may be given to prevent MTCT. In these circumstances, ARV prophylaxis should be administered during labor and delivery, if possible, or to the newborn during the first hours of life to be most effective. Expedited testing in the obstetrical setting is done with written, informed consent for maternal testing, and without consent for newborn testing.

Activities conducted by MPHPCP program staff include:

  • providing regulatory oversight of the approximately 145 birth facilities in New York State by monitoring compliance with the MPHPCP regulations;
  • providing education and technical assistance to prenatal providers and birth facilities onsite, by telephone or in writing;
  • working with staff in other NYSDOH programs, such as the Newborn Screening Program, Pediatric HIV Diagnostic Service and the Bureau of HIV/AIDS Epidemiology, to ensure that HIV-exposed infants are in care;
  • investigating "missed opportunities", that is, those cases in which HIV exposure is first identified through Newborn Screening and an undetected/untreated exposure of a newborn to HIV has occurred;
  • providing contractual oversight and direction to the Prenatal Care Providers Training Project (PreCARE), and
  • responding to inquiries from, and providing information to providers, consumers, and other state and federal agencies.

Outcomes

By providing program oversight, and with the collective efforts of facilities across the state, the NYSDOH has noted significant improvement in perinatal HIV testing rates and a marked decrease in mother-to-child HIV transmission rates:

  • In 1997, when routine newborn screening began, the statewide prenatal HIV testing rate was 64%. In 1999, when expedited testing in the obstetrical setting was implemented, the statewide prenatal testing rate had risen to 77%. By 2003, the rate had risen to 95%. In 2006, the statewide prenatal HIV testing rate remained at 95%.
  • Mother-to-child HIV transmission has decreased dramatically in New York State - from 97 infected infants in 1997 (10.7% rate) to 10 infected infants in 2006 (1.7% rate).

Contact:

Sheila Hackel
Public Health Program Nurse
Perinatal HIV Prevention Program
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 486-6048
phpp@health.state.ny.us

or

Felicia Schady
Director
Bureau of HIV Ambulatory Services
Division of HIV Health Care
(518) 473-8427
ffs01@health.state.ny.us

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Prenatal Care Providers Training Project (PreCARE)

Program Description

The Prenatal Care Providers Training Project (PreCARE), begun in 2000, is designed to reduce mother-to-child transmission (MTCT) of HIV through provision of technical assistance and training to prenatal and obstetrical providers. Topics such as prenatal counseling and testing, expedited testing in the peripartum period and developing linkages to clinical, supportive and comprehensive case management services for HIV-positive pregnant and postpartum women and their exposed infants are provided.

PreCARE’s training and technical assistance strategy is tailored to the specific needs of the site requesting assistance. Technical assistance consultations begin with a survey designed to identify facility-specific barriers to HIV counseling and testing in the prenatal or obstetrical settings, as well as issues impeding coordination of services for HIV-positive pregnant or postpartum women. Intervention strategies are based on the results of the survey, and often include training for prenatal providers on HIV-related issues. Training may be conducted at birthing hospitals, community-based clinics, managed care organizations and/or group practices that provide prenatal care and then refer their pregnant patients to the target hospital for delivery. "Grand Rounds" are also offered to hospitals that have requested updated information for the care and treatment of HIV-positive pregnant/postpartum women and their exposed infants. PreCARE obstetrical consultants with HIV expertise provide the Grand Rounds.

Since 2000, PreCARE has trained more than 4,600 health care and adjunct professionals on prenatal counseling and testing of pregnant women, and prevention of mother-to-child HIV transmission. In 1999, the rate for prenatal testing in New York State was 77%; in 2006, the statewide rate was 95%.

Contact:

Sheila Hackel
Public Health Program Nurse, Perinatal HIV Prevention Program
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 486-6048
phpp@health.state.ny.us

or

Felicia Schady
Director
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-8427
ffs01@health.state.ny.us

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Community Action for Prenatal Care Initiative (CAPC)

Program Description

The Community Action for Prenatal Care (CAPC) Initiative supports the development of community coalitions dedicated to the reduction of perinatal HIV transmission through the recruitment of high-risk pregnant women into prenatal care in targeted zip codes of the South Bronx, Central Brooklyn, Northern Manhattan, and Buffalo. The following lead agencies, experienced in community organization, provide CAPC services in each of the target areas: Bronx Lebanon Hospital Center, the Alliance for Family Education Care and Treatment in Brooklyn, the Northern Manhattan Perinatal Partnership, Inc. and the Buffalo Prenatal-Perinatal Network. Lead agencies are responsible for coordinating the activities of their local community coalitions, including implementation of a comprehensive model to reach high risk pregnant women who are not in prenatal care. The basic elements of the comprehensive model are:

  • local planning;
  • recruitment/referrals including:
    • direct outreach by specially trained outreach workers;
    • referrals from agencies serving high-risk women;
    • local social marketing.
  • intake and transitional case management;
  • user-friendly prenatal systems including training for health and human service providers.

In 2004, a Prenatal Care Linkage Specialist began outreach and engagement with pregnant women at New York City Department of Corrections’ Rikers Island Jail. The specialist, employed by the New York City Department of Health and Mental Hygiene, provides continuity of care after release by linking pregnant women with a CAPC lead agency and other community services.

Contact:

Patricia A. Doyle
Director, Community Action for Prenatal Care Initiative
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-3786
pad03@health.state.ny.us

or

Felicia Schady
Director
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-8437
ffs01@health.state.ny.us