HIV Testing Strategies in the Perinatal Setting

NCT ID: NCT00503308

Last Updated: 2015-05-22

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

281 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-10-31

Study Completion Date

2008-02-29

Brief Summary

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The purpose of the study is to determine whether an abbreviated pretest/post-test CDC recommended counseling is as equally acceptable to prenatal patients as the standard strategy using prenatal care nurses and medical providers at San Francisco General Hospital \[SFGH\]).

Detailed Description

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Approximately 40% of HIV-infected infants in the United States in 2000 were born to women not diagnosed with their HIV prior to delivery. (1) There are now effective medical therapies to prevent perinatal transmission, including anti-retroviral therapy, but this requires diagnoses of maternal HIV prior to delivery. Both the Centers for Disease Control and Prevention (CDC) and Institute of Medicine (IOM) have published strong recommendations for universal HIV-antibody testing of pregnant women.

This will be a randomized controlled, non-inferiority trial comparing two HIV testing strategies among English and Spanish-speaking patients presenting for prenatal care at SFGH WHC over the course of approximately one year. Eligible participants will be randomized by study personnel to either standard HIV counseling and testing (control arm) or abbreviated counseling and testing (study arm). Participants will receive a standard prenatal HIV testing brochure, undergo one of two HIV counseling/testing strategies, submit blood for an HIV-1 antibody test, and will follow-up with their medical provider for HIV test results. Upon completion of counseling, participants will undergo a short, structured (Pre-test) questionnaire administered by study staff. Following testing and receipt of results, participants will complete a second (Post-test) structured questionnaire administered by study staff.

Eligible women presenting to SFGH physician or midwife prenatal clinics will be recruited, consented and randomized by study staff to either the standard or abbreviated testing strategy. The outcomes studied will be patient satisfaction and the proportion of study participants who undergo HIV testing. Potential confounder variables to be measured will include demographic characteristics, prior HIV testing history, knowledge about HIV/AIDS, attitudes towards HIV testing, HIV test result, and type of provider (physician versus midwife).

Conditions

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HIV Infections Pregnancy Related

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Participants

Study Groups

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Abbreviated Consenting

Group Type EXPERIMENTAL

Abbreviated HIV test counseling

Intervention Type PROCEDURE

abbreviated HIV pre-test counseling

Standard Consenting

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Abbreviated HIV test counseling

abbreviated HIV pre-test counseling

Intervention Type PROCEDURE

Other Intervention Names

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opt-out HIV testing

Eligibility Criteria

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Inclusion Criteria

* Women 16 years of age or above seeking prenatal care at San Francisco General Hospital

Exclusion Criteria

* Women who do not speak Spanish or English
* Women younger than 16 years of age
* Women who obtained an HIV test during the index pregnancy prior to initiation of prenatal care at SFGH
* Women known to be infected with HIV at initiation of prenatal care at SFGH
Minimum Eligible Age

16 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Pfizer

INDUSTRY

Sponsor Role collaborator

University of California, San Francisco

OTHER

Sponsor Role lead

Responsible Party

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UCSF

Principal Investigators

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Deborah Cohan, MD

Role: PRINCIPAL_INVESTIGATOR

University of California, San Francisco

Locations

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UCSF, San Francisco General Hospital

San Francisco, California, United States

Site Status

Countries

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United States

References

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Rapid HIV testing of women in labor and delivery: www.cdc.gov/hiv/pubs/rt-women.htm: Centers for Disease Control and Prevention: Divisions of HIV/AIDS Prevention, 2002.

Reference Type BACKGROUND

Sambamoorthi U, Akincigil A, McSpiritt E, Crystal S. Zidovudine use during pregnancy among HIV-infected women on Medicaid. J Acquir Immune Defic Syndr. 2002 Aug 1;30(4):429-39. doi: 10.1097/00042560-200208010-00009.

Reference Type BACKGROUND
PMID: 12138350 (View on PubMed)

Centers for Disease Control and Prevention (CDC). From the Centers for Disease Control and Prevention. Progress toward elimination of perinatal HIV infection--Michigan, 1993-2000. MMWR Morb Mortal Wkly Rep. 2002 Feb 8;51(5):93-7.

Reference Type BACKGROUND
PMID: 11892955 (View on PubMed)

Kalish LA, Pitt J, Lew J, Landesman S, Diaz C, Hershow R, Hollinger FB, Pagano M, Smeriglio V, Moye J. Defining the time of fetal or perinatal acquisition of human immunodeficiency virus type 1 infection on the basis of age at first positive culture. Women and Infants Transmission Study (WITS). J Infect Dis. 1997 Mar;175(3):712-5. doi: 10.1093/infdis/175.3.712.

Reference Type BACKGROUND
PMID: 9041351 (View on PubMed)

Newell ML. Mechanisms and timing of mother-to-child transmission of HIV-1. AIDS. 1998 May 28;12(8):831-7. doi: 10.1097/00002030-199808000-00004. No abstract available.

