One Test. Two Lives. has brought together a group of experts across the country in fields related to perinatal HIV transmission to form a clinician panel dedicated to spreading the campaign message of the importance of testing all pregnant women for HIV. Members not only speak at local, regional, or national conferences and association meetings, but they are dedicated to helping CDC reduce the number of babies born with HIV by communicating with other health care providers who can benefit from the campaign's message and materials. Their support helps CDC share the important message of testing all pregnant women for HIV.
Consultant Workgroup members are volunteers promoting the goals of the One Test. Two Lives. campaign. Their work in the field of perinatal and pediatric HIV prevention enhances the campaign goals but is not directly supported by CDC.
- Recipient of the Butler University Robert Duncan Alumni Achievement Award for life-changing work in the area of women's healthh
- Fellow of the Infectious Diseases Society of America
- Fellow of the American College of Obstetricians and Gynecologists
- Member of the International Society for STD Research
Natali Aziz, M.D., M.S. is a clinical assistant professor at Stanford University School of Medicine in the department of obstetrics and gynecology, division of maternal-fetal medicine. She recently completed a clinical fellowship at the University of California at San Francisco in the divisions of reproductive infectious disease and maternal-fetal medicine, department of obstetrics, gynecology, and reproductive sciences.
- Recipient of the Julianne O'Callahan award for compassion in patient care presented by the obstetrics and gynecology residency program at Stanford University School of Medicine in 2002 and 2004
- Junior Fellow of the American College of Obstetricians and Gynecologists
- In-training member of the Society of Gynecological Investigation
- Associate member of the Society for Maternal-Fetal Medicine (SMFM)
- Faculty at the SMFM 2008 Annual Meeting workshop "Controversies in Perinatal HIV Management: Experiences from the National Perinatal HIV Hotline"
- Consultant for a perinatal HIV storyline on ABC's "General Hospital" through collaboration with CDC and Hollywood, Health, and Society
Learn more about Natali Aziz's work on HIV, Pregnancy and Testing
Natali Aziz, M.D., M.S. Clinical Assistant Professor, Director of Perinatal Infectious Diseases, Division of Maternal-Fetal Medicine in the Department of Obstetrics and Gynecology at Stanford University School of Medicine.
Dr. Natali Aziz has a deep interest in helping pregnant women learn their HIV status that is rooted in a passion for the prevention of perinatal transmission and the overall benefits of medical care for the mother. She has played an integral role in the Center for Disease Control's (CDC) One Test. Two Lives. program, participating in many initiatives since the program's conception. Most recently, she has been a key contributor for the One Test. Two Lives. perinatal curriculum for residency and nurse midwifery students. Dr. Aziz stresses that perinatal HIV education is a crucial component of both OB/GYN and midwifery training programs and is committed to increasing educational opportunities about this specific topic in these curriculums. She also believes perinatal HIV education should become a nationwide standard, integrated into trainings developed for residency programs. To promote One Test. Two Lives., and activities of similar focus, Dr. Aziz has served as a presenter, as well as participated in various panels that focus on HIV testing for pregnant women. She presented a study describing the findings of a survey of obstetric providers' HIV testing practices in clinical settings at the 2008 Infectious Disease Society for Obstetrics and Gynecology meeting in Seattle, WA.
Dr. Aziz actively supports CDC's HIV testing recommendations for women who are pregnant. She stresses that "the benefits of HIV testing are tremendous. If an HIV-infected woman does not know her status and is therefore not appropriately managed during pregnancy, the risk of transmission [to her unborn child] is 25%, [but] with early testing, appropriate treatment with HAART (highly active antiretroviral therapy), and achieving an undetectable maternal viral load, it can be reduced to less than 1-2%."
While Dr. Aziz supports testing, she does note that for clinicians, ensuring all patients are tested for HIV can prove to be difficult. Some common obstacles clinicians face include patient resistance to testing due to fear of HIV infection and stigma, and lack of knowledge on the benefits being treated. She also states that overcoming patient declination is another hurdle, especially if clinicians do not have the appropriate resources to demonstrate to patients the importance of being tested. These challenges are the reason Dr. Aziz is an advocate for CDC's One Test. Two Lives. : "The program is critical because it helps offer educational materials to inform patients…and utilizing patient educational materials is key to improving patient acceptance of HIV testing as a routine part of prenatal care."
