Perinatal HIV Service Coordination: Closing Gaps in the HIV Care Continuum for Pregnant Women and Eliminating Perinatal HIV Transmission in the United States.

Eliminating perinatal transmission of HIV and improving the care of childbearing women living with HIV in the United States require public health and clinical leadership. The Comprehensive Care Workgroup of the Elimination of Perinatal HIV Transmission Stakeholders Group, sponsored by the Centers for Disease Control and Prevention, developed a concept of perinatal HIV service coordination (PHSC) and identified 6 core functions through (1) semistructured exploratory interviews with contacts in 11 state or city health departments from April 2011 through February 2012, (2) literature review and summary of data on gaps in services and outcomes, and (3) group meetings from August 2010 through June 2017. We discuss leadership strategies for implementing the core functions of PHSC: strategic planning, access to services, real-time case finding, care coordination, comprehensive care, and data and case reviews. PHSC provides a systematic approach to optimize services and close gaps in perinatal HIV prevention and the HIV care continuum for childbearing women that can be individualized for jurisdictions with varying needs.

Integrating health and prevention services in syringe access programs: a strategy to address unmet needs in a high-risk population.

Injection drug users are at a high risk for a number of preventable diseases and complications of drug use. This article describes the implementation of a nurse-led health promotion and disease prevention program in New Jersey's syringe access programs. Initially designed to target women as part of a strategy to decrease missed opportunities for perinatal HIV prevention, the program expanded by integrating existing programs and funding streams available through the state health department. The program now offers health and prevention services to both men and women, with 3,488 client visits in 2011. These services extend the reach of state health department programs, such as adult vaccination and hepatitis and tuberculosis screening, which clients would have had to seek out at multiple venues. The integration of prevention, treatment, and health promotion services in syringe access programs reaches a vulnerable and underserved population who otherwise may receive only urgent and episodic care.

Routine prenatal HIV testing: women's concerns and their strategies for addressing concerns.

The purpose of this exploratory study was to solicit women's opinions about the process of routine prenatal HIV testing to identify strategies for routine testing that will address women's concerns, increase their level of comfort with testing, and support universal prenatal HIV testing. A convenience sample of English-speaking women between 18 and 45 years of age who were HIV-negative or of unknown HIV status were recruited for focus groups at four diverse community sites in four states. Focus group discussion questions addressed health care provider approaches and actions that would make a woman feel more comfortable with the process of routine prenatal HIV testing. Twenty-five women agreed to participate; most women (64%) were of Black, non-Hispanic race/ethnicity; 44% were 25-34 years of age. Thematic analysis of women's concerns about routine prenatal HIV testing fell into the following categories: fear, protecting the baby, protecting the woman, confidentiality, and stigma. Women's strategies for addressing these concerns were related to themes of education and information, normalizing HIV testing, patient-provider relationships, systems, and private communication. Participants offered numerous insightful and practical suggestions for addressing their concerns thereby supporting universal routine prenatal HIV testing. The themes that arose in this study support the conclusion that women will be more comfortable with routine prenatal HIV testing if they are fully informed and knowledgeable about the rationale for HIV testing during pregnancy and their right to decline, and if testing is carried out in a confidential and supportive health care environment.

Unique two-photoreceptor scanning eye of the nematode Mermis nigrescens.

A single eye is present in females of the nematode Mermis nigrescens. A pigment cup occupies the entire cross section near the anterior tip of the worm, and the curved cuticle at the tip becomes a cornea. The shading pigment is hemoglobin instead of melanin. The eye has been shown to provide a positive phototaxis utilizing a scanning mechanism; however, the eye's structure has not been sufficiently described. Here, we provide a reconstruction of the eye on the basis of light and electron microscopy of serial sections. Hemoglobin crystals are densely packed in the cytoplasm of expanded hypodermal cells, forming the cylindrical shadowing structure. The two putative photoreceptors are found laterally within the transparent conical center of this structure where they would be exposed to light from different anterior fields of view. Each consists of a multilamellar sensory process formed by one of the dendrites in each of the two amphidial sensory nerve bundles that pass through the center. Multilamellar processes are also found in the same location in immature adult females and fourth stage juvenile females, which lack the shadowing pigment and exhibit a weak negative phototaxis. The unique structure of the pigment cup eye is discussed in terms of optical function, phototaxis mechanism, eye nomenclature, and evolution.

