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AJPH First Look, published online ahead of print Sep 17, 2009
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November 2009, Vol 99, No. 11 | American Journal of Public Health 2079-2086
© 2009 American Public Health Association
DOI: 10.2105/AJPH.2008.154476

RESEARCH AND PRACTICE

Pregnancy as a Window of Opportunity for HIV Prevention: Effects of an HIV Intervention Delivered Within Prenatal Care

Trace S. Kershaw, PhD, Urania Magriples, MD, Claire Westdahl, CNM, MPH, Sharon Schindler Rising, CNM, MSN and Jeannette Ickovics, PhD

Trace S. Kershaw and Jeannette Ickovics are with the School of Public Health, and Center for Interdisciplinary Research on AIDS Yale University, New Haven, CT. Urania Magriples is with the Department of Obstetrics and Gynecology, Yale University, New Haven. Claire Westdahl is with Emory University, Atlanta, GA. Sharon Schindler Rising is with Centering Healthcare Institute Cheshire, CT.

Correspondence: Correspondence should be sent to Trace Kershaw, Yale University, 60 College St, New Haven, CT 06510 (e-mail: trace.kershaw{at}yale.edu). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link.

Objectives. We sought to determine whether an HIV prevention program bundled with group prenatal care reduced sexually transmitted infection (STI) incidence, repeat pregnancy, sexual risk behavior, and psychosocial risks.

Methods. We conducted a randomized controlled trial at 2 prenatal clinics. We assigned pregnant women aged 14 to 25 years (N = 1047) to individual care, attention-matched group care, and group care with an integrated HIV component. We conducted structured interviews at baseline (second trimester), third trimester, and 6 and 12 months postpartum.

Results. Mean age of participants was 20.4 years; 80% were African American. According to intent-to-treat analyses, women assigned to the HIV-prevention group intervention were significantly less likely to have repeat pregnancy at 6 months postpartum than individual-care and attention-matched controls; they demonstrated increased condom use and decreased unprotected sexual intercourse compared with individual-care and attention-matched controls. Subanalyses showed that being in the HIV-prevention group reduced STI incidence among the subgroup of adolescents.

Conclusion. HIV prevention integrated with prenatal care resulted in reduced biological, behavioral, and psychosocial risks for HIV.






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