Dr. Aziz explains that promoting the routine nature of perinatal testing can help both clinicians and patients overcome potential barriers. Her three very basic but key pieces of advice for implementing HIV screening during pregnancy include:
- Test all pregnant women as early as possible in pregnancy.
- Utilize an opt-out approach where possible.
- Test again in the third trimester and at time of labor (per Rapid HIV screening) as needed when pregnant women are at high risk for acquiring HIV infection and/or have an undocumented HIV status, respectively.
Dr. Aziz desires to make HIV testing a very routine and effortless part of prenatal care and to be involved in increasing OB/GYN resident knowledge about the importance of HIV perinatal management and One Test. Two Lives.
- Member of the Infectious Disease Society of Obstetrics and Gynecology and the Alpha-Omega-Alpha Medical Honor Society
- Associate member of the American Sexually Transmitted Diseases Association
- Fellow of the American College of Obstetricians and Gynecologists (ACOG).
- Reviewer for:
- Obstetrics and Gynecology
- American Journal of Obstetrics and Gynecology
- Journal of Pediatric and Adolescent Gynecology
- Journal of Infectious Diseases
- Sexually Transmitted Diseases
- Recognized by Obstetrics and Gynecology for distinction in superior editorial review in 2003 and 2006
- Invited expert to the Infectious Diseases in Obstetrics and Gynecology working group of ACOG
Learn more about Richard's work to "Test everyone and test early"
For Dr. Richard Beigi, doing routine HIV screening of his pregnant patients is nothing new. Even though rates of HIV in Pittsburgh are not high, he still screens his pregnant patients early in their pregnancy. "We hope that patients come in early in their pregnancy, that way we can get them treated. When diagnosed early and treated, perinatal HIV transmission is almost 100% preventable," Beigi said. Beigi has had patients that did not seek prenatal care because they were unable to attend regular appointments due to life circumstances. In these cases, Beigi says it is still important to test as soon as possible, "Diagnosing at 12 weeks gives more time for treatment to take effect than diagnosis at 32 weeks, but there is still an opportunity to prevent transmission in the third trimester or at labor and delivery." Beigi pointed out that Cesarean delivery can also be avoided by testing early and reducing the viral load of the pregnant patient before delivery.
Beigi became involved with CDC's One Test. Two Lives. campaign because he wanted to be a part of an educational campaign for obstetrical clinicians that shares the simple steps he and others have taken to incorporate HIV screening into their practices. He believes that sharing the kinds of materials provided by the campaign with his colleagues will increase their ease in incorporating regular HIV testing for their pregnant patients.
Why is Beigi confident that a little education can go a long way? The HIV test is easy–it is just a blood test," Beigi explained. He feels that providers who screen will learn what he has: talking to patients about testing takes less than a minute and for most patients who are unsure about testing, a simple conversation makes them comfortable with the test. Beigi said, "I really believe it's a good thing to test for. It's so easy, and it has proven interventions that work, which is not that common." Beigi also shared that because HIV testing is recommended during pregnancy, he has not had a problem with insurance reimbursements
The bottom line for Beigi is that HIV testing is quick and simple; and with effective treatments to reduce transmission, especially when detected early, physicians can play a critical role in reducing the spread of HIV.
Beigi is an asset to the One Test. Two Lives. campaign serving as a reviewer for the currently in-development curriculum on perinatal HIV prevention for OB residents and nurse-midwives. Acting on his passion to educate others about testing, Beigi also promoted the campaign to members of the Infectious Disease Society of Obstetricians and Gynecologists in an e-mail blast before the 2008 annual conference. He is engaged in other key research in the fight against HIV/AIDS including a cutting-edge, government funded research study testing microbicide use in pregnant women. Beigi is an assistant professor in the Department of Obstetrics and Gynecology at the University of Pittsburgh, Magee-Women's Hospital.
Kenneth Dominguez, M.D., M.P.H. is a medical epidemiologist on the clinical epidemiology team in the Division of HIV/AIDS Prevention at CDC and is a member of the United States Public Health Service (USPHS).
