Administrative Office
1611 NW 12 Ave.
Holtz Center, Suite 3003
Miami, FL 33136
Tel: (305) 585-5130
Fax: (305) 355-1187
HIV Prenatal Clinic
The Department's HIV Prenatal Clinic provides an invaluable service – preventing HIV transmission to babies.
One of the largest obstetrical HIV services in the U.S., the clinic provides prenatal care for 150 to 170 pregnant HIV positive women each year. Located at Ambulatory Care Center 4B, a Jackson Health System facility, the clinic is the primary provider of HIV care for pregnant women in Miami-Dade County.
Multidisciplinary Care
Prenatal care is provided by nurse practitioners under Dr. Amanda Cotter’s direct supervision. Dr. Cotter is fellowship trained in maternal-fetal medicine, a subspecialty of obstetrics that focuses on treating high-risk pregnancies. This is unique because other clinics of this kind usually provide care under an infectious diseases specialist, not a maternal-fetal medicine specialist. Since 2005, when Dr. Cotter joined the faculty, the rate of perinatal HIV transmission at the Perinatal HIV Clinic has been lower than 2%.
The clinic is staffed by University of Miami Health System employees and includes:
- Care coordinators
- Peer educator, who assists patients in accessing services, learning about clinical trials, and adhering to the appointment and medication regimens.
- Perinatal nurse, who educates patients about medication management, prenatal care, infant screening services, and helps patients prepare for labor and delivery.
- Clinical nutritionist
- Mental health team, who are part of The Healing Place, a clinic dedicated to providing compassionate, comprehensive mental health care to HIV positive individuals of all ages and their affected family members. This clinic is a service of the Department of Psychiatry and Behavioral Sciences.
Insurance is not necessary to receive treatment at the clinic. To refer a patient, or if you know you are HIV positive and pregnant, call 305-243-5832 to make an appointment.
Our History
The clinic has been providing care to HIV-positive pregnant women since the mid-1980s when UM researchers, Drs. Gwendolyn Scott, Mary Jo O’Sullivan, and Margaret Fischl, were among the first to suggest that HIV infection was transmitted from pregnant women to their infants. Since that time, UM and Jackson Health System have been at the forefront of national HIV clinical care and research efforts among pregnant women and their newborns. A formal collaboration of OB/GYN and Pediatric Infectious Disease was established in 1986 following the award of a National Institutes of Health grant to conduct a prospective study of maternal-infant HIV transmission.
Breakthrough Research
Dr. Mary Jo O’Sullivan, who served as director of the clinic until her retirement in 2005, served as co-investigator of the landmark study that led to the reduction of HIV transmission from mother to child during pregnancy. The largest number of participants was recruited at our clinic site. Published in 1994 in the New England Journal of Medicine, the study revealed that treating HIV positive pregnant women with the antiretroviral drug Zidovudine (AZT) in pregnancy, at delivery, and later treating their infants with AZT during the first six weeks of life, reduced the percentage of babies born with HIV from 25% to 8%. This has been an important study, from which more long-term studies have been initiated. The new Public Health Service guidelines for the treatment of pregnant women, released in November 2007, indicate that the three-pronged AZT regimen, antiretroviral therapy administered to the mother during pregnancy, labor and delivery, and then to the newborn, as well as elective cesarean section for women with high viral loads, can reduce the rate of perinatal HIV transmission to 2% or less.
Another important study conducted at our site was the Centers for Disease Control and Prevention funded Mother-Infant Rapid Intervention at Delivery (MIRIAD) study, which found that rapid HIV testing to pregnant women who did not know their HIV status could successfully be conducted while a woman was in labor. Since then, the labor and delivery unit at Jackson established a protocol for nursing staff to implement HIV testing to pregnant women who have no documented HIV test as standard of care. The protocol includes rapid testing upon patient consent and administration of AZT if rapid test is positive and includes specific time frames for testing and medication dosing. Before the mother and infant are discharged, the protocol requires staff to provide the mother with a two-week appointment for post-test counseling, referral to the Pediatric Infectious Disease specialist for newborn screening, a six-week post-partum appointment, medication education, and a prescription for antiretroviral therapy for the neonate.
Dr. Amanda Cotter continues to carry on HIV research in pregnant women through her participation in the multi-site trials sponsored by the International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT). Dr. Cotter also serves as member of the Perinatal HIV Guidelines committee and participated in the recent revisions released in November. She is also a member of the Florida/Caribbean AIDS Education and Training Service, and provides education and consultation services to clinicians throughout the region regarding HIV and pregnancy.
