A University of California, San Francisco program that uses certified nurse
midwives and nurse practitioners as primary care givers has significantly
reduced transmission of HIV from mother to child, according to a study
presented today (July 10) at the XIII International AIDS Conference in Durban,
The Bay Area Perinatal AIDS Center (BAPAC), based at the UCSF-affiliated San
Francisco General Hospital Medical Center, implements a coordinated care model
that includes consistent ongoing care, combination retroviral therapies, and
extensive counseling and support, said Maureen Shannon, CNM, FNP, MS, UCSF
associate clinical professor of family health care nursing and perinatal
coordinator at BAPAC.
From 1995 to 1999 the HIV transmission rate from mother to child for 65 women
who had more than three visits to the center was less than two percent. Women
who had no prenatal care or fewer than three visits had higher perinatal
transmission rates, she said.
Shannon explained that this model of care may have application in remote areas
of the United States, where there are more limited resources, notably
physicians, and in developing countries, where higher rates of HIV transmission
mean that prevention programs have to reach a larger number of women. Nurse
clinicians may help to close those gaps, said Shannon.
At BAPAC, nurse clinicians have developed a model that focuses on the reality
of how HIV-infected mothers cope with their disease, said Shannon. Caring for a
baby exposed to HIV in utero, while maintaining their own care, is often
challenging for new mothers. Simple interventions such as coordinating the
newborn infant’s HIV drug regimen with the mother’s medication schedule can
help with adherence, especially during the first few weeks postpartum. The
center offers mothers and their babies care by the same nurse clinicians (with
physician consultation as needed) from pregnancy through the child’s second
year, if indicated, explained Shannon.
In traditional models of care (in which the mother is referred to a
pediatrician after the birth of her child), mothers tend to neglect their own
health care. For this reason, clinicians at BAPAC evaluate both mother and baby
at the same time during clinic visits. This enables nurse clinicians and the
social worker to assess the health of the mother and child, provide primary and
gynecological follow-up care for the mother, provide HIV testing and primary
care for the infant, monitor adherence to medication regimens, assess the
mother’s psychosocial well being, and address other family issues (such as HIV
testing of partners). Shannon noted that the clinic also functions as a support
system for HIV-infected mothers, who get to know each other when they come for
“These factors combine to improve care for patients who are at risk. Mothers
are often dealing with fear and guilt associated with potentially having
infected their child and isolation from family and friends who may not know
about the disease,” she said. “Our focus is really from a caregiving
standpoint. How do we keep mothers well so their own response to HIV improves
as they care for their babies effectively?”
BAPAC was one of the first programs in the country to provide coordinated care
and services for HIV-positive pregnant women and their families. It was formed
by a collaborative effort between Diane Wara, MD, UCSF professor of pediatrics,
and the UCSF at SFGHMC Department of Obstetrics, Gynecology and Reproductive
Sciences. It is the only perinatal AIDS treatment center in Northern California
and serves women from hundreds of miles away. The center extends telephone
outreach services to remote parts of California and is part of the HIV Warm
Line consultant team, a national help line for clinicians.
Current research at BAPAC is focusing on the long-term outcomes of children
born to HIV-infected mothers, said Shannon.
Collaborators on this study include Joella Canales, a BAPAC administrative
assistant,and Soraya Dahud, a BAPAC research assistant.