Use of the perinatal and neonatal clinical history form in the Dominican Republic and its implications for improving testing and treatment of HIV and syphilis during pregnancy
M. Connolly1, C. Bautista2, A. Castro3
1University of Michigan, Ann Arbor, United States, 2COPRESIDA, Santo Domingo, Dominican Republic, 3Harvard Medical School, Global Health and Social Medicine, Boston, United States
As a component of the Latin American and Caribbean Initiative for the
Integration of Prenatal Care with the Testing and Treatment of HIV and Syphilis
(ILAP), we conducted the Perinatal and Neonatal Clinical History Form Project
(PANC) in the Dominican Republic (DR). In countries where the Perinatal and
Clinical History Form (HCP) is used, the frequency of completion of the form
and the reliability of data reporting are unknown. The objectives of the PANC Project
were to investigate the current use of the HCP, identify weaknesses of the HCP
as a tool for the collection of data about HIV and syphilis, and obtain
suggestions for the improvement of data collection and reporting.
Seventeen semi-structured interviews were conducted in 2009, in addition to
direct observation of the process of taking clinical histories and the trajectory
of both the physical form and the data it contained. Interview notes were coded
to identify common themes and to create flowcharts. Information was
supplemented by review of government and research documents.
In the DR, maternal-infant healthcare providers are familiar with the HCP and
use it on a daily basis, but its utility as a tool for improving clinical
follow-up and epidemiological analysis is not emphasized. The HCP is filled out
incompletely and no system exists for manual or electronic compilation of data
from the HCP. All interviewees agreed upon the importance of including
variables related to the clinical management of HIV and/or syphilis.
The results of this study demonstrate that there exists a need to establish a
mechanism for the monitoring and evaluation of HCP use, spanning from when it
is filled out during a prenatal visit to the extraction and analysis of epidemiological
data, with the ultimate objective of improving prenatal and neonatal clinical
care for HIV, syphilis, and other perinatal conditions.
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