Examining legal consequences of HIV-specific policies as barriers to perinatal care and drug use treatment

The National Institute on Drug Abuse, part of the Department of Health and Human Services National Institutes of Health, awarded The Trustees of Columbia University in the City of New York $172,160 on December 9, 2026, under the Drug Use and Addiction Research Programs (CFDA 93.279).

The award funds a postdoctoral fellowship to examine how HIV-specific state legal policies function as barriers to perinatal care and drug use treatment engagement among pregnant women. The research employs a mixed-methods convergent parallel design across two primary aims. Aim 1 involves creating a database of HIV-specific state features across all 50 states and the District of Columbia from 2010 to 2025. Aim 2 examines how pregnant women perceive and are affected by these state characteristics in their care-seeking behavior for both perinatal care and drug treatment, with particular attention to people who use drugs and those experiencing multiply marginalized status. The project addresses rising severe maternal morbidity rates and the increasing prevalence of opioid use disorder diagnosed at delivery, signaling inadequate access to drug treatment care during pregnancy.

Performance occurs in New York, New York. The period of performance extends from December 9, 2026, through August 14, 2029. This is classified as a Project Grant, an assistance type supporting defined research activities.

Abstract

Maternal health is a pressing public health concern in the united states. Indicators of maternal health include severe maternal morbidity, which encompasses severe consequences of labor and delivery. Rates of severe maternal morbidity have increased over time, with varying rates by state; to abate these rising rates, adequate, timely prenatal care is needed. However, structural factors, such as various state-level characteristics, may impact care engagement. One aspect of state-level attributes relevant to the pregnancy period is HIV-specific state characteristics, which create a context where people with HIV can face consequences for non-disclosure of their HIV status prior to SEX. The impact of these state-level characteristics on care engagement may be exacerbated for people who are multiply marginalized, including people who use drugs. Drug use is increasingly implicated during the perinatal period, with evidence suggesting opioid use disorder (OUD) is increasingly diagnosed at delivery, which is an indicator that pregnant women are not receiving needed drug treatment care earlier in the perinatal period. To function as a barrier to both drug treatment and perinatal care, pregnant women must be aware of HIV-specific features in their respective states; no study to date has examined how pregnant women view these state characteristics. The overarching goals of this F32 postdoctoral fellowship proposal, "examining HIV-specific state characteristics as barriers to perinatal care and drug use treatment," are to understand whether these features shape care engagement (i.e., drug treatment, perinatal care) among pregnant women, using a mixed-methods approach with a convergent parallel design. Aim 1 of this proposal will involve creating a database of HIV-specific state features in all 50 states and DC, from 2010-2025. Aim 2 will examine how pregnant women with HIV, including those who used opioids or stimulants during the prenatal period, understand and view these HIV-specific state characteristics. Interviews will explore potential mechanisms through which knowledge of HIV-specific state-level attributes impact engagement with prenatal and postpartum care, HIV-related care, and drug treatment access. Aim 3 of this proposal will leverage healthcare cost and utilization project (HCUP) inpatient and emergency department data (2010-2022) to examine how HIV-specific state characteristics impact severe maternal morbidity and substance use disorder hospitalizations among peripartum women. Findings from this F32, articulating potential harms arising from HIV-specific state-level attributes, will help to inform future interventions within the healthcare setting. Understanding barriers to care seeking, including perinatal care and drug treatment, will help clinicians to develop interventions with the goal of improving healthcare access for pregnant women. The proposed postdoctoral fellowship will allow the principal investigator to develop skills needed to transition to the next step in her career as a leading academic researcher in drug use epidemiology, maternal health, and HIV research.