Giving Clinicians the Tools They Need
Shannon Weber, M.S.W.
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."