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Consumer materials now available on using AZT to lower risk of mother-to-baby HIV transmission

The Public Health Service has released new public information materials that will help pregnant women who have the human immunodeficiency virus (HIV) make informed decisions about medical interventions that can reduce mother-to-child (perinatal) transmission of HIV, the virus that causes acquired immunodeficiency syndrome (AIDS).

In the United States alone, about 7,000 infants are born each year to HIV-positive women. As many as 2,000 of these infants will acquire the virus in utero, during childbirth, or through breastfeeding. HIV/AIDS is the seventh leading cause of death in children 1-4 years of age and the fourth leading cause of death among women 25-44 years of age.

The new consumer information explains the results of a National Institutes of Health study (AIDS Clinical Trial Group [ACTG] protocol 076), which showed that use of the antiretroviral drug zidovudine, commonly known as azidothymidine or AZT, reduced the rate of perinatal transmission of HIV by two-thirds.

The women in the study were given either AZT or a placebo beginning between 14 and 34 weeks gestation and continuing for the remainder of the pregnancy and during delivery. For the first 6 weeks of life, AZT was also given to the babies of the women who received the drug. Among children born to women who took AZT, the rate of perinatal transmission fell from one in four to one in twelve, a two-thirds reduction.

The PHS has launched a public information campaign that will target the population at greatest risk with a consumer brochure, HIV and Pregnancy: Is AZT the Right Choice for You and Your Baby? (available in English, Spanish, and Haitian Creole), and English-and Spanish-language posters, flyers, videotapes, and audiotapes. In addition, public service announcements in English and Spanish will air on radio stations targeted to African-American and Hispanic audiences in the 40 cities with the highest prevalence of HIV infection in women.

The multimedia educational materials were developed by an interagency group within the Department of Health and Human Services, in collaboration with the Columbia University School of Public Health. The information in these materials is presented in a straightforward and objective manner, to help women weigh the risks and benefits of AZT therapy during pregnancy. To put a real-life face on the decisionmaking process, the materials include stories of women who have been faced with this decision.

The educational materials will be distributed through federally funded facilities, such as clinics and community health centers. In addition, HHS' Health Care Financing Administration has arranged for special joint efforts with four States to reach pregnant women with the information.

For more information, or to order copies of HIV and Pregnancy: Is AZT the Right Choice for You and Your Baby? (Publication No. 96-0007) or other materials, call the HIV/AIDS Treatment Information Service (ATIS), toll free, at 800-448-0440 or 800-243-7012 (TTY service for the deaf).

New grants awarded for study of health care markets

AHCPR has awarded grants totaling $1.4 million in first year funding to study changes that are now reshaping America's health care system as a result of complex market forces. Most of the projects will be completed in 2 years or less.

According to AHCPR Administrator Clifton R. Gaus, Sc.D., the proposals selected for funding are of exceptionally high quality and represent AHCPR's sense of priorities for the in-depth study of health care market forces.

The delivery of health care services in the United States is now undergoing dramatic transformation. Changes include, for example, mergers and consolidation of health care organizations, a move toward greater collective purchasing of health care and health insurance, and innovations that are brought about by single large employers—providers of employee health benefits—who are seeking more value for their health care dollar. The growth of managed care organizations and a decline in the number of independent hospitals and physician groups are among the most obvious changes that have occurred in response to market forces.

There is limited information about the types of market structures and organizations that are emerging in the health care sector. Even less is known about how these structures are influencing the competitive strategies of health providers and insurers, the quality and types of care available in the market, or the price and equitable distribution of services.

Some key research questions to be addressed by the grantees include: How has HMO market structure influenced formation of provider networks? What have been the effects on costs and premiums? How do rural providers perceive and respond to market changes? Do hospital mergers reduce costs? Are savings passed on to consumers as lower prices? Are savings retained by hospitals as higher profits?

Answers to these and other research questions are needed as a basis for discussion by all participants in the health care system—in both the public and private sectors. According to Dr. Gaus, findings from this research will provide purchasers and providers of health care with an evidence-based understanding of what structural and behavioral changes are taking place in health care markets, how and why these changes are occurring, and their implication.

Following is a list of recipients and amounts of awards for new AHCPR grants for research on topics related to market forces in a changing health care system:

  • Georgetown University, Washington, DC, "Effects of managed care on physicians and their practices," $183,000.
  • University of Alabama, Birmingham, "Effects of managed care on hospital and physician integration," $160,000.
  • University of Pennsylvania, Philadelphia, "Impact of HMOs on integrated networks and services," $139,000.
  • University of Illinois, Chicago, "Impact of managed care on physician markets," $150,000.
  • University of Nebraska Medical Center, Omaha, "Impact of changing markets on rural health care providers," $108,000.
  • University of Pennsylvania, Philadelphia, "Efficiency in hospitals: Do HMOs and preferred provider organizations 'buy right'?" $185,000.
  • University of Minnesota, Minneapolis, "Effects of horizontal hospital mergers on efficiency, profitability and consumer prices," $128,000.
  • RAND Corporation, Santa Monica, CA, "Health care markets, managed care, and hospital performance," $195,000.
  • Carnegie Mellon University, Pittsburgh, PA, "Determinants of HMO efficiency from 1985 to 1994," $88,000.
  • Virginia Commonwealth University, Richmond, "Performance of strategic hospital collectives," $140,000.

The studies of health care markets funded by AHCPR complement studies of changes in health care financing and organization sponsored by the Robert Wood Johnson Foundation (RWJ), a national philanthropy devoted to health care. Efforts were made to coordinate the research portfolios of AHCPR and RWJ to avoid project duplication.

AHSR announces February 15 deadline for abstracts

The Association for Health Services Research (AHSR) will hold its annual meeting June 9-11, 1996, in Atlanta, GA. AHSR has issued its 13th annual call for abstracts for research on critical issues in health care policy, delivery, and clinical practice to be presented in 15 sessions at the 1996 annual meeting. Abstracts also may be presented at a poster session during the meeting.

For more information or to request a copy of the call for abstracts, contact AHSR's annual meeting staff at (202) 223-2477.

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