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

Kershaw, Trace; Magriples, Urania; Westdahl, Claire; Rising, Sharon Schindler; Ickovics, Jeannette R.

doi:10.2105/ajph.2008.154476

Cited by 104 publications

(111 citation statements)

References 37 publications

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“…Described in detail previously, 10,11,18 CenteringPregnancy Plus begins with standard clinical intake (a history and a physical) conducted individually. Thereafter, all care occurs within the group except concerns requiring privacy or urgent medical attention.…”

Section: Methodsmentioning

confidence: 99%

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Cluster Randomized Controlled Trial of Group Prenatal Care: Perinatal Outcomes Among Adolescents in New York City Health Centers

et al. 2016

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Objectives We compared an evidence-based model of group prenatal care to traditional individual prenatal care on birth, neonatal, and reproductive health outcomes. Methods We performed a multisite cluster randomized controlled trial in 14 health centers in New York City (2008–2012). We analyzed 1148 pregnant women aged 14 to 21 years, at less than 24 weeks of gestation, and not at high obstetrical risk. We assessed outcomes via medical records and surveys. Results In intention-to-treat analyses, women at intervention sites were significantly less likely to have infants small for gestational age (< 10th percentile; 11.0% vs 15.8%; odds ratio = 0.66; 95% confidence interval = 0.44, 0.99). In as-treated analyses, women with more group visits had better outcomes, including small for gestational age, gestational age, birth weight, days in neonatal intensive care unit, rapid repeat pregnancy, condom use, and unprotected sex (P = .030 to < .001). There were no associated risks. Conclusions CenteringPregnancy Plus group prenatal care resulted in more favorable birth, neonatal, and reproductive outcomes. Successful translation of clinical innovations to enhance care, improve outcomes, and reduce cost requires strategies that facilitate patient adherence and support organizational change.

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Section: Methodsmentioning

confidence: 99%

“…10 We also documented improved outcomes among women randomized to group prenatal care that bundled reproductive health promotion (CenteringPregnancy Plus): greater than 50% reduction in rapid repeat pregnancy among all women and incident STI among adolescents. 11 …”

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confidence: 99%

Cluster Randomized Controlled Trial of Group Prenatal Care: Perinatal Outcomes Among Adolescents in New York City Health Centers

et al. 2016

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“…This study has been described previously. 17,18 Briefly, to be included, women had to be less than 24 weeks gestation, 14-25 years old, and English or Spanish speaking. All patients had public (e.g., Medicaid) or hospital assistance for complete prenatal care insurance coverage.…”

Section: Participants and Proceduresmentioning

confidence: 99%

Economic Dependence and Unprotected Sex: The Role of Sexual Assertiveness among Young Urban Mothers

et al. 2010

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In the USA, sexual intercourse is the leading route of human immunodeficiency virus transmission among women, primarily through their main partner. Because male condom use is not directly under a woman's control, gender inequalities may help shape this sexual risk behavior. To examine this association, data came from follow-up interviews of young, primarily minority, pregnant women enrolled in a prospective, randomized controlled trial. Specifically, we aimed to determine the relationship between economic dependence on a male partner and condom use, and to establish whether this relationship was mediated by sexual assertiveness. Overall, 28% of women reported being economically dependent on a male partner. Young women dependent on a male partner were 1.6 times more likely to report not using a condom at last sex than women not dependent on their partner (95% confidence interval=1.11-2.32; p=0.01). Sexual assertiveness mediated the relationship between economic dependence and condom use (Sobel=2.05, p=0.04). Coupled with past research, this study supports the premise that sexual behaviors may be rooted in a complex web of social determinants. Addressing gender inequalities in contextual factors may promote healthier decisions within sexual relationships.

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“…Randomized controlled trials demonstrating improved outcomes among women and newborns after participation in group ANC compared with standard ANC have been conducted in the United States7, 8, 9, 10, 11, 12 and Sweden,13 which the World Bank classifies as high‐income economies, and Iran,14, 15 which is classified as an upper middle‐income economy. Published benefits include increased uptake of postnatal family planning services, greater gestational age at birth and birth weight, lower incidence of sexually transmitted infections, healthier maternal weight trajectories, fewer depressive symptoms, and increased satisfaction with care 16.…”

Section: Introductionmentioning

confidence: 99%

Use of a Facilitated Group Process to Design and Implement a Group Antenatal and Postnatal Care Program in Rwanda

Sayinzoga¹,

Lundeen²,

Gakwerere³

et al. 2018

J Midwife Womens Health

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IntroductionThe government of Rwanda is exploring strategies that may reduce the incidence of prematurity and low birth weight. Large‐scale implementation of group antenatal care (ANC) and postnatal care (PNC) within the context of the Rwanda national health care system is under consideration. To launch a cluster randomized controlled trial of group ANC and PNC in 5 districts in Rwanda, the implementation team needed a customized group care model for this context and trained health care workers to deliver the program.ProcessAdapting the group ANC and group PNC model for the Rwandan context was accomplished through a group process identical to that which is fundamental to group care. A technical working group composed of 10 Rwandan maternal‐child health stakeholders met 3 times over the course of 3 months, for 4 to 8 hours each time. Their objectives were to consider the evidence on group ANC, agree on the priorities and constraints of their ANC delivery system, and ultimately define the content and structure of a combined group ANC and PNC model for implementation in Rwanda. The same group process was employed to train health care workers to act as group ANC facilitators.OutcomesA customized group ANC and PNC model and guidelines for its introduction were developed in the context of a cluster randomized controlled trial in 36 health centers. Descriptions of this model and the implementation plan are included in this article.DiscussionOur experience suggests that the group process fundamental to successful group ANC and PNC is an effective method to customize and implement this innovative health services delivery model in a new context and is instrumental in achieving local ownership.

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

Cited by 104 publications

References 37 publications

Cluster Randomized Controlled Trial of Group Prenatal Care: Perinatal Outcomes Among Adolescents in New York City Health Centers

Cluster Randomized Controlled Trial of Group Prenatal Care: Perinatal Outcomes Among Adolescents in New York City Health Centers

Economic Dependence and Unprotected Sex: The Role of Sexual Assertiveness among Young Urban Mothers

Use of a Facilitated Group Process to Design and Implement a Group Antenatal and Postnatal Care Program in Rwanda

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