Those receiving prenatal care and antiviral treatments already were more likely to get AZT
How well are medical advances translated into the community practice? In the case of HIV-infected pregnant women, where they get their care may matter the most.
In 1994, researchers were stunned when they found that the anti-HIV drug AZT, taken during the second and third trimester, could reduce mother-newborn transmission of AIDS by as much as two-thirds. Along with national educational efforts, New York State mounted an information campaign, sending letters to physicians and other health care specialists, even conducting marketing campaigns to high-risk groups.
Researchers at Jefferson Medical College asked, how quickly would community practitioners, notoriously slow to change, adopt new practices to treat their often poor, pregnant, HIV-infected patients? What's more, which patients would benefit?
While community physicians in New York State responded rapidly to the findings, patients in certain health care settings benefited more than others. The researchers found that women who were more likely to receive antiretroviral treatment during pregnancy were those who already were being treated at a medical center that performed HIV clinical trials, those who were being treated at sites paid by the state to deliver a range of specific HIV-focused services to persons enrolled on Medicaid, those who were receiving prenatal care, or those receiving methadone.
"Where women get their medical care plays a major role in getting access to important medical advances," says Barbara Turner, M.D., professor of medicine at Thomas Jefferson University in Philadelphia, who led the study.
Dr. Turner, who is Director of Health Care Research at the Jefferson Center for Research and Medical Education in Health Care, and her co-workers report their findings June 15 in the Annals of Internal Medicine.