Implementing CenteringPregnancy Group Prenatal Care for Minority Women Living with HIV at an Urban University Hospital

Abstract

Introduction: Pregnant women with HIV require sustained education and support throughout pregnancy to achieve healthy perinatal outcomes. To enhance prenatal care for women with HIV, the Prenatal Immunology Service at the University of Miami Miller School of Medicine adapted the Centering Healthcare Institute's CenteringPregnancy curriculum to include HIV content. Nurse-midwives introduced the curriculum in a pilot project to learn if women would enroll in group prenatal care. A retrospective record review was conducted to evaluate perinatal outcomes among women with HIV who received prenatal care in a group setting.Methods: Data were collected from the electronic health records of women with HIV who received either CenteringPregnancy-HIV group prenatal care or traditional prenatal care between March 2015 and July 2016. Sociodemographic factors, HIV immune markers, and pregnancy and birth outcomes were reviewed. Univariate and bivariate statistics and multiple regression models assessed differences between women in CenteringPregnancy-HIV group prenatal care compared with women with HIV in traditional care.Results: Among women with HIV who received prenatal care during the pilot project, 128 met eligibility criteria for review. Perinatal outcomes were analyzed for 117 women who had a live birth; of these, 14 participated in CenteringPregnancy-HIV group prenatal care, and 103 received traditional care. Demographic profiles were similar in both groups. No significant differences in perinatal outcomes were observed among women in CenteringPregnancy-HIV group prenatal care compared with women with HIV in traditional prenatal care.Discussion: Women with HIV can often feel stigmatized and isolated. Group prenatal care can foster patient engagement, self-management, and social support to improve adherence to antiretroviral and other health regimens that promote healthy outcomes for both woman and newborn. Although results of this pilot study were not statistically significant, they show that CenteringPregnancy-HIV group prenatal care may be an option for women with HIV, but the benefits need further exploration in larger studies.

Pre‐Exposure Prophylaxis for HIV Infection and the Role of the Women's Health Care Provider in HIV Prevention

“…Direct maternity and well‐woman care for seropositive individuals have been successfully implemented in settings where interprofessional collaboration models are the norm 56,58 . Additionally, group prenatal care with midwives has been evaluated as a potentially supportive setting for seropositive individuals 59 . Midwives can provide excellent care to individuals living with HIV when they have supportive relationships with primary infectious disease providers and collaborating obstetricians.…”

A Model of Group Prenatal Care for Patients with Prenatally Diagnosed Fetal Anomalies

“…Centering-Pregnancy, first described in 1996, has been used in a variety of settings for women with specialized needs, including lowincome women, Spanish-speaking women, and women in the military, as well as among pregnant women affected by opioid use disorder and women who are HIV positive. [16][17][18][19][20] This article reviews the process used to adapt and implement the CenteringPregnancy prenatal care model to suit the needs of families who receive a prenatal diagnosis of a fetal abnormality and who receive care at a referral center. Challenges and outcomes of the program are presented, as are implications for implementing group prenatal care programs in other unique settings.…”

“…To address the needs of this specialized population, a team at Children's Hospital of Philadelphia explored the implementation of group prenatal care based on the CenteringPregnancy model for women with pregnancies affected by prenatally diagnosed fetal anomalies. CenteringPregnancy, first described in 1996, has been used in a variety of settings for women with specialized needs, including low‐income women, Spanish‐speaking women, and women in the military, as well as among pregnant women affected by opioid use disorder and women who are HIV positive …”

Evaluation of human immunodeficiency virus–adapted group prenatal care

“…Potter et al compared 14 women who participated in Centering with 103 women receiving traditional individual care at the University of Miami and found no significant difference in select perinatal outcomes. 15 We know of no other quantitative evaluations of group prenatal care for women living with HIV.…”

“…14 One previous study has evaluated select perinatal outcomes for group prenatal care for pregnant women living with HIV; however, their cohort only included 14 women who participated in the Centering program. 15 Harris Health System in Houston, TX, cares for approximately 40 to 50 pregnant women living with HIV per year. Before 2013, prenatal care in this system was provided through a standard individual care model.…”