This project will utilize a research database on HIV care in New Jersey, created by merging multiple administrative and claims record systems, to investigate the impact of drug use, drug abuse treatment, psychiatric comorbidity, characteristics of HIV-related health care, and other factors on access to prenatal care and adherence to recommendations for antiviral treatment during pregnancy to prevent vertical transmission of HIV. The study will investigate characteristics of health care (including drug abuse treatment) received during and preceding pregnancies ending in childbirth, among women in New Jersey who participate in Medicaid and who are reported with AIDS or HIV to the state surveillance system. Among HIV+ injection drug using women, we will determine the extent to which drug abuse treatment is received before and during pregnancy and distinguish consistent from episodic treatment use; we will also determine the proportion and characteristics of women with HIV giving birth who experience emergency room visits, hospitalizations, and other acute health care events indicative of active drug abuse before or during pregnancy. We will determine the proportion and characteristics of HIV+ women giving birth who have care needs that are complicated by severe mental illness or other psychiatric comorbidity and the types of psychiatric comorbidity which are experienced. We will investigate the receipt of prenatal care and the use of zidovudine (ZDV) during pregnancy to prevent vertical transmission of HIV; determine the timing of initiation of ZDV treatment during pregnancies and the extent to which use is consistent or episodic; and relate these patterns to drug abuse treatment and other aspects of the health care received before and during pregnancy as well as to psychiatric comorbidity, calendar year, stage of HIV illness, age, race, participation in a case-managed Medicaid waiver program, and other respondent characteristics. These analyses will provide crucial information on the connections among drug abuse treatment, medical care of HIV disease, and prevention of vertical transmission; help identify ways in which the health care system (including drug abuse treatment programs) can best address the health care needs of women with HIV; and identify barriers to prevention of vertical transmission of HIV and means of overcoming these barriers.
