Family Planning &Preconception HIV Testing Recent Centers for Disease Control and Prevention human immunodeficiency virus (HIV) testing and preconception health recommendations call for the provision of routine, universal HIV screening for women of reproductive age. Although limited, evidence suggests that up to 50% of pregnant women with HIV infection in the US are initially detected via prenatal screening. While this detection rate illustrates the relative success of efforts to promote prenatal screening, it also points to a critical gap in preconception screening practices, as unawareness of infection status at time of conception represents an important """"""""missed opportunity"""""""" for early detection. Federal Title X Family Planning Program grantees, such as the applicant organization, are uniquely positioned to deliver routine preconception HIV testing services to a racially and ethnically diverse, and primarily low-income, patient population. Yet, efforts to elevate routine preconception HIV screening to the status of a core family planning service have met with mixed success at best. Given the critical role that health care providers play in institutionalizing practice guidelines and influencing patient receptivity to services, we hypothesize that the integration of a brief, evidence-based counseling model could effect positive changes in both provider and patient preconception testing behaviors. Thus, we propose to adapt the health care provider delivered Options risk reduction intervention, which is based on the Information-Motivation- Behavioral Skills model of HIV prevention and uses Motivational Interviewing techniques to deliver risk reduction messages.
The specific aims of the proposed study are to: 1. Conduct formative research with family planning providers and patients to understand the prevalence of preconception-based HIV testing among patients, to determine how often providers offer HIV testing to their patients, and to identify the informational, motivational, and behavioral skills facilitators of and barriers to HIV testing. 2. Modify the content of the Options intervention to ensure that it targets deficits, and capitalizes on strengths, in information, motivation and behavioral skills, relative to preconception-based HIV testing;We will use various quantitative (survey) and qualitative (focus group, free list, semi-structured interview) methodologies. We will also explore patient receptivity to preconception HIV testing and the extent to which environmental-level factors impede or facilitate HIV service delivery. The proposed study will then: 3. Conduct a pilot study to assess the feasibility of translating the adapted intervention into family planning settings;4. Assess the potential effect of the adapted intervention on preconception-based HIV testing uptake in family planning settings. 5. Examine the extent to which the effects of the adapted intervention are moderated by individual (e.g., provider, patient) and contextual (e.g., clinic environment) factors. We hypothesize that: a) family planning providers delivering services at intervention site clinics will show improvement in their routine preconception HIV testing intentions and b) rates of preconception HIV testing will be higher at intervention site family planning clinics when compared to clinics with continuing standard of care. To support attainment of the study aims, Deborah Cornman, PhD, a key member of the University of Connecticut's Center for Health, Intervention, and Prevention team that developed Options, will serve as a co-investigator, and a Community Advisory Board that includes Title X family planning provider and patient representatives will provide guidance in all phases of the proposed study. In addition, two clinicians who have successfully integrated family planning services at their respective Philadelphia HIV clinics will serve as clinical consultants. The intervention content and evaluation will be documented as a replication manual. Integration of the intervention at familyplanning agencies nationwide will promote routine preconception testing for HIV as the gateway to treatment, care, and prevention for women of reproductive age.
To properly plan pregnancy prevention and childbearing in the context of HIV risk, there is an urgent need to increase the proportion of all women receiving routine, voluntary preconception HIV testing and related services. The proposed study will assess the beliefs that influence both practitioner's preconception testing intentions and behaviors as well as patient receptivity to testing. A brief, theory- based intervention to promote the uptake of HIV testing services in Title X family planning settings will be designed and evaluated. Integration of the intervention at family planning agencies nationwide will promote routine preconception testing for HIV as the gateway to treatment, care, and prevention for women of reproductive age.