An end to perinatal HIV: success in the US requires ongoing and innovative efforts that should expand globally.

The dramatic reduction of perinatally transmitted HIV in the United States has been a striking success story in the HIV epidemic. Routine HIV screening during pregnancy followed by appropriate therapy has been extremely effective. This paper puts forth three strategies needed to maintain these gains and reach the goal of eliminating perinatal HIV: standardize medical interventions and policy changes that support perinatal HIV reduction; institute HIV screening in routine preconception care to identify HIV infection in women before pregnancy; and critically focus attention and resources on primary prevention of HIV infection in women. Healthcare providers should incorporate HIV prevention education and routine screening into women's primary health care. Public health leaders should support and fund prevention strategies directed at young women. Successful approaches that have nearly eliminated perinatal HIV transmission in the United States offer valuable lessons that should be applied to primary HIV prevention for women in the United States and globally.

A faculty trainer model: increasing knowledge and changing practice to improve perinatal HIV prevention and care.

Although routine counseling and HIV testing of pregnant women is recommended, it is not yet universally offered. This paper reports on a project that trained health care providers from 2000 to 2002 using a faculty trainer (or train-the-trainer) model. The goals of the projects were to increase knowledge and change practice, increase HIV counseling and testing in prenatal care, and improve management of HIV in pregnant women. In four jurisdictions of the southeastern United States, 193 health care providers attended faculty trainer workshops using a standardized curriculum. Eighteen providers used the curriculum to train an additional 545 health care providers over 2 years. Participants in both faculty trainer workshops and trainerled seminars reported significant increases in perceived knowledge in all content areas and the intention to change clinical practice. The number of providers who became faculty trainers and then led seminars varied widely among the jurisdictions. Six-month follow-up of faculty trainers, although limited by a 63% response rate, found that over 90% of respondents reported the workshop had a positive impact on their care of women with and at risk for HIV. Our findings indicate the faculty trainer model is an effective way to educate practicing clinicians. Key elements to successful implementation were: ongoing support of faculty trainers by acquired immune deficiency syndrome (AIDS) educators, involvement of local HIV experts as trainers and resource persons, and use of a standardized curriculum based on national guidelines.

Rapid diagnostic testing for HIV. Clinical implications.

There have been many advances in HIV counseling, testing, and referral over the past ten years. One of the most recent advances is the United States Food and Drug Administration's (FDA) approval of a rapid test. As a result of the availability of rapid diagnostic testing for HIV, practices regarding testing and counseling need to be updated, particularly in time-sensitive situations in which rapid results are crucial.

Service needs of male caretakers of HIV-infected and affected children: policy and practice implications.

The number of male caretakers (biological fathers and other men) of HIV-infected and affected children is substantial and may increase in the US and elsewhere as more women become infected. Little information exists about the needs these men have for support services to help them better perform their parenting roles as male caretakers (MCs). This paper discusses the service needs of MCs at Ryan White CARE Act Title IV programs, the challenges providers at these programs face in serving MCs, and the strategies they have found effective in working with MCs. Providers report that MCs have specific service needs including the need for emotional support. Title IV programs meet these needs in a limited way because they are organized primarily around the needs of female rather than male caretakers. We discuss how Title IV programs can tailor existing service delivery and implement organizational change to facilitate MCs' service access and utilization. Further research directly with MCs is necessary to learn more about their service needs and the barriers MCs face in accessing services.

Rapid diagnostic testing for HIV. Clinical implications.

There have been many advances in HIV counseling, testing, and referral over the past ten years. One of the most recent advances is the United States Food and Drug Administration's (FDA) approval of a rapid test. As a result of the availability of rapid diagnostic testing for HIV, practices regarding testing and counseling need to be updated, particularly in time-sensitive situations in which rapid results are crucial.