Translating clinical trial results into practice: the effect of an AIDS clinical trial on prescribed antiretroviral therapy for HIV-infected pregnant women.
BACKGROUND
The success of Pediatric AIDS Clinical Trials Group (PACTG) Protocol 076 in preventing vertical HIV transmission prompted intensive efforts to inform lay-persons and professionals about the trial's results.


OBJECTIVE
To explore community responsiveness to these efforts by assessing temporal, maternal, and health care factors associated with prescribed antiretroviral therapy before and after PACTG Protocol 076.


METHODS
Retrospective cohort study.


METHODS
New York State Medicaid program.


METHODS
2607 HIV-infected women who delivered a living child between January 1993 and September 1996.


METHODS
Adjusted odds of being prescribed antiretroviral treatment in the second or third trimester for women who delivered in period 1 (during the trial [January 1993 to February 1994]), period 2 (after the trial's end and announcement of the results to publication of the results [March 1994 to November 1994]), and period 3 (after publication of the trial results [December 1994 to September 1996]).


RESULTS
The adjusted odds of being prescribed antiretroviral therapy increased 21% per month in period 2 and decreased to 3% per month in period 3. In all time periods, the adjusted odds of being prescribed antiretroviral therapy were at least 60% greater (P < 0.05) for women who were treated at an institution that performed HIV clinical trials, received HIV-focused ambulatory care, or had adequate prenatal care visits. After the trial, women receiving methadone treatment had at least twofold (95% CI, 1.5- to 4.3-fold) greater adjusted odds of being prescribed antiretroviral therapy than women who did not take any illicit drugs. Latin-American women, older women, and women born in the United States had greater adjusted odds (P < 0.05) of being prescribed treatment in period 3.


CONCLUSIONS
Community practice responded rapidly to efforts to disseminate the results of PACTG Protocol 076; however, the absolute increase in prescribed therapy was greatest for women who had adequate prenatal visits or were receiving HIV-focused care, care at a site that performed clinical trials, or methadone therapy.
Turner
B J
BJ
Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107-5083, USA. barbara.turner@mail.tju.edu
Newschaffer
C J
CJ
Zhang
D
D
Fanning
T
T
Hauck
W W
WW
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D002986:Clinical Trials as Topic; D003153:Community Health Services / Q000592:standards; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008484:Medicaid; D008691:Methadone / Q000627:therapeutic use; D009518:New York; D016017:Odds Ratio; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011295:Prenatal Care; D012189:Retrospective Studies; D013223:Statistics as Topic; D014481:United States
D000701:Analgesics, Opioid; D019380:Anti-HIV Agents; D008691:Methadone