A collaborative program between a school of public health and a local health department to increase HIV testing of pregnant women.

OBJECTIVE: This study evaluates the effectiveness of a continuing medical education (CME) program that sought to increase HIV testing of women attending maternity clinics of the City of Houston Department of Health and Human Services (HDHHS). The CME program consisted of 14 training sessions given in 1995, 1996, 1997, 1999, and 2000. Educational objectives included increasing patient knowledge of HIV perinatal testing, increasing patient appreciation of the importance of HIV testing, and developing staff skills in educating and counseling women to accept HIV testing during pregnancy. METHODS: The CME program was based on assessment of clinician learning needs and an algorithm of the testing process, both jointly developed by faculty from the University of Texas Health Science Center at Houston School of Public Health and HDHHS personnel. The algorithm was also used to assess the care delivered. The CME was evaluated by examining changes in the percentage of women tested in the maternity clinics. RESULTS: In 1995, the year before the education program, 5.7% of women seen in the maternity clinics were tested for HIV. After the program began, testing rates rose to 64.2% in 1996, 65.5% in 1997, and 43.3% in 1998. Given the decline in testing in 1998, additional CME sessions were conducted in 1999-2000. The rate of testing rose to 62.3% in 1999 and 76.5% in 2000. CONCLUSION: Cooperative planning between university and health department personnel can create CME programs that alter provider behaviors and service delivery patterns to increase HIV testing. Outcomes need to be regularly monitored, however, to determine the need for maintenance or performance reinforcement.

Host-parasite relationships of caryophyllaeid cestodes and aquatic oligochaetes: II. Effects of host age and mixed infections.

Experiments were conducted to assess the relationship between annelid age and susceptibility of the annelid as an intermediate host for a caryophyllaeid, as well as the effect a mixed-species infection has on rate of metacestode development and parasite mortality. Four host-parasite systems were studied: Biacetabulum biloculoides and Hunterella nodulosa in Limnodrilus hoffmeisteri and Glaridacris catostomi in Ilyodrilus templetoni and Tubifex tubifex. Annelids were divided into 3 age classes: immature, approximately 7 days old; intermediate, approximately 14 days old; and mature, approximately 30 days old. Immature oligochaetes in all groups were more susceptible to infection, their parasites exhibited a lower mortality rate than 30-day-olds, and the total number of parasites in this group was higher than for the other age classes. Metacestodes reached the infective stage earlier in immature as compared to older oligochaetes. Interspecific competition between B. biloculoides and H. nodulosa resulted in increased parasite mortality and a slower rate of parasite development for the species that became established second. A prior infection with one species of cestode also affected the susceptibility of L. hoffmeisteri to infection with another species.