- Recipient of a Commendation Medal for achievements in perinatal HIV prevention in 2000 from the USPHS
- Recipient of the Assistant Secretary of Health Award for outstanding team performance from the Department of Health and Human Services in 2001 for leadership in developing the "Blueprint for Action on Breastfeeding"
- Recipient of the Juan Carlos Finlay Award for Achievement in Hispanic outreach and mentoring presented by the Hispanic Officer's Advisory Committee of USPHS in 2000
- CDC consultant to the Committee on Pediatric AIDS for the American Academy of Pediatrics
- CDC consultant to the Antiretroviral Pregnancy Registry
Learn more about Ken's work on "Pregnancy, HIV and Latinos"
In 2008, Latinos accounted for just 15 percent of the population but they comprised 19 percent of newly diagnosed cases of HIV and AIDS, and had 3 fold higher rates of diagnoses of HIV compared to white nonhispanics, statistics that Dr. Ken Dominguez, an epidemiologist for the Centers for Disease Control and Prevention (CDC) and Captain in the U.S. Public Health Service specializing in preventing the spread of HIV/AIDS, knows all too well.
"The epidemic has additional complications for Latinos. Limited access to health care, cultural barriers, stigma, and legal issues make it difficult to battle the rise of HIV/AIDS," says Dominguez. "Language barriers play a big role in terms of quality of care, being able to clearly communicate with your patients."
Passionate to help address some of these issues for Latinos, Dominguez joined the outreach efforts for One Test. Two Lives. to help increase awareness of the importance of testing women for HIV early in pregnancy among providers who are not regularly testing their patients. Since 1995, CDC has recommended all pregnant women be tested for HIV and, if infected, get treatment for themselves to improve their health and to prevent passing the virus to their infant.
We discovered that a primary factor for a woman's acceptance of HIV testing was the strength of the provider's recommendation to get tested. If the provider said, 'this was important, please get tested,' the patient was more likely to accept it."
--Ken Dominguez, on the importance testing for HIV during pregnancy
"The One Test. Two Lives. campaign offers important information to both health care providers and patients on the benefits of early prenatal care and HIV testing to prevent transmitting the virus from mother to child," said Dominguez. "All of the educational materials are available in Spanish, which is critical to reach Latinos."
Continues Dominguez, "The brochures and fact sheets available in the One Test. Two Lives. provider resource kit are effective tools that enable physicians to communicate about universal voluntary prenatal testing for HIV to their patients."
In addition to his work with One Test. Two Lives., Dominguez has worked with a perinatal HIV prevention program for Latinas in South Carolina called "Empowering Latinas to Lash out against HIV/STIs" (ELLAs). The program, interviews Spanish-speaking health care providers to determine any perceived barriers to counseling and administering an HIV test to pregnant Latinas in South Carolina. It also explores where Latina women get their HIV information and possible barriers related to their decision to seek early prenatal care and to take the HIV test during pregnancy.
Dominguez has been involved in HIV issues since he first came to CDC in 1991, when he conducted research to study the rate of new HIV-infections in pregnant women in the CDC –Belle Glade Study, near Lake Okochobee, in Palm Beach County, Florida.
In 1993, Dominguez became involved with mother-to-child HIV transmission efforts through CDC's "Perinatal Guidelines Evaluation Project "– a four-city study to determine if physicians were following guidelines for HIV screening and antiretroviral therapy (ARV) treatment.
Along with additional research, these guidelines were a precursor for CDC's current recommendation for opt-out HIV screening, which offers routine HIV screening for all patients unless they decline. Says Dominguez, "With opt-out, you get very strong provider recommendation because the physician is saying 'we'll test you unless you say no.'"
More recently in 2008, he and colleagues from St. Jude's Hospital in Memphis, TN, and University of Miami, in Miami, FL, were the first to publish a case series which documented prechewing of food by caregivers as a novel mode of mother-to-child HIV transmission and recommends health care providers ask pregnant women about this practice and warn against it if one is HIV-infected. Dominguez emphasizes, "This represents yet another important reason why a pregnant woman would want to know her HIV status."
He also coauthored a recent report in March 2011, in CDC's Morbidy and Mortality Weekly Report describing the prevalence of prechewing among caregivers of HIV-exposed children in pediatric HIV clinics in the U.S.
- Director of the National HIV/AIDS Clinicians' Consultation Center, which includes the National HIV Telephone Consultation Service, National Clinicians' Post-Exposure Prophylaxis Hotline, and National Perinatal Consultation and Referral Service
- Vice chair of the University of California at San Francisco's department of community medicine at San Francisco General Hospital
- Serves as the Principal Investigator of the San Francisco AIDS Education and Training Center.
