Introduction: The rate of HIV vertical transmission has drastically decreased with the implementation of ACTG 076 using ZDV during pregnancy, delivery, and newborn administration. The issue facing health care providers is the practical application of this protocol within clinical and community settings.

Project Description: The Helena Hatch Special Care Center (HHSCC), is a SPNS/WIN-funded program providing coordinated medical care, counseling, education and social services for women with HIV in the out-patient, hospital, and home environment. In response to PHS recommendations for reducing perinatally acquired HIV, HHSCC developed guidelines to:

• enhance multidisciplinary management of the client,

• track system and client adherence to the protocol,

• respond to clients' needs throughout the perinatal process.

These guidelines were created with multispecialty input (medicine, pediatrics, and obstetrics) as well as client interaction. They include instructions for clinical management and cross-disciplinary communication during prenatal intrapartum, and postpartum periods, as well as forms and checklists to be implemented throughout the process.

Project Results: Since the inception of these guidelines there has been improved coordination among members of the multispecialty team throughout the three phases of the 076 protocol. Therapeutic adherence has increased at both the provider and client levels. Vertical HIV transmission rates continue to decline (1994=44.4%, 1995=9%, 1996<5%).

Findings and Implications: Application of ACTG 076 Protocol and the Helena Hatch Special Care Center guidelines have significantly reduced vertical transmission in St. Louis. Implementation of 076 at the local level can be better realized when there is a clearly defined mechanism for communication and tracking among providers at all levels and disciplines, and attention to client needs.