SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 2, Issue 23 (November 14, 1997)

Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).

Introduction

Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.

One of the primary goals of the Maternal and Pediatric Services (MAPS) of Brooklyn project is to promote early identification of HIV infection in pregnant women. Once a woman tests positive, she can start treatment and have the opportunity to reduce perinatal transmission through ZDV prophylaxis. One of the most effective means of achieving this goal has been working with health care providers in the community and encouraging them to adopt universal HIV counseling and offer testing as a standard of prenatal care.

In New York State, all prenatal care providers are now required to comply with this standard as a result of health department regulations that have been implemented in the past 18 months. The first regulation, which went into effect in May 1996, requires that all prenatal care providers (except providers who are not part of an HMO) counsel and offer HIV testing to all pregnant patients. On February 1, 1997, the Department of Health instituted mandatory neonatal HIV screening of all infants born in New York State. In response to these new regulations, MAPS of Brooklyn developed a standardized training module geared specifically towards private OB/GYN practices that need to integrate HIV counseling and testing into their routine care. MAPS also has adopted the curriculum for pediatricians who are responsible for giving post-test results from the Newborn Screening Program.

The focus of the MAPS training module is to help clinicians perform HIV counseling and testing in the clinical setting in as simple and concise a manner as possible. The curriculum is designed to help providers give both the best and legally required standards of HIV counseling and testing for patients, while acknowledging the importance of time management. The training module includes information on the benefits of early diagnosis and reduction of perinatal transmission, the legal requirements for pre- and post-test counseling, updates on the New York State Department of Health regulations, as well as role-play and values clarification exercises. The trainees are led through the various components of a 5-minute counseling session that includes: a description of the meaning of the test; discussion of confidentiality issues; the decision of whether to have the test; an assessment of the patient’s ability to cope; and, answering of patient’s additional questions.

The objectives of the MAPS training curriculum are to: 1) train all clinicians so that they will be equipped with the knowledge and skills to logically and compassionately discuss the main issues surrounding HIV testing during pregnancy and post-partum; 2) encourage all clinicians to integrate HIV counseling and testing into prenatal care; and 3) alleviate the discomfort of discussing HIV/AIDS by integrating the discussion of HIV into routine medical care and personal health management. Thus, MAPS provides a number of follow-up services for practitioners who need specific technical assistance in setting up universal HIV counseling and testing (see the box to the left).

Because the goal is to optimize the number of pregnant women who receive counseling and testing, the protocol suggests a "whole office approach." That is, the administrative and nursing support staff who may come in contact with the pregnant client must do their part to help promote HIV testing. For example, a practice may want to include an informational packet on HIV during orientation, display HIV-related posters in the waiting and examination rooms, and have plenty of literature on hand. The MAPS training is free of charge and staff travel to the physicians’ offices. Evaluation has shown that providers feel much more prepared to discuss HIV testing, and they appreciate the customized approach.

For more information, contact Cathy Rohweder at the State University of New York Health Science Center at Brooklyn, 450 Clarkson Avenue, Box #1240, Brooklyn, NY 11203, 718.270.1846, e-mail: crohweder@netmail.hscbklyn.edu.

SUNY MAPS Resource Page

SPNS/Fax is produced by The Measurement Group–PROTOTYPES Evaluation and Dissemination Center (EDC). Editorial comments should be made to The Measurement Group at 5811A Uplander Way, Culver City, California 90230, 310.216.1051, 310.670.7735 (fax).
 

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