- Captain in the United States Public Health Service (USPHS)
- Member of the American College of Nurse-Midwives
- Member of the Commissioned Officers Association of the USPHS, Inc
- Member of Reserve Officers Association
Learn more about Yvonne's work on "A quick test can detect HIV".
Yvonne Green, RN, CNM, MSN, the director of CDC's Office of Women's Health, has a message for clinicians who care for pregnant women:
A quick test can detect HIV. If HIV is caught early, you have the ability to give hope and impact a pregnant woman and the lifelong health of her infant.
Screening is a crucial step for women who are HIV positive to be identified early enough to gain the most benefit from treatment. For pregnant women, screening allows the chance to greatly reduce transmitting the virus to the baby. Many women might not know the importance of an HIV test, which is why Green urges clinicians to provide information to their patients about the virus and to screen all of their pregnant patients as part of routine prenatal care.
For Green, supporting the One Test. Two Lives. program which is a part of the Act Against AIDS campaign, is a natural extension of a career championing the cause of women's health. A registered nurse by training, Green began her interest in public health early while working in public health hospitals and public health clinics, including sexually-transmitted disease (STD) clinics, in Oklahoma and California. She then joined CDC in the fight against STDs. At CDC when the AIDS epidemic was beginning, Green worked to help get messages of prevention to those at high risk for HIV. "All of us in public health have the opportunity to bring attention to health issues that affect women and to promote prevention to keep women healthy at all stages of their lives," Green commented. A key message that she promotes is that HIV can be prevented and that HIV-positive pregnant women do not have to pass the virus on to their babies.
Green's passion for promoting women's health has been a great support to the One Test. Two Lives. program. She has spread the message of universal screening for all pregnant women to clinicians through the Office's various e-newsletter articles, sharing information at conferences, and speaking at health professional and consumer events.
With inspired efforts to educate clinicians and pregnant women about HIV screening, Green is an asset to the One Test. Two Lives. program. We were especially pleased to collaborate on outreach efforts to nurse-midwives at the American College of Nurse-Midwives annual meeting.
CDC's Office of Women's Health
Working to promote and protect the health, safety, and quality of life to women at every stage of life
CDC's Office of Women's Health (OWH) works within and outside CDC to raise awareness of women's health and to promote activities that will improve the health and safety of women.
Jan Kriebs, C.N.M., M.S.N., F.A.C.N.M. is an assistant professor and director of midwifery in the department of obstetrics, gynecology, and reproductive sciences at the University of Maryland in Baltimore.
- Member of American College of Nurse-Midwives
- Member of the Association of Reproductive Health Professionals
- Faculty at the American College of Nurse-Midwives 2008 annual meeting presentation entitled "Counseling and Testing: What We All Need to Know about HIV"
- Guest editor of the Journal of Midwifery and Women's Health May/June 2008 issue on infectious diseases
Learn more about Jan's work on "HIV Testing During Pregnancy"
Jan Kriebs runs a practice at the University of Maryland that includes a clinic for pregnant women who are HIV positive. She knows first hand the importance of testing a mother for HIV early in pregnancy. Her clinic delivers approximately 40 babies each year from pregnant women who are HIV positive with only a 1% transmission rate. The babies who are born HIV positive usually have mothers who acquired HIV during pregnancy or were not tested early enough. Through working with pregnant women living with HIV she has seen the beneficial impact on women who learn about their status early and receive healthcare and appropriate treatment.
"It's a very special time; moms living with HIV deserve for their birth to be just as special and just as happy as anyone else. The first step is getting the diagnosis at the right time."
--Jan Kriebs, on the importance of testing for HIV early during pregnancy
No place is immune to HIV
Kriebs joined the outreach efforts of One Test. Two Lives. to spread the word about HIV testing early in pregnancy to providers who are not regularly testing their patients. "Some healthcare providers will not have many positive patients, but that doesn't mean they do not have any," says Kriebs. The challenge is to reach the healthcare providers who will not see HIV very frequently in their practice and are therefore less likely to test, especially if they do not believe patients in their practice are at risk.
Many patients don't believe they are at risk for HIV or are scared to ask about getting a test. Jan observed that "It's human to shy away from asking questions you don't want the answer to." Kriebs tells her patients, "If you are diagnosed early and can work with us, there's only a 1-2% chance that your child will be HIV positive." Her experience working with patients supports her belief that increasing a women's understanding about the chances of reducing mother-to-child transmission will make her more likely to accept an HIV test. Healthcare providers need information to share with their patients about HIV testing in pregnancy like the brochures and fact sheets available in the One Test. Two Lives. provider resource kit.
