Pregnancy as a window of opportunity for HIV prevention: effects of an HIV intervention delivered within prenatal care

Abstract

Objectives: We sought to determine whether an HIV prevention program bundled with group prenatal care reduced sexually transmitted infection (STI) incidence, repeat pregnancy, sexual risk behavior, and psychosocial risks.

Methods: We conducted a randomized controlled trial at 2 prenatal clinics. We assigned pregnant women aged 14 to 25 years (N = 1047) to individual care, attention-matched group care, and group care with an integrated HIV component. We conducted structured interviews at baseline (second trimester), third trimester, and 6 and 12 months postpartum.

Results: Mean age of participants was 20.4 years; 80% were African American. According to intent-to-treat analyses, women assigned to the HIV-prevention group intervention were significantly less likely to have repeat pregnancy at 6 months postpartum than individual-care and attention-matched controls; they demonstrated increased condom use and decreased unprotected sexual intercourse compared with individual-care and attention-matched controls. Subanalyses showed that being in the HIV-prevention group reduced STI incidence among the subgroup of adolescents.

Conclusion: HIV prevention integrated with prenatal care resulted in reduced biological, behavioral, and psychosocial risks for HIV.

Figures

FIGURE 1

CONSORT study description. Note. CP = CenteringPregnancy group prenatal care control group; CPP = CenteringPregnancy group prenatal care plus HIV prevention components; IC = standard individual prenatal care control group; STI = sexually transmitted infection.

FIGURE 2

Among young pregnant women at 2 public clinics, (a) condom use percentage by intervention condition and (b) occasions of unprotected sexual intercourse by intervention condition: Atlanta, GA, and New Haven, CT, September 2001–December 2004. Note. CP = CenteringPregnancy group prenatal care control group; CPP = CenteringPregnancy group prenatal care plus HIV prevention components; IC = standard individual prenatal care control group. Sample size was N = 1047.

FIGURE 3

Sexually transmitted infection (STI) incidence at 12 months postpartum among young pregnant women at 2 public clinics, by intervention condition and age group: Atlanta, GA, and New Haven, CT, September 2001–December 2004. Note. STI testing for chlamydia and gonorrhea only. CP = CenteringPregnancy group prenatal care control group; CPP = CenteringPregnancy group prenatal care plus HIV prevention components; IC = standard individual prenatal care control group; STI = sexually transmitted infection. Sample size was N = 1047.