We plan to recruit a total of 381 HIV infected and high risk women into the study, with each consortium site enrolling an equal number of women. The Washington Metropolitan Surveillance Area (WMSA) has the sixth highest cumulative number of AIDS cases among metropolitan areas nationally, and the second highest prevalence of HIV infection in women of child-bearing age in the nation as of 1991.1 Of the estimated 7,557 HIV infected women in the WMSA, 75% are African-American, 19% are White, and 3% are Hispanic.2 The 658 HIV infected women the consortium currently treats reflect the ethnic distribution of HIV infection in the WMSA as a whole. About one-quarter of our patients have CD4 cell counts below 200 cells/mm3, and one-half are between 200 and 500, and the remaining quarter are above 500. HIV seronegative controls will be recruited from high risk populations in order to determine the rate of incident HIV seroconversion and identify factors that increase risk of seroconversion. At the center of our Retention and Recruitment plan are five full-time Community Outreach Worker/Patient Advocates (OW). Each OW will work directly with the community and our patient population to recruit and screen patients for the WIHS study. Our ORs will also act as case managers for WIHS women to assess their needs and minimize barriers to study participation. We plan to provide numerous incentives and benefits such as on-site child care, food coupons and transportation vouchers. There is a key investigator and OW at each site. Our gynecologic Nurse Practitioner and LPN will travel to each site weekly. A gynecologist with subspecialty training in oncology and obstetrics will visit each site monthly to oversee more difficult exams and provide basic gynecologic care. Laboratories will be processed on a daily basis at a single site -- Maryland Medical Labs -- and study-wide specimens will be returned to Georgetown daily for processing storage and shipment. Case report forms will be completed on site and returned to Georgetown for computer entry on a weekly basis. Information from questionnaires, physical examinations, laboratories and chart abstractions will be elicited to follow and collect data on the natural history of HIV disease. Women enrolled in the study will be linked to preexisting medical, social, and educational resources within the community in order to streamline delivery of services.
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