Regardless of the information that patients have, it is important for healthcare providers to offer the HIV test. Kriebs says, "Motherhood really changes your life, and getting this diagnosis adds an extra hurdle," so it is easy to understand why a patient might be reluctant to ask for a test. A patient's hesitation to ask for a test or lack of knowledge makes it even more imperative for healthcare providers to offer the test to their patients. Kriebs points to the Perinatal HIV Hotline of the HIV/AIDS Clinicians' Consultation Center at the University of California-San Francisco as a resource for healthcare providers who want to learn more about talking to their patients about HIV testing. Learning how to talk to an HIV-positive patient can help both the provider and the patient. "Telling a pregnant woman she has HIV is not the same as sharing if the baby is a boy or a girl: it's a hard thing to talk about," says Kriebs.
Kriebs noted that telling a woman she is HIV positive means taking time to talk about what comes next, who she needs to notify, and who will be able to care for her; however, she believes that the benefit of preventing HIV transmission to the baby outweighs the extra time taken to talk to a woman about a positive diagnosis.
Spreading the Word
How does Kriebs propose reaching providers who think their patients are not at risk? "Just keep singing and hope the choir gets bigger," which is exactly what she is doing. She co-authored a piece in the Resource for Clinicians section of the Journal of Midwifery and Women's Health, Volume 53, Number 3, May/June 2008, "HIV Counseling and Testing in Pregnancy." Kriebs includes messages about perinatal HIV prevention in presentations she gives around Maryland and at national conferences such as her presentation, "Counseling and Testing: What every midwife needs to know about HIV" at the American College of Nurse Midwives annual meetings in 2008 and 2009. She has also included information about the One Test. Two Lives. campaign and preventing mother-to-child HIV transmission in the Maryland Perinatal Network newsletter.
- Project officer for the national HIV prevention partnership organizations working on perinatal HIV prevention projects
- Co-author of the HIV screening recommendations MMWR, Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings
- Guest Editor for the American Journal of Obstetrics & Gynecology September 2007 Supplement, "Achievements, Issues, and Challenges: Prevention of Mother-to-Child HIV Transmission in the United States and in Resource-Limited Settings"
- Member of the American Public Health Association
- Invited speaker to many national scientific, clinical, and professional meetings on the topic of perinatal HIV transmission prevention and treatment
- Member of the Infectious Diseases Society of America
- Member of the Pediatric Infectious Disease Society
- Member of the American Academy of Pediatrics
- Former professor of pediatrics at Emory University School of Medicine
Learn more about Steve's work on "Eliminating Mother to Child Transmission"
During the two-plus decades that pediatrician and epidemiologist Steven R. Nesheim, MD, has worked to lower the incidence of mother-to-child transmission of HIV, progress has often occurred at a fast pace. But as elimination of perinatal HIV transmission comes closer into view, progress is likely to shift to a slower, steadier pace.
At the epidemic's peak in 1991, during Dr. Nesheim's tenure at the Department of Pediatrics and as Medical Director of the Pediatric/Adolescent Infectious Disease Program at Emory University's Grady Health System in Atlanta, the number of infants infected with HIV perinatally stood at 1,650.1 But in 1994, when clinical trials showed that timely use of anti-retroviral prophylaxis reduced the risk of HIV transmission from mother to infant, sharp drops in the incidence quickly followed. By 2009, an estimated 151 U.S. infants were infected with HIV transmitted from their mothers, according to data presented by Dr. Nesheim and colleagues at the 2012 Conference on Retroviruses and Opportunistic Infections.2
With elimination of perinatal transmission of HIV on the horizon, the public health, surveillance, and clinical communities began to consider how that goal could be achieved and sustained, according to Dr. Nesheim, who joined the CDC's Division of HIV/AIDS Prevention in 2007. As experts began to discuss the ramifications, Dr. Nesheim realized that the goal of elimination (defined as an incidence of less than 1 per 100,000 live-born infants and a mother-to-child transmission of less than 1%) would not mean that the work required to get there would be over.
