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Background:  Perinatal HIV care presents special prevention and treatment challenges. Clinicians require information and expert consultation on a range of issues, including:  risk of transmission; rapid and standard HIV testing; ART in pregnancy, labor, and delivery; and care and testing of the newborn. In September 2004 the HRSA/AETC National HIV Clinicians’ Consultation Center (NCCC) expanded to include a free 24-hour telephone consultation service, the National Perinatal HIV Consultation and Referral Service (Perinatal Hotline). To anticipate the types of questions to be asked, we reviewed calls during the preceding 23 months to the NCCC’s HIV Telephone Consultation Service (Warmline), which provides consultation across the entire range of HIV topics.

Methods:  Warmline calls relating to perinatal issues from November 2002 through September 2004 were reviewed and categorized by topic. Search topics included: perinatal, prenatal, pregnancy, infant, and neonatal.

Results:  A total of 278 perinatal calls were identified among 4010 Warmline calls. The most common questions regarded ART in pregnancy, n = 100 (36.0%), including 21 questions about use of ART in labor and delivery. One third of the calls for which ART histories were available were about ART-naïve pregnant women. There were 59 (21.2%) questions about management of exposed infants, including HIV testing (20) and choice of post-exposure prophylaxis (26). There were 40 (14.4%) questions regarding HIV testing of the pregnant woman, including 4 specifically about rapid testing. Other topics included:  general information, guidelines and protocols (n = 20, 7.2%); preconception counseling and contraception (n = 17; 6.1%); management of opportunistic infections (n = 13; 4.7%); mode of delivery (n = 11; 3.9%); and other topics (n = 18; 6.5%).

Conclusions:  Clinicians’ clinical questions about perinatal HIV transmission and perinatal care fall into 3 major areas:  ART in pregnancy (36.0%), care of exposed infants (21.2%), and HIV testing (14.4%). The urgency of some of these clinical questions, especially questions about HIV management in labor and delivery and care of infants, supports the need for a 24-hour consultation service. It is expected that the percentage of questions regarding HIV testing will increase dramatically as the emphasis on testing pregnant women and the availability of rapid testing becomes more widespread.

Keywords: Perinatal; Testing; Infant