FIMR/HIV Case Review

Overview of the Project

The use of antiretroviral medications and other therapies for HIV-infected pregnant women have been breakthroughs in the fight against perinatal HIV infection and have contributed to the significant decline in mother-to-child HIV transmission in this country.

The Centers for Disease Control and Prevention (CDC) estimates that there are between 100 and 300 cases of mother-to-child HIV transmission each year in the United States and recommends that all of these cases be reviewed as sentinel health events.

The FIMR/HIV Prevention Methodology is an adaptation of the National Fetal and Infant Mortality Review (NFIMR) process and is designed to review cases of perinatal HIV exposure in communities with elevated rates of HIV infection among women of child-bearing age.

The goal of the program is to identify and address missed opportunities for perinatal HIV prevention and treatment in targeted communities and improve systems of care for pregnant women with HIV infection and their families.

The FIMR/HIV Prevention Methodology follows the key steps of the traditional FIMR process:

Gather medical information about the woman and her baby from as many records as are available.

Conduct an interview with the mother, if she agrees.

Convene a Case Review Team (CRT) composed of experts in maternal child health and HIV to review case summaries developed from the medical information and the interviews; identify issues; and make recommendations for change, where appropriate

Convene a Community Action Team (CAT) composed of a diverse group of community leaders to review the CRT recommendations; prioritize identified issues; and design and implement interventions to improve service systems and resources for HIV-infected pregnant women and their families.

Confidentiality is a Key Component of the Process

All information obtained from the medical records and the interviews is strictly confidential. Cases are assigned a number and the names of the mothers, the babies, the providers, the institutions involved, and any other identifying information, such as birth dates for both mother and baby, are removed.

No case is reviewed without the mother's specific written consent.

The FIMR/HIV Prevention Methodology is a collaborative project among the CDC, CityMatCH, the American College of Obstetricians and Gynecologists (the College), and NFIMR. The project began with three pilot sites— Baton Rouge, LA; Detroit, MI; and Jacksonville, FL— in 2005. The experiences of these sites are documented in FIMR/HIV: Pilot Project Overview & Lessons Learned.