Please describe your presentation and your key findings.
Studies have shown that the weekly administration of 17-alpha hydroxyprogesterone caproate (17P) starting at 16 to 20 weeks of pregnancy to week 37 is effective in reducing the rate of preterm birth. Even though 17P injections have been shown to reduce the risk of a subsequent preterm birth by 33%, it has also been found to be underutilized. Alamance County has an infant mortality rate of 8.1 deaths per 1,000 live births and is ranked in the top 25 highest infant mortality rates in the state, with complications due to preterm birth as one of the contributing factors to the infant mortality rate. Knowing that 17P, an important intervention in reducing preterm birth, was underutilized, the Alamance County Health Department (ACHD) applied for and received funding from the March of Dimes in 2018 to conduct focus groups around this topic. ACHD patients who had experienced a prior preterm birth were recruited for the six patient focus groups (n = 10). Questions were developed about their choice to use or not use 17P during a subsequent pregnancy, including their perception of the benefits and barriers of the drug. Four focus groups were also held for ACHD maternity providers, nurses and private maternity providers in the county (n=14) to discuss their perception of the effectiveness of 17P and what barriers and challenges patients may experience. Qualitative findings showed that for ACHD patients, transportation was the biggest barrier to receiving weekly 17P injections. Private providers noted that their privately insured patients often struggle with the cost of the drug. All groups emphasized the need for more education about both 17P and preterm birth. Data collected from the focus groups was used to inform the ACHD’s Infant Mortality Reduction strategies. The focus groups also inspired private providers to rally around this issue and look for ways to increase utilization at their own practices.
What is your professional background and how did you become involved in the work related to the presentation?
I work at the Alamance County Health Department as a Program Manager for our infant mortality reduction strategies. We receive recurring funding from the Women’s Health Branch of the NC Department of Health and Human Services to implement strategies to help reduce our county’s high rate of infant mortality. Some of the strategies we have implemented in the past include Centering Pregnancy, volunteer doula services, infant safe sleep initiatives and improved access to long acting reversible contraception. All of these are important strategies, but none of them directly work on the issue of preterm birth which is the biggest factor in infant death in our county, as reported by the county’s Child Fatality Taskforce. As a result, we started researching 17P as a potential strategy. By conducting a chart review, we found that only 13 ACHD maternity patients with a history of preterm birth used 17P in 2017, which represents a 23% usage rate among those eligible for the intervention. We wanted to learn why it might be underutilized, hypothesizing that many social determinants of health most likely stand in the way of women getting a weekly injection throughout their pregnancy. It felt important to talk to women in our community who have experienced preterm birth and get their ideas of what interventions would best help improve access, especially as my coursework at Gillings has emphasized this! As a result, we are piloting giving gas cards weekly to women receiving 17P, embedding additional prompts into our electronic medical records and reviewing different educational materials that can help better explain what preterm birth and 17P are.
What are some general highlights from the Conference? Was this your first time attending this particular conference?
This was my third year attending the NCPHA Fall Conference. I always enjoy networking with other public health practitioners across the state and having the chance to hear new ideas. This year it was especially exciting to meet several of my virtual classmates and professors in real life. I am always energized by this conference. This was my first time presenting at the conference. It was a great opportunity to grow professionally and I was proud to share the work we are doing at ACHD. I also received the Academic Practice Based Research Speed Round – Student Award at this year’s conference!