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Using the Fetal Infant Mortality Review to assess availability and impact of contraceptives on the prevention of perinatal HIV transmission in Philadelphia
Thesis

Using the Fetal Infant Mortality Review to assess availability and impact of contraceptives on the prevention of perinatal HIV transmission in Philadelphia

Michelle Holliday
Master of Public Health (M.P.H.), Drexel University
Jun 2012
DOI:
https://doi.org/10.17918/etd-4018
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Holliday_Michelle_2012404.44 kB
PDF Project Access upon request, Email title, URL, or DOI to archives@drexel.edu
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Holliday_Michelle_2012_Suppl1322.30 kB
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Abstract

Perinatal HIV Transmission Pennsylvania--Philadelphia Contraceptives Public Health
Background: Family planning services and preconception care have been identified as essential to preventing perinatal HIV transmission. Data from the Philadelphia Fetal Infant Mortality Review/HIV (FIMR/HIV) project and the Preconception Counseling and Contraception Provider Survey suggest underutilization of contraception and infrequent discussions of preconception counseling by providers with their patients. Objectives: This project investigates the relationship between provider knowledge and the discussion of pregnancy planning and contraception and explores the impact of this relationship on perinatal HIV transmission in Philadelphia. Methods: 21 cases of perinatal exposure from the FIMR/HIV project were reviewed and 10 Ryan White Care physicians, nurse practitioners and nurses were interviewed using semi-structured interviews. Interviews were transcribed, coded using theme identification and analyzed for commonalities and differences across themes. Results: Cases indicated that 52.4% of women did not use contraception and 38.1% of pregnancies were unplanned. Providers reported both facilitating and inhibiting factors such as family planning on site and social chaos/stigma influencing access to care for women of childbearing age with HIV in Philadelphia. Aspects such as time and competing elements in the patient-provider discussion are barriers to consistent discussion. In addition, respondents reported that discussions occur annually, at varied rates and/or when initiated by the patient. Providers reported no knowledge of formal preconception counseling guidelines. Conclusion: Results illuminate the need to examine perinatal HIV prevention in the context of psychosocial factors experienced by women of childbearing age with HIV in addition to improved coordination of care, enhanced referral systems and development of rigid guidelines for preconception counseling content.

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