Reference Type BACKGROUND
PMID: 9631135 (View on PubMed)

Frenkel LM, Cowles MK, Shapiro DE, Melvin AJ, Watts DH, McLellan C, Mohan K, Murante B, Burchett S, Bryson YJ, O'Sullivan MJ, Mitchell C, Landers D. Analysis of the maternal components of the AIDS clinical trial group 076 zidovudine regimen in the prevention of mother-to-infant transmission of human immunodeficiency virus type 1. J Infect Dis. 1997 Apr;175(4):971-4. doi: 10.1086/514003.

Reference Type BACKGROUND
PMID: 9086162 (View on PubMed)

Shapiro DE, Tuomala R, Samelson R, et al. Mother-to-Child HIV Transmission Rates According to Antiretroviral Therapy, Mode of Delivery, and Viral Load (PACTG 367): Abstract #114. 9th Conference on Retroviruses and Opportunistic Infections. Seattle, WA, 2002.

Reference Type BACKGROUND

Phillips KA, Bayer R, Chen JL. New Centers for Disease Control and Prevention's guidelines on HIV counseling and testing for the general population and pregnant women. J Acquir Immune Defic Syndr. 2003 Feb 1;32(2):182-91. doi: 10.1097/00126334-200302010-00010.

Reference Type BACKGROUND
PMID: 12571528 (View on PubMed)

Centers for Disease Control and Prevention. Revised recommendations for HIV screening of pregnant women. MMWR Recomm Rep. 2001 Nov 9;50(RR-19):63-85; quiz CE1-19a2-CE6-19a2.

Reference Type BACKGROUND
PMID: 11718473 (View on PubMed)

Centers for Disease Control and Prevention (CDC). HIV testing among pregnant women--United States and Canada, 1998-2001. MMWR Morb Mortal Wkly Rep. 2002 Nov 15;51(45):1013-6.

Reference Type BACKGROUND
PMID: 12458916 (View on PubMed)

Centers for Disease Control and Prevention (CDC). Advancing HIV prevention: new strategies for a changing epidemic--United States, 2003. MMWR Morb Mortal Wkly Rep. 2003 Apr 18;52(15):329-32.

Reference Type BACKGROUND
PMID: 12733863 (View on PubMed)

Ruiz JD, Molitor F, Prussing E, Peck L, Grasso P. Prenatal HIV counseling and testing in California: women's experiences and providers' practices. AIDS Educ Prev. 2002 Jun;14(3):190-5. doi: 10.1521/aeap.14.3.190.23896.

Reference Type BACKGROUND
PMID: 12092921 (View on PubMed)

Simpson WM, Johnstone FD, Goldberg DJ, Gormley SM, Hart GJ. Antenatal HIV testing: assessment of a routine voluntary approach. BMJ. 1999 Jun 19;318(7199):1660-1. doi: 10.1136/bmj.318.7199.1660. No abstract available.

Reference Type BACKGROUND
PMID: 10373168 (View on PubMed)

Walmsley S. Opt in or opt out: what is optimal for prenatal screening for HIV infection? CMAJ. 2003 Mar 18;168(6):707-8. No abstract available.

Reference Type BACKGROUND
PMID: 12642426 (View on PubMed)

Stringer EM, Stringer JS, Cliver SP, Goldenberg RL, Goepfert AR. Evaluation of a new testing policy for human immunodeficiency virus to improve screening rates. Obstet Gynecol. 2001 Dec;98(6):1104-8. doi: 10.1016/s0029-7844(01)01631-3.

Reference Type BACKGROUND
PMID: 11755561 (View on PubMed)

Simpson WM, Johnstone FD, Boyd FM, Goldberg DJ, Hart GJ, Prescott RJ. Uptake and acceptability of antenatal HIV testing: randomised controlled trial of different methods of offering the test. BMJ. 1998 Jan 24;316(7127):262-7. doi: 10.1136/bmj.316.7127.262.

Reference Type BACKGROUND
PMID: 9472506 (View on PubMed)

Carusi D, Learman LA, Posner SF. Human immunodeficiency virus test refusal in pregnancy: a challenge to voluntary testing. Obstet Gynecol. 1998 Apr;91(4):540-5. doi: 10.1016/s0029-7844(97)00714-x.

Reference Type BACKGROUND
PMID: 9540937 (View on PubMed)

Cohan D, Gomez E, Greenberg M, Washington S, Charlebois ED. Patient perspectives with abbreviated versus standard pre-test HIV counseling in the prenatal setting: a randomized-controlled, non-inferiority trial. PLoS One. 2009;4(4):e5166. doi: 10.1371/journal.pone.0005166. Epub 2009 Apr 15.

Reference Type DERIVED
PMID: 19367335 (View on PubMed)

Other Identifiers

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2004-0319

Identifier Type: -

Identifier Source: org_study_id

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