While clearly a major public health achievement, eliminating perinatal HIV transmission "is not just a one-time thing...it's a process, not an event," he said. "It won't be trying to reduce incidence from 150 to 80 and then we're done." Instead, "We have to focus on 8,700 pregnancies annually 3 [the approximate number of women with HIV infection who give birth each year] and, from that, reduce the number of infected infants to 80 every year, which is not easy or automatic."
To address this challenge, Dr. Nesheim and colleagues at the CDC began collaborating with numerous stakeholders from the federal government, state and local health departments, clinical experts, and key non-governmental organizations. The two-year effort resulted in the development and implementation of a six-part framework to eliminate mother-to-child HIV transmission (EMCT) in the United States.
The framework takes a comprehensive approach to reaching that goal. It provides a blueprint for implementing proven perinatal HIV prevention and treatment strategies for all HIV-infected women that accomplishes the following:
- Assures that HIV care includes comprehensive reproductive health care, family planning, preconception care services, and HIV testing according to CDC's recommendations
- Conducts comprehensive, real-time case findings of all HIV-infected pregnant women and their exposed infants
- Makes available comprehensive clinical care and social services for women and infants
- Performs detailed reviews of select cases to identify missed prevention opportunities to identify and address local system improvements through quality improvement methodology modeled after the Fetal and Infant Mortality Review (FIMR)
- Conducts research and long-term follow-up to develop safe and effective interventions
- Assures data reporting for HIV surveillance and evaluation of mother-to-child transmission elimination efforts.
The EMCT framework reflects significant input of evidence-based research, coordination, and follow-up. But to Dr. Nesheim, another way to think about it is simply "how to improve on what's being done for pregnant women. If we can get pregnant women in proper care, identify them, get them tested and treated, that alone…will further reduce the number of babies that get infected."
And that, over time, will reduce the number of adolescents and young adults with perinatally acquired HIV, a population Dr. Nesheim is well-acquainted with from his experience as Medical Director of Grady Health System's Ponce De Leon Center. Founded in 1993, the center provides medical and support services and is one of the largest facilities in the United States providing HIV/AIDS care to approximately 5,000 men, women, adolescents, and children.
While the survival and well-being of adolescents born with HIV is remarkable, "they are not just sailing into adulthood unscathed," Dr. Nesheim said. An article he and colleagues at the CDC published in 2011 in Current Opinions in Obstetrics and Gynecology4 confirms that observation. Adolescents who are long-term HIV survivors have three distinct behavioral health challenges: decreased medication adherence, sexual activity that brings risk of pregnancy and transmission, and mental health problems. To benefit fully from treatment advances, they need coordinated, multidisciplinary support services, including medication adherence, reproductive health counseling, and mental health and educational planning.
With the tremendous progress made toward eliminating perinatal HIV transmission, Dr. Nesheim points to HIV testing as the resource that yields the biggest pay-off. "One of the best things people can do is to get tested," he said. Testing and the information it provides puts into motion the interventions that will make perinatal HIV elimination a reality.
Yet attaining this goal will bring distinct challenges, Dr. Nesheim predicts. "We still have thousands of HIV-infected women delivering every year who need preventive efforts," he noted. "We will have to accomplish that in a different way every year with a new group of HIV-infected women."
- Lindegren ML, Byers RH, Thomas P, et al. Trends in perinatal transmission of HIV/AIDS in the United States. JAMA 1999;282:531–538. (cited in Mother-to-Child [Perinatal] HIV Transmission and Infection, Factsheets, Centers for Disease Control and Prevention). Available at:www.cdc.gov/hiv/group/gender/pregnantwomen/index.html
- Taylor A, Little K, Zhang X et al. Estimated Perinatal ARV Exposure, Cases Prevented, and Infected Infants in the Era of ARV Prophylaxis: US._CROI, 2012 Seattle. 19th Conference on Retroviruses and Opportunistic Infections.
- Whitmore SK, Zhang X, Taylor A, et al. Estimated Number of Infants Born to HIV-Infected Women in the United States and Five Dependent Areas, 2006. JAIDS. 1 July 2011; 57(3): 218–222.
- Koenig, LJ, Nesheim SR, Abramowitz S. Adolescents with Perinatally Acquired HIV: Emerging Behavioral and Health Needs for Long-Term Survivors. Curr Opin Obstet Gynec 2011, epublished August 11.
- Member of the American Medical Association
- Junior Fellow of the American College of Obstetricians and Gynecologists
- Member of the Society for Maternal-Fetal Medicine
- Recipient of the Carlomagna Award in 2006 from Louisiana State University
- Member of the Women HIV International Clinical Conference Planning Committee
- Appeared on a Web cast from the Maternal Child Health Bureau, "Preventing Perinatal HIV Transmission"
- Works with the San Francisco AIDS Education and Training Center as part of their Rapid Testing in Labor and Delivery project
Learn more about Shannon Weber, M.S.W work on "Giving Clinicians the Tools They Need"
Six years ago, Shannon Weber, MSW, helped launch the National Perinatal HIV Hotline and Referral Service at San Francisco General Hospital, a resource that provides expert guidance to clinicians treating and managing HIV in pregnant women and HIV-exposed infants.
Today, the Perinatal HIV Hotline (888-448-8765) remains a free service of the National HIV/AIDS Clinicians’ Consultation Center (NCCC). It is staffed by what Ms. Weber describes as a "phenomenal group" of about 20 faculty members of the University of California–San Francisco. They represent a wide spectrum of primary and specialty care experts, including infectious disease specialists, pharmacists, family physicians, and internists.
In addition to the 24/7 Perinatal HIV Hotline, Ms. Weber coordinates the 300-plus member Perinatal HIV Clinicians Network, which provides referrals to callers for local and regional resources for care for HIV-positive pregnant women and HIV-exposed infants. The NCCC also provides consultation to clinicians on all aspects of HIV testing and clinical care and recommendations on managing occupational exposures through two other hotlines.
Inquiries to the Perinatal HIV Hotline came on the heels of the CDC’s recommendations that called for HIV screening as part of routine prenatal screening tests. "We would get clinicians asking for help," such as how to approach the topic of positive HIV test results with their patients or where to find local resources for treatment, says Ms. Weber. "When you ask people to make a change in clinical practice, you have to give them the tools to get it done."
The timing of the CDC’s One Test. Two Lives. toolkit, combined with the expertise available through the Perinatal HIV Hotline, helped fill that void. "The campaign and the toolkit made it easy for clinicians to talk to their patients, and we were able to support clinicians with their real or perceived barriers" to implementing routine prenatal screening and caring for patients, she says.
A patient’s positive HIV test result can prompt a first-time call to the Perinatal HIV Hotline. In one scenario Ms. Weber describes, an obstetrician called the hotline after receiving an unexpected, positive result in a routine first trimester HIV test. The provider sought help in interpreting the test results, explaining the results to his patient, and getting a referral for HIV-specific care. Assistance in interpreting and discussing test results were provided by the Perinatal HIV Hotline, and the HIV Clinicians Network identified a local program specializing in care for HIV-positive pregnant women.
Some clinicians resisted the idea that their patient population needed to be screened for HIV, Ms. Weber recalls.
"So many clinicians said, ‘This is not part of my practice, not my patient population.’" Stigma remains a major barrier, as does the lack of information about changing patterns of HIV transmission.
For example, in 2009, heterosexual contact with a person known to have, or at high risk for, HIV accounted for 8,461 diagnoses of HIV infection among adolescent and adult females, compared to 1,483 diagnoses among adolescent and adult female injection drug users, according to CDC data.
At the same time, the evidence that perinatal HIV prevention works continues to grow. For example, published studies cited by the CDC* have found that the number of infants infected with HIV through perinatal transmission dropped from an estimated peak of 1,650 in 1991 to between 86 and 186 in 2004.
Even after clinicians became more aware of the changing HIV transmission patterns, they worried about the potential time commitment that a conversation about HIV screening with patients could represent.
To address that concern, Ms. Weber says, "We framed [conversations about] testing as part of the routine standard of care. It became much easier for clinicians." This script on how to introduce an HIV test runs about minute to 90 seconds in length.
Getting clinicians to embrace routine HIV screening—even with expert resources and practical educational tools—hasn’t always been an easy task yet Ms. Weber is working with a formidable asset: a mother’s concern for her baby.
"Women really want to do the best thing for their baby. We have a window of opportunity of 9 months where her doctor can help the mother do what’s best," says Ms. Weber. Clinicians can open this window by saying, "Hey, I do [screening] for all my patients, and it’s one way to make sure both you and your baby are healthy and happy."
- Page last reviewed: January 20, 2016
- Page last updated: January 20, 2016
- Content source: