1
|
Rosenthal M, Stolz A, Haskin L, Leung SYJ, Wong C, O'Grady T, Swain CA, Kaufman S. Prevalence of Repeat Prenatal HIV Screening in New York State. J Womens Health (Larchmt) 2024; 33:1240-1247. [PMID: 38864110 DOI: 10.1089/jwh.2023.0835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Description: New York State Department of Health (NYSDOH) recommends that all pregnant patients receive human immunodeficiency virus (HIV) screening during pregnancy. This study assessed the prevalence of repeat prenatal HIV testing and factors associated with receipt of the recommended tests. Methods: Data from the NYSDOH newborn screening program were used to randomly select pregnant persons without HIV who delivered a liveborn infant in 2017. Receipt of repeat testing was defined as an initial HIV test in the first or second trimesters and the final in the third trimester (relaxed); or an initial test in the first trimester and the final in the third trimester (strict). Relative risks (RRs) and 95% confidence intervals were calculated in bivariate analyses. Adjusted RRs were calculated to determine associations between demographic and clinical factors and receipt of repeat HIV testing. Results: The cohort included 2,225 individuals. Roughly one quarter (24%) received the recommended tests in the first or second and third trimesters and 17% received them in the first and third trimesters. Individuals who reported Hispanic or Asian race/ethnicities, had government-funded insurance, started prenatal care in the first trimester, delivered in New York City, or received prenatal hepatitis C virus screening were significantly more likely to receive repeat testing using either definition. Conclusions: Despite the benefits and cost-effectiveness, the prevalence of repeat prenatal HIV screening during the third trimester remains persistently low. Improved messaging and targeted education and resources to assist prenatal providers could reinforce the importance of repeat testing and reduce residual perinatal HIV transmission.
Collapse
Affiliation(s)
- Mark Rosenthal
- Division of HIV/STI Epidemiology, Evaluation, and Partner Services, New York State Department of Health, Albany, New York, USA
| | - Amanda Stolz
- Division of HIV/STI Epidemiology, Evaluation, and Partner Services, New York State Department of Health, Albany, New York, USA
| | - Lisa Haskin
- Division of HIV and Hepatitis Health care, New York State Department of Health, AIDS Institute, Albany, New York, USA
| | - Shu-Yin John Leung
- Office of Program Evaluation and Research, New York State Department of Health, AIDS Institute, Albany, New York, USA
| | - Calvin Wong
- Division of HIV/STI Epidemiology, Evaluation, and Partner Services, New York State Department of Health, Albany, New York, USA
| | - Thomas O'Grady
- Division of HIV/STI Epidemiology, Evaluation, and Partner Services, New York State Department of Health, Albany, New York, USA
- University at Albany School of Public Health, Albany, New York, USA
| | - Carol-Ann Swain
- Division of HIV/STI Epidemiology, Evaluation, and Partner Services, New York State Department of Health, Albany, New York, USA
| | - Suzanne Kaufman
- Division of HIV and Hepatitis Health care, New York State Department of Health, AIDS Institute, Albany, New York, USA
| |
Collapse
|
2
|
Lampe MA, Nesheim SR, Mendoza MCB, Borkowf CB, Henderson AC, Ewing AC, Kourtis AP. Prevented perinatal HIV infections in the era of antiretroviral prophylaxis and treatment, United States, 1994-2020. Int J Gynaecol Obstet 2024; 166:126-134. [PMID: 38415793 DOI: 10.1002/ijgo.15438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE The primary aim of this serial cross-sectional analysis is to estimate the total number of prevented perinatal HIV transmissions from the time of the initial recommendation for perinatal zidovudine (ZDV) prophylaxis in 1994 through 2020 in the US. METHODS The estimated number of prevented transmissions was calculated as annual differences between expected and observed numbers of perinatal HIV transmissions. Annual expected number of transmissions was estimated by multiplying the annual number of births to women with HIV by 0.2255 (22.55%), i.e., the transmission rate of the control group in the ACTG Protocol 076 trial. We used published point estimates or, if only ranges were given, the midpoints of those ranges as the best estimates of the annual numbers of births to women with HIV and infants with perinatal HIV. When data were not available, we linearly interpolated or extrapolated the available data to obtain estimated numbers for each year. RESULTS Between 1978 and 2020, the approximate number of live births to women with HIV was 191 267 (95% confidence interval [CI] 190 392-192 110) and for infants with diagnosed perinatal HIV, it was 21 379 (95% CI 21 088-21 695). Since 1994, the annual number of infants born with HIV decreased from 1263 (95% CI 1194-1333) to 33 in 2019 (95% CI 22-45) and 36 in 2020 (95% CI 25-48), corresponding to a 97% reduction. Cumulatively, an estimated total of 22 732 (95% CI 21 340-24 462) perinatal HIV infections were prevented from 1994 through to 2020. CONCLUSION The elimination of perinatal HIV transmission-accompanied by the cumulative number of prevented cases exceeding that of perinatal HIV infections-is a major public health achievement in the US.
Collapse
Affiliation(s)
- Margaret A Lampe
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Steven R Nesheim
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria C B Mendoza
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Craig B Borkowf
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexis C Henderson
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- DLH Corporation, Atlanta, Georgia, USA
| | - Alexander C Ewing
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Athena P Kourtis
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
3
|
Luo Y, Zhou YH, Zhao H. Can newborn infants with positive HIV soon after birth be diagnosed with intrauterine infection? J Infect Public Health 2023; 16:1722-1728. [PMID: 37734127 DOI: 10.1016/j.jiph.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/15/2023] [Accepted: 08/17/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) can occur intrauterine, intrapartum, and postpartum. Currently, infants with confirmed positive results in virological tests before 48 h of age are defined as having intrauterine infection. AIM We herein review the literature that identifies emerging challenges in diagnosing intrauterine HIV infection to rethink the current diagnostic criteria. FINDINGS A number of reports have shown that some infants who were diagnosed with intrauterine HIV infection after birth became negative for HIV in the subsequent follow-ups, including negative HIV antibodies at the age of 12-18 months. Such "clearance" of HIV was attributed to various reasons: neonatal antiretroviral treatment (ART), false positivity, strong host immune response, or unknown factors in maternal breast milk. DISCUSSIONS Positive HIV tests in newborn infants shortly after birth do not necessarily indicate HIV infection, because maternal HIV can enter fetal circulation intrapartum due to the repetitive, strong uterine contractions. The infants are therefore exposed to, but may not yet be infected with HIV at that time. The current diagnostic criteria cannot differentiate HIV exposure from HIV infection, leading to so-called "challenges in diagnosing intrauterine HIV infection". Those infants diagnosed with intrauterine infection who cleared HIV later were less likely to have been truly infected with HIV, but more likely to have been exposed to HIV. Moreover, we suggest that the determination of HIV antibody titers in infants' serial serum samples can provide valuable information to distinguish intrapartum exposure from intrauterine infection.
Collapse
Affiliation(s)
- Yuqian Luo
- Department of Pathology and Laboratory Medicine, Nanjing Drum Tower Hospital and Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Jiangsu, China
| | - Yi-Hua Zhou
- Department of Pathology and Laboratory Medicine, Nanjing Drum Tower Hospital and Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Jiangsu, China; Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing Medical University, Jiangsu, China.
| | - Hong Zhao
- Department of Infectious Diseases, Second Hospital of Nanjing, Southeast University, Nanjing, China.
| |
Collapse
|
4
|
Tsega NT, Belay DG, Asratie MH, Gashaw M, Endalew M, Aragaw FM. Individual and community-level determinants and spatial distribution of prenatal HIV test uptake in Ethiopia: Spatial and multilevel analysis. Front Public Health 2023; 11:962539. [PMID: 36895690 PMCID: PMC9989264 DOI: 10.3389/fpubh.2023.962539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Human immunodeficiency virus (HIV) testing and counseling services are routine prenatal care services for the prevention of mother-to-child transmission of HIV. Although the prevalence of HIV infection is high among women, evidence suggests that the uptake of HIV testing during prenatal services in Ethiopia is scarce. Therefore, the aim of this study was to investigate individual- and community-level determinants and the spatial distribution of prenatal HIV test uptake in Ethiopia based on the 2016 Ethiopian Demographic and Health Survey. Methods Data were accessed from the 2016 Ethiopian Demographic and Health Survey. A total weighted sample of 4,152 women aged 15-49 years who gave birth in the 2 years preceding the survey were included in the analysis. The Bernoulli model was fitted using SaTScan V.9.6 to identify cold-spot areas and ArcGIS V.10.7 to explore the spatial distribution of prenatal HIV test uptake. Stata version 14 software was used to extract, clean, and analyze the data. A multilevel logistic regression model was used to identify the individual- and community-level determinants of prenatal HIV test uptake. An adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI) was used to declare significant determinants of prenatal HIV test uptake. Results The prevalence of HIV test uptake was 34.66% (95% CI: 33.23, 36.13%). The spatial analysis revealed that the distribution of prenatal HIV test uptake was significantly varied across the country. In the multilevel analysis, the following individual and community-level determinants were significantly associated with prenatal HIV test uptake: women who attained primary education (AOR = 1.47, 95% CI: 1.15, 1.87) and secondary and higher education (AOR = 2.03, 95% CI: 1.32, 3.11); women from middle (AOR = 1.46; 95% CI: 1.11, 1.91) and rich household wealth status (AOR = 1.81; 95% CI: 1.36, 2.41); those who had health facility visits in the last 12 months (AOR = 2.17; 95% CI: 1.77, 2.66); women who had higher (AOR = 2,07; 95% CI: 1.66, 2.59) and comprehensive HIV-related knowledge (AOR = 2.90; 95% CI: 2.09, 4.04); women who had moderate (AOR = 1.61; 95% CI: 1.27, 2.04), lower (AOR = 1.52; 95% CI: 1.15, 1.99), and no stigma attitudes (AOR = 2.67; 95% CI: 1.43, 4.99); those who had awareness of MTCT (AOR = 1.83; 95% CI: 1.50, 2.24); those from rural areas (AOR = 0.31; 95% CI: 0.16, 0.61); high community level of education for women (AOR =1.61; 95% CI: 1.04, 2.52); and those living in large central (AOR = 0.37; 95% CI: 0.15, 0.91) and small peripheral areas (AOR = 0.22; 95% CI: 0.08, 0.60). Conclusion In Ethiopia, prenatal HIV test uptake had significant spatial variations across the country. Both individual- and community-level determinants were found to be associated with prenatal HIV test uptake in Ethiopia. Hence, the impact of these determinants should be recognized while developing strategies in "cold spot" areas of prenatal HIV test uptake to enhance prenatal HIV test uptake in Ethiopia.
Collapse
Affiliation(s)
- Nuhamin Tesfa Tsega
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Moges Gashaw
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mastewal Endalew
- Department of Environmental and Occupational Health and Safety, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
5
|
Punglia RS, Hassett MJ. Variation in Cardiac Dose Explains a "Fraction" of the Disparities Among Breast Cancer Patients. J Natl Cancer Inst 2022; 114:1570-1571. [PMID: 35916721 PMCID: PMC9745427 DOI: 10.1093/jnci/djac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Rinaa S Punglia
- Correspondence to: Rinaa S. Punglia, MD, MPH, Department of Radiation Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA (e-mail: )
| | - Michael J Hassett
- Harvard Medical School, Boston, MA, USA,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the current standards of care for both HIV treatment and HIV prevention in 2019. RECENT FINDINGS Current HIV treatment is started as soon as feasible in a person with HIV infection and consists of a three-drug oral daily antiretroviral regimen, consisting of two nucleoside analogue reverse transcriptase inhibitors combined with a third drug, either an integrase inhibitor, a non-nucleoside reverse transcriptase inhibitor, or a protease inhibitor. Present treatment regimens are potent, convenient, generally well tolerated and durable, and lead to a normal life expectancy. Present antiretroviral-based HIV prevention strategies focus on treating people with HIV infection with antiretrovirals as soon as feasible to reduce their risk of transmitting to others, and providing two-drug pre-exposure prophylaxis (PrEP) and three-drug post-exposure prophylaxis (PEP) to those HIV-uninfected individuals who are at risk for HIV infection. PrEP is highly effective when used correctly. Further data on early antiretroviral therapy and PrEP are needed to demonstrate any impact on HIV epidemic control. SUMMARY HIV treatment and HIV prevention have improved markedly in recent years due to the development of oral antiretrovirals that are potent, convenient, and generally well tolerated, and lead to virologic suppression and decreased HIV transmission.
Collapse
|
7
|
Venkatesh KK, Morrison L, Tuomala RE, Stek A, Read JS, Shapiro DE, Livingston EG. Profile of Chronic Comorbid Conditions and Obstetrical Complications Among Pregnant Women With Human Immunodeficiency Virus and Receiving Antiretroviral Therapy in the United States. Clin Infect Dis 2021; 73:969-978. [PMID: 33768226 DOI: 10.1093/cid/ciab203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate the frequency and associated characteristics of chronic comorbid conditions and obstetrical complications among pregnant women with human immunodeficiency virus (HIV) and receiving antiretroviral therapy (ART) in comparison to those without HIV. METHODS We compared 2 independent concurrent US pregnancy cohorts: (1) with HIV (International Maternal Pediatric Adolescent AIDS Clinical Trials Protocol P1025, 2002-2013) and (2) without HIV (Consortium for Safe Labor Study, 2002-2007). Outcomes were ≥2 chronic comorbid conditions and obstetrical complications. For women with HIV, we assessed whether late prenatal care (≥14 weeks), starting ART in an earlier era (2002-2008), and a detectable viral load at delivery (≥400 copies/mL) were associated with study outcomes. RESULTS We assessed 2868 deliveries (n = 2574 women) with HIV and receiving ART and 211 910 deliveries (n = 193 170 women) without HIV. Women with HIV were more likely to have ≥2 chronic comorbid conditions versus those without HIV (10 vs 3%; adjusted OR [AOR]: 2.96; 95% CI: 2.58-3.41). Women with HIV were slightly less likely to have obstetrical complications versus those without HIV (both 17%; AOR: .84; 95% CI: .75-.94), but secondarily, higher odds of preterm birth <37 weeks. Late entry to prenatal care and starting ART in an earlier era were associated with a lower likelihood of ≥2 chronic comorbidities and obstetrical complications; detectable viral load at delivery was associated with a higher likelihood of obstetric complications. CONCLUSIONS Pregnant women with HIV receiving ART have more chronic comorbid conditions, but not necessarily obstetrical complications, than their peers without HIV.
Collapse
Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio, USA
| | - Leavitt Morrison
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ruth E Tuomala
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Alice Stek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer S Read
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, USA
| | - David E Shapiro
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth G Livingston
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| |
Collapse
|
8
|
McKinney J, Jackson J, Sangi-Haghpeykar H, Hickerson L, Hawkins J, Peters Y, Levison J. HIV-Adapted Group Prenatal Care: Assessing Viral Suppression and Postpartum Retention in Care. AIDS Patient Care STDS 2021; 35:39-46. [PMID: 33571047 DOI: 10.1089/apc.2020.0249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Viral suppression and postpartum retention in care have far-reaching health implications for pregnant women living with HIV and their children, yet remain public health challenges. Prenatal care presents a unique opportunity to engage pregnant women in care. The purpose of this study is to evaluate whether group prenatal care is effective in impacting these outcomes for pregnant women living with HIV. A retrospective cohort study was performed of all women living with HIV who obtained prenatal care from a community-based health center between 2013 and 2019. Women who spoke English or Spanish, remained within the system, and had not participated in group prenatal care previously were included. Women self-selected a prenatal care model: 85 selected group care and 109 elected individual care. Group prenatal care followed a standard Centering Pregnancy® curriculum with the addition of HIV-related topics. The primary outcomes of the study were viral suppression (viral load <20 copies/mL) and postpartum retention in care (attending at least one or two visits with HIV primary care within 12 months postpartum). After adjusting for potential confounding factors, women who participated in group prenatal care were significantly more likely to have at least one HIV primary care visit postpartum {adjusted odds ratio (aOR) = 2.71 [95% confidence interval (CI 1.14-6.46)]; p = 0.024}, and had a trend for achieving viral suppression by the time of delivery [aOR = 2.29 (95% CI 0.94-5.55); p = 0.068]. We have demonstrated that group prenatal care for pregnant women living with HIV is feasible and effective, with positive impacts on retention in care and viral suppression, factors that affect long-term outcomes from patients living with HIV.
Collapse
Affiliation(s)
- Jennifer McKinney
- Department of Maternal Fetal Medicine and Baylor College of Medicine, Houston, Texas, USA
| | - Josef Jackson
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Haleh Sangi-Haghpeykar
- Department of Maternal Fetal Medicine and Baylor College of Medicine, Houston, Texas, USA
| | - Latia Hickerson
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas, USA
| | - Joanna Hawkins
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Yvette Peters
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas, USA
| | - Judy Levison
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas, USA
| |
Collapse
|
9
|
Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus. Nurs Res 2020; 69:197-209. [PMID: 31972851 DOI: 10.1097/nnr.0000000000000422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Maintaining adherence to antiretroviral therapy (ART) is a significant challenge for human immunodeficiency virus (HIV)-infected racial and ethnic minority adolescents and young adults (youth). Given the consequences of suboptimal ART adherence, there is a pressing need for an expanded understanding of adherence behavior in this cohort. OBJECTIVES As part of an exploratory sequential, mixed-methods study, we used qualitative inquiry to explore adherence information, motivation, and behavioral skills among HIV-infected racial and ethnic minority youth. Our secondary aim was to gain an understanding of the contextual factors surrounding adherence behavior. METHODS The information-motivation-behavioral skills model (IMB model) was applied to identify the conceptual determinants of adherence behavior in our target population, along with attention to emergent themes. In-depth, individual, semistructured interviews, including open-ended questions with probes, were conducted with a convenience sample of HIV-infected racial and ethnic minority youth (ages 16-29 years), receiving ART and with evidence of virologic failure (i.e., detectable HIV viral load). New participants were interviewed until information redundancy was reached. Qualitative interviews were digitally recorded, transcribed verbatim, and analyzed using Atlas.ti (v8). Directed content analysis was performed to generate categories and broad themes. Coding was initially conceptually driven (IMB model) and shifted to a data-driven approach, allowing for the discovery of key contextual factors that influence adherence behavior in this population. Methodological rigor was ensured by member checks, an audit trail, thick descriptive data, and triangulation of data sources. RESULTS Twenty racial and ethnic minority participants (mean age = 24.3 years, 55.0% male) completed interviews. We found adherence information was understood in relation to HIV biomarkers; adherence motivation and behavioral skills were influenced by stigma and social context. We identified five primary themes regarding ART self-management: (a) emerging adulthood with a chronic illness, (b) stigma and disclosure concerns, (c) support systems and support deficits, (d) mental and behavioral health risks and challenges, and (e) mode of HIV transmission and perceptions of power and control. DISCUSSION Key constructs of the IMB model were applicable to participating HIV-infected youth yet did not fully explain the essence of adherence behavior. As such, we recommend expansion of current adherence models and frameworks to include known contextual factors associated with ART self-management among HIV-infected racial and ethnic minority youth.
Collapse
|
10
|
Jhaveri R. Screening for Hepatitis C Virus: How Universal Is Universal? Clin Ther 2020; 42:1434-1441. [PMID: 32712026 PMCID: PMC7376340 DOI: 10.1016/j.clinthera.2020.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 12/19/2022]
Abstract
In March and April of 2020, public health authorities issued major updates to screening recommendations for hepatitis C virus infection. With the rise in cases driven by injection drug use coupled with access to highly effective therapies promising a cure, all adults aged ≥18 years should receive one-time hepatitis C virus antibody screening in any health care setting. Although the recommendation is dubbed "universal," this commentary reviews the details of the recommendations and discusses the high-risk populations not entirely captured with these changes.
Collapse
Affiliation(s)
- Ravi Jhaveri
- Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Box 20, Chicago, IL, USA.
| |
Collapse
|
11
|
Aslam MV, Owusu-Edusei K, Nesheim SR, Gray KM, Lampe MA, Dietz PM. Trends in Women With an HIV Diagnosis at Delivery Hospitalization in the United States, 2006-2014. Public Health Rep 2020; 135:524-533. [PMID: 32649273 DOI: 10.1177/0033354920935074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The risk of mother-to-child HIV transmission can be reduced to ≤0.5% if the mother's HIV status is known before delivery. This study describes 2006-2014 trends in diagnosed HIV infection documented on delivery discharge records and associated sociodemographic characteristics among women who gave birth in US hospitals. METHODS We analyzed data from the 2006-2014 National Inpatient Sample and identified delivery discharges and women with diagnosed HIV infection by using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We used a generalized linear model with log link and binomial distribution to assess trends and the association of sociodemographic characteristics with an HIV diagnosis on delivery discharge records. RESULTS During 2006-2014, an HIV diagnosis was documented on approximately 3900-4400 delivery discharge records annually. The probability of having an HIV diagnosis on delivery discharge records decreased 3% per year (adjusted relative risk [aRR] = 0.97; 95% CI, 0.94-0.99), with significant declines identified among white women aged 25-34 (aRR = 0.93; 95% CI, 0.88-0.97) or those using Medicaid (aRR = 0.93; 95% CI, 0.90-0.97); among black women aged 25-34 (aRR = 0.95; 95% CI, 0.92-0.99); and among privately insured women who were black (aRR = 0.96; 95% CI, 0.92-0.99), Hispanic (aRR = 0.92; 95% CI, 0.86-0.98), or aged 25-34 (aRR = 0.96; 95% CI, 0.92-0.99). The probability of having an HIV diagnosis on delivery discharge records was greater for women who were black (aRR = 8.45; 95% CI, 7.56-9.44) or Hispanic (aRR = 1.56; 95% CI, 1.33-1.83) than white; for women aged 25-34 (aRR = 2.33; 95% CI, 2.12-2.55) or aged ≥35 (aRR = 3.04; 95% CI, 2.79-3.31) than for women aged 13-24; and for Medicaid recipients (aRR = 2.70; 95% CI, 2.45-2.98) or the uninsured (aRR = 1.87; 95% CI, 1.60-2.19) than for privately insured patients. CONCLUSION During 2006-2014, the probability of having an HIV diagnosis declined among select sociodemographic groups of women delivering neonates. High-impact prevention efforts tailored to women remaining at higher risk for HIV infection can reduce the risk of mother-to-child HIV transmission.
Collapse
Affiliation(s)
- Maria Vyshnya Aslam
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kwame Owusu-Edusei
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven R Nesheim
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristen Mahle Gray
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret A Lampe
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patricia Marie Dietz
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
12
|
McKinney J, Hickerson L, Guffey D, Hawkins J, Peters Y, Levison J. Evaluation of human immunodeficiency virus-adapted group prenatal care. Am J Obstet Gynecol MFM 2020; 2:100150. [PMID: 33345881 DOI: 10.1016/j.ajogmf.2020.100150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Efforts to further decrease perinatal transmission of HIV include efforts to improve engagement and retention in prenatal care. Group prenatal care has been reported to have benefits in certain other high-risk groups of pregnant women but has not been previously evaluated in pregnant women living with HIV. OBJECTIVE This study aimed to evaluate changes in HIV knowledge, stigma, social support, depression, self-efficacy, and medication adherence after HIV-adapted group prenatal care. STUDY DESIGN All women living with HIV who presented for prenatal care at ≤30 weeks' gestation in Harris Health System (Houston, TX) between September 2013 and December 2017 were offered either group or individual HIV-focused prenatal care. Patients were recruited for the study at their initial prenatal visit. HIV topics, such as HIV facts, disclosure, medication adherence, safe sex and conception, retention in care, and postdelivery baby testing, were added to the standard CenteringPregnancy curriculum (ten 2-hour sessions per pregnancy). Knowledge and attitudes toward factors associated with adherence to HIV treatment regimens (stigma, loneliness, perceived social support, and depressive symptoms) were compared on written pre- and postsurveys. Surveys included 58 items derived from validated scales, with Likert and dichotomous responses. McNemar's test, Wilcoxon signed-rank test, and paired t-tests compared pre- and postsurvey responses. RESULTS A total of 190 women living with HIV received prenatal care in the clinic during the study period, 93 (49%) of whom participated in CenteringHIV. A total of 66 Centering participants enrolled in the study and 42 of those completed the pre- and postsurveys. Among women in the Centering program who completed pre- and postsurveys, significant differences were noted with improved perceived social support from family (P=.011) and friends (P=.005), decreased depression (Edinburg Postnatal Depression Scale, ≥10; 43% vs 18%; P<.001; Edinburg Postnatal Depression Scale score mean (standard deviation), 9.3 (5.8) pre vs 5.2 (4.9) post; P<.001), and decreased missed medication doses related to depressed mood (P=.014). No statistically significant differences were noted in HIV knowledge, HIV stigma, attitude, or self-efficacy. CONCLUSION HIV-focused group prenatal care may positively affect perceived social support and depression scores, factors that are closely associated with antiretroviral adherence and retention in the care for pregnant women living with HIV.
Collapse
Affiliation(s)
- Jennifer McKinney
- Department of Obstetrics and Gynecology, Harris Health System, Houston, TX; Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX
| | - Latia Hickerson
- Department of Obstetrics and Gynecology, Harris Health System, Houston, TX
| | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX
| | - Joanna Hawkins
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX; School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Yvette Peters
- Department of Obstetrics and Gynecology, Harris Health System, Houston, TX
| | - Judy Levison
- Department of Obstetrics and Gynecology, Harris Health System, Houston, TX; Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX.
| |
Collapse
|
13
|
Liu XI, Momper JD, Rakhmanina NY, Green DJ, Burckart GJ, Cressey TR, Mirochnick M, Best BM, van den Anker JN, Dallmann A. Prediction of Maternal and Fetal Pharmacokinetics of Dolutegravir and Raltegravir Using Physiologically Based Pharmacokinetic Modeling. Clin Pharmacokinet 2020; 59:1433-1450. [PMID: 32451908 DOI: 10.1007/s40262-020-00897-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Predicting drug pharmacokinetics in pregnant women including placental drug transfer remains challenging. This study aimed to develop and evaluate maternal-fetal physiologically based pharmacokinetic models for two antiretroviral drugs, dolutegravir and raltegravir.
Collapse
Affiliation(s)
- Xiaomei I Liu
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, USA.
| | - Jeremiah D Momper
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Natella Y Rakhmanina
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, USA
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - Dionna J Green
- Office of Pediatric Therapeutics, US Food and Drug Administration, Silver Spring, MD, USA
| | - Gilbert J Burckart
- Office of Clinical Pharmacology, US Food and Drug Administration, Silver Spring, MD, USA
| | - Tim R Cressey
- PHPT/IRD 174, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | | | - Brookie M Best
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - John N van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, USA
- Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - André Dallmann
- Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
- Clinical Pharmacometrics, Bayer, Leverkusen, Germany
| |
Collapse
|
14
|
HIV Screening During Pregnancy in a U.S. HIV Epicenter. Infect Dis Obstet Gynecol 2020; 2020:8196342. [PMID: 32454582 PMCID: PMC7229534 DOI: 10.1155/2020/8196342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/11/2020] [Accepted: 03/20/2020] [Indexed: 11/30/2022] Open
Abstract
Background The CDC and ACOG have issued guidelines for HIV screening in pregnancy for patients living in areas with high prevalence of HIV in order to minimize perinatal vertical transmission. There is a lack of data examining providers' compliance with these guidelines in at-risk patient populations in the United States. Objective To evaluate if HIV screening in pregnant women was performed according to guidelines at a large, urban, tertiary care medical center in South Florida. Study Design. A retrospective review was performed on 1270 prenatal and intrapartum records from women who delivered a live infant in 2015 at a single institution. Demographic and outcome data were chart abstracted and analyzed using arithmetic means and standard deviations. Results Of the 1270 patients who met inclusion criteria, 1090 patients initiated prenatal care in the first or second trimester and delivered in the third trimester. 1000 (91.7%) patients were screened in the first or second trimester; however, only 822 (82.2%) of these were retested in the third trimester during prenatal care. Among the 178 patients lacking a third trimester test, 159 (89.3%) received rapid HIV testing upon admission for delivery. Of the 1090 patients who initiated prenatal care in the first or second trimester and delivered in the third trimester, 982 (90.1%) were screened in accordance with recommended guidelines. Of the 1270 patients initiating care in any trimester, 24 (1.9%) had no documented prenatal HIV test during prenatal care, however 22 (91.7%) had a rapid HIV test on admission for delivery. Two (0.16%) patients were not tested prenatally or prior to delivery. Conclusion Despite 99.8% of women having at least one HIV screening test during pregnancy, there is room for improvement in routine prenatal screening in both early pregnancy and third trimester prior to onset of labor in this high-risk population.
Collapse
|
15
|
Shihan H, Arsenault S, Secord E. Perinatal HIV Transmission: Missed Opportunities and Proposed Solutions. Neoreviews 2020; 20:e79-e85. [PMID: 31261088 DOI: 10.1542/neo.20-2-e79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Much progress has been made in the elimination of perinatal human immunodeficiency virus (HIV). Since the 1980s, the transmission rate from pregnant women to their children has dropped from approximately 25% to less than 1% in resource-rich areas. Routine HIV testing in pregnancy, the introduction of multidrug antiretroviral therapy for pregnant women, and the recognition that HIV viral load directly correlates with viral transmission have all led to the elimination of perinatal HIV. However, there are still missed opportunities that could further minimize transmission.
Collapse
|
16
|
Drumhiller K, Geter A, Elmore K, Gaul Z, Sutton MY. Perceptions of Patient HIV Risk by Primary Care Providers in High-HIV Prevalence Areas in the Southern United States. AIDS Patient Care STDS 2020; 34:102-110. [PMID: 32202928 DOI: 10.1089/apc.2019.0219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The southern United States accounted for 52% of new HIV diagnoses in 2015. Visits to primary care providers (PCPs) offer opportunities for routine HIV screening. However, of at-risk persons in the United States who visited a health care provider within the previous year, >75% were not offered a test for HIV. Perceptions of patient population risk by PCPs could offer insight into these missed opportunities, and inform development of HIV testing interventions for PCPs to increase routine screening. During April-October 2017, we conducted online surveys regarding PCP's perceptions of patient HIV risk in six areas of the South with high-HIV prevalence. Surveys queried HIV-related knowledge, beliefs, attitudes, and practices. Free-text responses to the question "Are there any unique or special risk factors relating to HIV infection in your patient population?" were analyzed using NVivo for applied thematic analysis. Of 526 respondents, the mean age was 47 years with 65% white, 13% Asian/other, 13% black, 6% Hispanic/Latino; 71% female; 93% straight/heterosexual; and 35% offered HIV screening correctly based on standard of care. Main themes revealed were as follows: (1) provider perceptions of patient risk factors (e.g., "injection drug use is rampant"), (2) provider perceptions of patient barriers to access and care (e.g., "concern for parental notification and cost for treatment"), and (3) provider misconceptions of HIV risk and patient stigmatization (e.g., "I have a low-risk population"). Our findings suggest that PCPs in the South may warrant education regarding local HIV prevalence and routine HIV screening and prevention practices.
Collapse
Affiliation(s)
- Kathryn Drumhiller
- Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, Georgia
- Chenega Professional and Technical Services, Herndon, Virginia
| | - Angelica Geter
- Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, Georgia
| | - Kim Elmore
- Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, Georgia
| | - Zaneta Gaul
- Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, Georgia
- ICF, Atlanta, Georgia
| | - Madeline Y. Sutton
- Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, Georgia
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia
| |
Collapse
|
17
|
Jiménez de Ory S, Ramos JT, Fortuny C, González-Tomé MI, Mellado MJ, Moreno D, Gavilán C, Menasalvas AI, Piqueras AI, Frick MA, Muñoz-Fernández MA, Navarro ML. Sociodemographic changes and trends in the rates of new perinatal HIV diagnoses and transmission in Spain from 1997 to 2015. PLoS One 2019; 14:e0223536. [PMID: 31647824 PMCID: PMC6812742 DOI: 10.1371/journal.pone.0223536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/22/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There are not enough nationwide studies on perinatal HIV transmission in connection with a combination of antiretroviral treatments in Spain. Our objectives were to study sociodemographic changes and trends in the rates of HIV diagnoses and perinatal transmission in Spain from 1997 to 2015. METHODS A retrospective study using data from Spanish Paediatric HIV Network (CoRISpe) and Spanish Minimum Basic Data Set (MDBS) was performed. HIV- diagnosed children between 1997 and 2015 were selected. Sociodemographic, clinical and immunovirological data of HIV-infected children and their mothers were studied in four calendar periods (P1: 1997-2000; P2: 2001-2005; P3: 2006-2010; P4: 2011-2015). Rates of perinatal HIV diagnoses and transmission from 1997 to 2015 were calculated. RESULTS A total of 532 HIV-infected children were included in this study. Of these children, 406 were Spanish (76.3%) and 126 immigrants (23.7%). A decrease in the number of HIV diagnoses, 203 (38.2%) children in the first (P1), 149 (28%) in the second (P2), 130 (24.4%) in the third (P3) and 50 (9.4%) in the fourth (P4) calendar periods was studied. The same decrease in the Spanish HIV-infected children (P1, 174 (46.6%), P2, 115 (30.8%), P3, 65 (17.4%) and P4, 19 (5.1%)) was monitored. However, an increase in the number of HIV diagnoses by sexual contact (P1: 0%; P2: 1.3%; P3: 4.6%; P4: 16%) was observed. The rates of new perinatal HIV diagnoses and perinatal transmission in Spanish children decreased from 0.167 to 0.005 per 100,000 inhabitants and 11.4% to 0.4% between 1997 and 2015, respectively. CONCLUSIONS A decline of perinatal HIV diagnoses and transmission was observed. However, an increase of teen-agers HIV diagnoses with sexual infection was studied. Public awareness campaigns directed to teen-agers are advisable to prevent HIV infection by sexual contact.
Collapse
Affiliation(s)
- Santiago Jiménez de Ory
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), CoRISpe, Madrid, Spain
| | - José Tomas Ramos
- Servicio de Pediatría, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Claudia Fortuny
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues del Llobregat, Spain
| | - María Isabel González-Tomé
- Servicio de Infecciosas Pediátricas, Hospital Universitario Doce de Octubre, Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria José Mellado
- Pediatrics, Immunodeficiencies and Infectious Diseases Unit, Hospital Universitario La Paz, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - David Moreno
- Department of Pediatrics, Regional Maternal-Child University Hospital, Malaga, Spain
- IBIMA Multidisciplinary Group for Pediatric Research, Malaga, Spain, Malaga University, Malaga, Spain
| | - César Gavilán
- Department of Paediatrics, University Clinical Hospital of San Juan de Alicante, San Juan de Alicante, Alicante, Spain
- Department of Paediatrics, Miguel Hernández University of Elche, Campus of Sant Joan d'Alacant, Alicante, Spain
| | | | - Ana Isabel Piqueras
- Department of Pediatric Surgery, and Department of Pediatrics, Hospital La Fe, Valencia, Spain
| | - M. Antoinette Frick
- Tropical Medicine and International Health Unit. Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Angeles Muñoz-Fernández
- Section Immunology, Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain, Spanish HIV HGM BioBank, Madrid, Spain
| | - Maria Luisa Navarro
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Medical School, Universidad Complutense de Madrid, Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | | |
Collapse
|
18
|
Follow up of HIV perinatal exposure and accomplishment of strategies to reduce the risk of viral transmission, experience in a reference hospital in Medellín. ACTA ACUST UNITED AC 2019; 39:66-77. [PMID: 31529835 DOI: 10.7705/biomedica.v39i3.4450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Indexed: 11/21/2022]
Abstract
Introduction: Prevention of mother-to-child transmission of the human immunodeficiency virus (HIV) is essential to limit the spread of the disease. Colombian data about HIV infection in pregnancy are scarce, as well as on the results of the strategies used worldwide to reduce perinatal transmission.
Objective: To describe the characteristics and outcomes of pregnant women infected with HIV and their children in a reference center in Medellín.
Materials and methods: We conducted a retrospective observational study for the 2012-2015 period by studying the clinical records of newborns exposed to HIV and their mothers. We evaluated the characteristics of prenatal care, deliveries, and infant postnatal care, as well as the follow-up data to confirm or exclude HIV transmission.
Results: We included 106 infants and their mothers. We found that 39,6% of mothers knew about the HIV diagnosis before pregnancy and 58,5% were diagnosed during pregnancy; 95.3% of them attended prenatal controls, but only 46.5% as of the first trimester; 95% of them received antiretrovirals, but 23.9% started therapy just during the third trimester. Only 63% of women had a viral load for HIV after 34 weeks of gestation. None of the 103 children with follow up had confirmed presence for HIV and in 88% of them, it was discarded.
Conclusions: No cases of perinatal HIV transmission were found in the study. However, difficulties and delays persist in prenatal care, in timely maternal follow-up to confirm or discard HIV, and for early detection of maternal co-infections and their effects on newborns.
Collapse
|
19
|
Abstract
The number of infants born with HIV in the United States has decreased for years, approaching the Centers for Disease Control and Prevention's incidence goal for eliminating perinatal HIV transmission. We reviewed recent literature on perinatal HIV transmission in the United States. Among perinatally HIV-exposed infants (whose mothers have HIV, without regard to infants' HIV diagnosis), prenatal and natal antiretroviral use has increased, maternal HIV infection is more frequently diagnosed before pregnancy and breast-feeding is uncommon. In contrast, mothers of infants with HIV are tested at a lower rate for HIV, receive prenatal care less often, receive antiretrovirals (prenatal and natal) less often and breastfeed more often. The incidence of perinatal HIV remains 5 times as high among black than white infants. The annual number of births to women with HIV was estimated last for 2006 (8700) but has likely decreased. The numbers of women of childbearing age living with HIV and HIV diagnoses have decreased. The estimated time from HIV infection to diagnosis remains long among women and men who acquired HIV heterosexually. It is important to review the epidemiology and to continue monitoring outcomes and other health indicators for reproductive age adults living with HIV and their infants.
Collapse
|
20
|
Gnanashanmugam D, Rakhmanina N, Crawford KW, Nesheim S, Ruel T, Birkhead GS, Chakraborty R, Lawrence R, Jean-Philippe P, Jayashankar L, Hoover A, Statton A, DʼSouza P, Fitzgibbon J, Hazra R, Warren B, Smith S, Abrams EJ. Eliminating perinatal HIV in the United States: mission possible? AIDS 2019; 33:377-385. [PMID: 30475262 PMCID: PMC6355361 DOI: 10.1097/qad.0000000000002080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: In 2015, only 53 infants born in the United States acquired HIV - the lowest recorded number of perinatal HIV infections. Recognizing this significant achievement, we must acknowledge that the United States has not yet reached the goal of eliminating perinatal HIV transmission. This analysis describes different approaches to perinatal HIV preventive services among five states and the District of Columbia as case studies. Continuous focus on improving identification, surveillance and prevention of HIV infection in pregnant women and their infants is necessary to reach the goal of eliminating perinatal HIV transmission in the United States.
Collapse
Affiliation(s)
- Devasena Gnanashanmugam
- Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Natella Rakhmanina
- Children's National Medical Center, Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
| | - Keith W Crawford
- Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Steven Nesheim
- Centers for Disease Control and Prevention (Division of HIV/AIDS Prevention), Atlanta, Georgia
| | - Theodore Ruel
- University of California- San Francisco, San Francisco, California
| | | | | | | | - Patrick Jean-Philippe
- Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Lakshmi Jayashankar
- Columbus Technologies Inc., Contractor to National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Ashley Hoover
- Louisiana State Department of Health, Baton Rouge, Louisiana
| | - Anne Statton
- Pediatric AIDS Chicago Prevention Initiative, Chicago, Illinois
| | - Patricia DʼSouza
- Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Joseph Fitzgibbon
- Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | | | - Somer Smith
- Emory University School of Medicine, Atlanta, Georgia
- Theratechnologies, Inc., Montreal, Quebec, Canada
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health and Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| |
Collapse
|
21
|
Gross MS, Taylor HA, Tomori C, Coleman JS. Breastfeeding with HIV: An Evidence-Based Case for New Policy. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2019; 47:152-160. [PMID: 30994076 PMCID: PMC7053566 DOI: 10.1177/1073110519840495] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To help eliminate perinatal HIV transmission, the US Department of Health and Human Services recommends against breastfeeding for women living with HIV, regardless of viral load or combined antiretroviral therapy (cART) status. However, cART radically improves HIV prognosis and virtually eliminates perinatal transmission, and breastfeeding's health benefits are well-established. In this setting, pregnancy is increasing among American women with HIV, and a harm reduction approach to those who breastfeed despite extensive counseling is suggested. We assess the evidence and ethical justification for current policy, with attention to pertinent racial and health disparities. We first review perinatal transmission and breastfeeding data relevant to US infants. We compare hypothetical risk of HIV transmission from breastmilk to increased mortality from sudden infant death syndrome, necrotizing enterocolitis and sepsis from avoiding breastfeeding, finding that benefits may outweigh risks if mothers maintain undetectable viral load on cART. We then review maternal health considerations. We conclude that avoidance of breastfeeding by women living with HIV may not maximize health outcomes and discuss our recommendation for revising national guidelines in light of autonomy, harm reduction and health inequities.
Collapse
Affiliation(s)
- Marielle S Gross
- Marielle S. Gross, M.D., M.B.E., is a Hecht-Levi postdoctoral research fellow in the Berman Institute of Bioethics at Johns Hopkins University where she recently completed residency training in Gynecology & Obstetrics. She attended medical school at the University of Florida, and previously completed degrees in Philosophy, Jewish Ethics and Bioethics at Columbia University, the Jewish Theological Seminary, and New York University, respectively. Holly A. Taylor, Ph.D., M.P.H., is a Core Faculty member of the Johns Hopkins Berman Institute of Bioethics and Associate Professor in the Department of Health Policy and Management (HPM), Bloomberg School of Public Health. Dr. Taylor received her B.A. from Stanford University, her M.P.H. from the School of Public Health at the University of Michigan and her Ph.D. in health policy with a concentration in bioethics from the Bloomberg School of Public Health, Johns Hopkins University. Cecilia Tomori, Ph.D., studied biology and education at Swarthmore College and obtained her Ph.D. in Anthropology from the University of Michigan in 2011. She completed a postdoctoral fellowship at Johns Hopkins School of Public Health and served as faculty there between 2013-2017. Jenell S. Coleman, M.D., M.P.H., is associate professor in the Johns Hopkins School of Medicine Department of Gynecology and Obstetrics with a joint appointment in the Department of Medicine and is the medical director of the John's Hopkins Women's Health Center. Dr. Coleman earned her M.D. from the University of Pennsylvania School of Medicine and completed Ob/Gyn residency at the University of California, Los Angeles. She completed a fellowship in reproductive infectious diseases at the University of California, San Francisco and received an M.P.H. from the University of California, Berkeley
| | - Holly A Taylor
- Marielle S. Gross, M.D., M.B.E., is a Hecht-Levi postdoctoral research fellow in the Berman Institute of Bioethics at Johns Hopkins University where she recently completed residency training in Gynecology & Obstetrics. She attended medical school at the University of Florida, and previously completed degrees in Philosophy, Jewish Ethics and Bioethics at Columbia University, the Jewish Theological Seminary, and New York University, respectively. Holly A. Taylor, Ph.D., M.P.H., is a Core Faculty member of the Johns Hopkins Berman Institute of Bioethics and Associate Professor in the Department of Health Policy and Management (HPM), Bloomberg School of Public Health. Dr. Taylor received her B.A. from Stanford University, her M.P.H. from the School of Public Health at the University of Michigan and her Ph.D. in health policy with a concentration in bioethics from the Bloomberg School of Public Health, Johns Hopkins University. Cecilia Tomori, Ph.D., studied biology and education at Swarthmore College and obtained her Ph.D. in Anthropology from the University of Michigan in 2011. She completed a postdoctoral fellowship at Johns Hopkins School of Public Health and served as faculty there between 2013-2017. Jenell S. Coleman, M.D., M.P.H., is associate professor in the Johns Hopkins School of Medicine Department of Gynecology and Obstetrics with a joint appointment in the Department of Medicine and is the medical director of the John's Hopkins Women's Health Center. Dr. Coleman earned her M.D. from the University of Pennsylvania School of Medicine and completed Ob/Gyn residency at the University of California, Los Angeles. She completed a fellowship in reproductive infectious diseases at the University of California, San Francisco and received an M.P.H. from the University of California, Berkeley
| | - Cecilia Tomori
- Marielle S. Gross, M.D., M.B.E., is a Hecht-Levi postdoctoral research fellow in the Berman Institute of Bioethics at Johns Hopkins University where she recently completed residency training in Gynecology & Obstetrics. She attended medical school at the University of Florida, and previously completed degrees in Philosophy, Jewish Ethics and Bioethics at Columbia University, the Jewish Theological Seminary, and New York University, respectively. Holly A. Taylor, Ph.D., M.P.H., is a Core Faculty member of the Johns Hopkins Berman Institute of Bioethics and Associate Professor in the Department of Health Policy and Management (HPM), Bloomberg School of Public Health. Dr. Taylor received her B.A. from Stanford University, her M.P.H. from the School of Public Health at the University of Michigan and her Ph.D. in health policy with a concentration in bioethics from the Bloomberg School of Public Health, Johns Hopkins University. Cecilia Tomori, Ph.D., studied biology and education at Swarthmore College and obtained her Ph.D. in Anthropology from the University of Michigan in 2011. She completed a postdoctoral fellowship at Johns Hopkins School of Public Health and served as faculty there between 2013-2017. Jenell S. Coleman, M.D., M.P.H., is associate professor in the Johns Hopkins School of Medicine Department of Gynecology and Obstetrics with a joint appointment in the Department of Medicine and is the medical director of the John's Hopkins Women's Health Center. Dr. Coleman earned her M.D. from the University of Pennsylvania School of Medicine and completed Ob/Gyn residency at the University of California, Los Angeles. She completed a fellowship in reproductive infectious diseases at the University of California, San Francisco and received an M.P.H. from the University of California, Berkeley
| | - Jenell S Coleman
- Marielle S. Gross, M.D., M.B.E., is a Hecht-Levi postdoctoral research fellow in the Berman Institute of Bioethics at Johns Hopkins University where she recently completed residency training in Gynecology & Obstetrics. She attended medical school at the University of Florida, and previously completed degrees in Philosophy, Jewish Ethics and Bioethics at Columbia University, the Jewish Theological Seminary, and New York University, respectively. Holly A. Taylor, Ph.D., M.P.H., is a Core Faculty member of the Johns Hopkins Berman Institute of Bioethics and Associate Professor in the Department of Health Policy and Management (HPM), Bloomberg School of Public Health. Dr. Taylor received her B.A. from Stanford University, her M.P.H. from the School of Public Health at the University of Michigan and her Ph.D. in health policy with a concentration in bioethics from the Bloomberg School of Public Health, Johns Hopkins University. Cecilia Tomori, Ph.D., studied biology and education at Swarthmore College and obtained her Ph.D. in Anthropology from the University of Michigan in 2011. She completed a postdoctoral fellowship at Johns Hopkins School of Public Health and served as faculty there between 2013-2017. Jenell S. Coleman, M.D., M.P.H., is associate professor in the Johns Hopkins School of Medicine Department of Gynecology and Obstetrics with a joint appointment in the Department of Medicine and is the medical director of the John's Hopkins Women's Health Center. Dr. Coleman earned her M.D. from the University of Pennsylvania School of Medicine and completed Ob/Gyn residency at the University of California, Los Angeles. She completed a fellowship in reproductive infectious diseases at the University of California, San Francisco and received an M.P.H. from the University of California, Berkeley
| |
Collapse
|
22
|
HIV Care Continuum among Postpartum Women Living with HIV in Atlanta. Infect Dis Obstet Gynecol 2019; 2019:8161495. [PMID: 30894788 PMCID: PMC6393891 DOI: 10.1155/2019/8161495] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/04/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction While increased healthcare engagement and antiretroviral therapy (ART) adherence occurs during pregnancy, women living with HIV (WLWH) are often lost to follow-up after delivery. We sought to evaluate postpartum retention in care and viral suppression and to identify associated factors among WLWH in a large public hospital in Atlanta, Georgia. Methods Data from the time of entry into prenatal care until 24 months postpartum were collected by chart review from WLWH who delivered with ≥20 weeks gestational age from 2011 to 2016. Primary outcomes were retention in HIV care (two HIV care visits or viral load measurements >90 days apart) and viral suppression (<200 copies/mL) at 12 and 24 months postpartum. Obstetric and contraception data were also collected. Results Among 207 women, 80% attended an HIV primary care visit in a mean 124 days after delivery. At 12 and 24 months, respectively, 47% and 34% of women were retained in care and 41% and 30% of women were virally suppressed. Attending an HIV care visit within 90 days postpartum was associated with retention in care at 12 months (aOR 3.66, 95%CI 1.72-7.77) and 24 months (aOR 4.71, 95%CI 2.00-11.10) postpartum. Receiving ART at pregnancy diagnosis (aOR 2.29, 95%CI 1.11-4.74), viral suppression at delivery (aOR 3.44, 95%CI 1.39-8.50), and attending an HIV care visit within 90 days postpartum (aOR 2.40, 95%CI 1.12-5.16) were associated with 12-month viral suppression, and older age (aOR 1.09, 95% CI 1.01-1.18) was associated with 24-month viral suppression. Conclusions Long-term retention in HIV care and viral suppression are low in this population of postpartum WLWH. Prompt transition to HIV care in the postpartum period was the strongest predictor of optimal HIV outcomes. Efforts supporting women during the postpartum transition from obstetric to HIV primary care may improve long-term HIV outcomes in women.
Collapse
|
23
|
Adhikari EH, Yule CS, Roberts SW, Rogers VL, Sheffield JS, Kelly MA, McIntire DD, Barnes A. Factors Associated with Postpartum Loss to Follow-Up and Detectable Viremia After Delivery Among Pregnant Women Living with HIV. AIDS Patient Care STDS 2019; 33:14-20. [PMID: 30601060 DOI: 10.1089/apc.2018.0117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pregnant women living with HIV are at risk for loss to follow-up and viral rebound after delivery. We conducted a retrospective cohort study of women with HIV who delivered at Parkland Hospital, Dallas, to identify factors associated with postpartum loss to HIV care 1 year after delivery. Logistic regression was used to identify factors predicting loss to follow-up. For a subset of women, we compared odds of viremia detectable at delivery and postpartum among women with higher versus lower pill burden regimens. We included 604 women with HIV who delivered between 2005 and 2015. Three hundred ninety-one (65%) women completed at least one visit with an HIV provider within 1 year of delivery. The follow-up rate among black, non-Hispanic women was 65%; 57% for white, non-Hispanic women; and 78% for Hispanic women. Women without follow-up presented for prenatal care later (17 vs. 11 weeks, p < 0.001), and were less likely to be on antiretroviral therapy at initial prenatal visit (29% vs. 49%, p < 0.001). Factors predicting loss to follow-up in multivariate analysis included low-level viremia at delivery [adjusted odds ratio (aOR) = 2.85, 95% confidence interval (CI) = 1.73-4.71] and failure to return for a postpartum visit (aOR = 3.19, 95% CI = 2.07-4.94). High antiretroviral pill burden (≥6 pills daily) was associated with viremia (>1000 copies/mL) at the first prenatal visit (OR = 8.7, 95% CI = 4.6-16.6) through 1 year postpartum (OR = 2.3, 95% CI = 1.2-4.4). Viremia at delivery, failure to return for a postpartum visit, and high pill burden during pregnancy are predictors of postpartum loss to HIV care.
Collapse
Affiliation(s)
- Emily H. Adhikari
- Department of Obstetrics and Gynecology and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Casey S. Yule
- Department of Obstetrics and Gynecology and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Scott W. Roberts
- Department of Obstetrics and Gynecology and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vanessa L. Rogers
- Department of Obstetrics and Gynecology and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeanne S. Sheffield
- Department of Obstetrics and Gynecology and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mary Ann Kelly
- Department of Obstetrics and Gynecology and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Donald D. McIntire
- Department of Obstetrics and Gynecology and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Arti Barnes
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
24
|
Koumans EH, Harrison A, House LD, Burley K, Ruffo N, Smith R, FitzHarris L, Johnson CH, Taylor AW, Nesheim SR. Characteristics associated with lack of HIV testing during pregnancy and delivery in 36 U.S. states, 2004-2013. Int J STD AIDS 2018; 29:1225-1233. [PMID: 29969977 PMCID: PMC6698709 DOI: 10.1177/0956462418780053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Centers for Disease Control and Prevention and the American Congress of Obstetricians and Gynecologists recommend universal prenatal HIV testing to prevent perinatal HIV transmission in the U.S.; since the 1990s perinatal HIV transmission has declined. In 2006, 74% of women with a recent live birth reported testing for HIV prenatally or at delivery. We used Pregnancy Risk Assessment Monitoring System data from 36 states and New York City from 2004 to 2013 (N = 387,424) to assess characteristics associated with lack of self-reported testing and state-to-state variability in these associations. Overall, 75.2% (95% confidence interval [CI] 75.0-75.5) of women with a recent live birth reported an HIV test. There were significant differences in testing prevalence by state, ranging from 91.8% (95% CI 91.0-92.6) in New York to 42.3% (95% CI 41.7-43.5) in Utah. In adjusted analysis, characteristics associated with no reported testing included being married, white, non-Hispanic, multiparous, not smoking during pregnancy, and having neither Medicaid nor Special Supplemental Nutritional Program for Women, Infants, and Children. White married women were 57% (adjusted prevalence ratio [aPR] 1.57, 95% CI 1.52-1.63) more likely to report no test compared to white unmarried women. Multiparous married women were 57% (aPR 1.57, 95% CI 1.51-1.64) more likely to report no test compared to multiparous unmarried women. Women who were married, white, non-Hispanic, and multiparous women were 23% less likely to be tested than other women combined. Marital status was significantly associated with lower prevalence of testing in 35 of the 37 reporting areas, and race was significant in 30 of 35 states with race information. The prevalence of reported HIV testing during pregnancy or at delivery remains below 80%. Opportunities exist to increase HIV testing among pregnant women, particularly among certain subpopulations.
Collapse
Affiliation(s)
- Emilia H Koumans
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ayanna Harrison
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- DB Consulting Group, Inc., Atlanta, GA, USA
| | - L Duane House
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kim Burley
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- DB Consulting Group, Inc., Atlanta, GA, USA
| | - Nan Ruffo
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- DB Consulting Group, Inc., Atlanta, GA, USA
| | - Ruben Smith
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren FitzHarris
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- ICF, Atlanta, GA, USA
| | - Christopher H Johnson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Allan W Taylor
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven R Nesheim
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
25
|
Abrams EJ, Mellins CA, Bucek A, Dolezal C, Raymond J, Wiznia A, Jurgrau A, Bamji M, Leu CS, Ng YKW. Behavioral Health and Adult Milestones in Young Adults With Perinatal HIV Infection or Exposure. Pediatrics 2018; 142:e20180938. [PMID: 30097528 PMCID: PMC6317560 DOI: 10.1542/peds.2018-0938] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Young adults living with perinatally acquired HIV infection (PHIVYAs) are at risk for poor biomedical and behavioral health outcomes. Few studies offer a comprehensive overview of the functioning of this population in young adulthood and the role of HIV. METHODS Data come from the Child and Adolescent Self-Awareness and Health Study, a longitudinal behavioral health cohort study of PHIVYAs and perinatally HIV-exposed but uninfected young adults (PHEUYAs) who are compared on psychiatric and neurocognitive functioning, sexual and substance use behaviors, health and reproductive outcomes, and young adult milestones. RESULTS Overall, 27% of participants met criteria for a psychiatric disorder, including mood (11%), anxiety (22%), and substance use (28%), with no HIV status differences. PHIVYAs performed worse on 2 neurocognitive tests. There were no HIV status differences in condomless sex (41%) or pregnancies (41% women; 38% men). Both groups exhibited similar adult milestones: 67% graduated high school or an equivalent, 19% were in college, and 42% were employed. However, 38% were neither in school or working, 12% reported incarceration, and 16% were ever homeless. Among PHIVYAs, 36% were viremic (>200 copies per mL), and 15% were severely immunocompromised (CD4+ cell count <100 cells per mm3). CONCLUSIONS Many PHIVYAs achieve adult milestones related to school, employment, sexual relationships, and starting families. However, they and PHEUYAs have high rates of psychiatric and substance use disorders and behavioral risks, which can jeopardize long-term health and adult functioning, particularly in the context of HIV. These findings underscore an urgent need to escalate interventions.
Collapse
Affiliation(s)
- Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health,
- Vagelos College of Physicians and Surgeons, and
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Amelia Bucek
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Jeannette Raymond
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea Jurgrau
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; and
| | | | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Yiu Kee Warren Ng
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; and
| |
Collapse
|
26
|
Andrews MM, Storm DS, Burr CK, Aaron E, Hoyt MJ, Statton A, Weber S. Perinatal HIV Service Coordination: Closing Gaps in the HIV Care Continuum for Pregnant Women and Eliminating Perinatal HIV Transmission in the United States. Public Health Rep 2018; 133:532-542. [PMID: 30096026 PMCID: PMC6134567 DOI: 10.1177/0033354918789912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Eliminating perinatal transmission of HIV and improving the care of childbearing women living with HIV in the United States require public health and clinical leadership. The Comprehensive Care Workgroup of the Elimination of Perinatal HIV Transmission Stakeholders Group, sponsored by the Centers for Disease Control and Prevention, developed a concept of perinatal HIV service coordination (PHSC) and identified 6 core functions through (1) semistructured exploratory interviews with contacts in 11 state or city health departments from April 2011 through February 2012, (2) literature review and summary of data on gaps in services and outcomes, and (3) group meetings from August 2010 through June 2017. We discuss leadership strategies for implementing the core functions of PHSC: strategic planning, access to services, real-time case finding, care coordination, comprehensive care, and data and case reviews. PHSC provides a systematic approach to optimize services and close gaps in perinatal HIV prevention and the HIV care continuum for childbearing women that can be individualized for jurisdictions with varying needs.
Collapse
Affiliation(s)
- Mary-Margaret Andrews
- Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Deborah S. Storm
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Carolyn K. Burr
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Erika Aaron
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
- AIDS Activities Coordination Office, Philadelphia Department of Health, Philadelphia, PA, USA
| | - Mary Jo Hoyt
- François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Anne Statton
- Pediatric AIDS Chicago Prevention Initiative, Chicago, IL, USA
| | - Shannon Weber
- Perinatal HIV Hotline, HIVE, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
27
|
Smith SL, Chahroudi AM, Camacho-Gonzalez AF, Gillespie S, Wynn BA, Badell ML, Swartzendruber A, Hazra R, Wortley P, Chakraborty R. Evaluating Facility Infrastructure for Prevention of Mother-to-Child Transmission of HIV-A 2015 Assessment of Major Delivery Hospitals in Atlanta, Georgia. J Pediatric Infect Dis Soc 2018; 7:e102-e106. [PMID: 29986059 PMCID: PMC6097576 DOI: 10.1093/jpids/piy058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/12/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Our goal was to evaluate the infrastructure of programs for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) in major delivery units in the Atlanta, Georgia, metropolitan statistical area and to assess the knowledge, attitude, and practice of providers in these facilities around PMTCT. METHODS Hospital assessments and individual knowledge and practices were surveyed among 71 healthcare providers from March 2015 to March 2016 in 11 hospitals that deliver 40000 infants annually, which represents 70% of all deliveries in the Atlanta metropolitan statistical area. Included were questions about HIV testing for mother-infant pairs, test result turnaround times, policies and procedures for PMTCT, opt-out versus opt-in testing, availability of rapid point-of-care testing on labor and delivery units, and postnatal prophylaxis. RESULTS Seventy-three percent (8 of 11) of the hospitals had limitations in their PMTCT infrastructure, and 36% (4 of 11) reported no standardized policies for care of HIV-infected women. Three labor and delivery units used opt-in HIV testing of women. Only 27% (3 of 11) of the hospitals reported nucleic acid testing of HIV-exposed infants. Oral zidovudine for infant prophylaxis was available in all the hospitals, but 64% (7 of 11) of them did not stock nevirapine. Fifty-nine percent (24 of 44) of the obstetricians did not routinely offer rapid testing at delivery without a third-trimester HIV test, and 78% (n = 32 of 41) of them did not offer testing at delivery if the woman declined antenatal testing. The facility with the most annual births in Georgia did not offer rapid testing at delivery for women with an unknown HIV status. CONCLUSION We identified several limitations in PMTCT infrastructure that might have contributed to perinatal HIV transmissions. The need to address these healthcare gaps to eliminate mother-to-child transmission of HIV in the United States is urgent.
Collapse
Affiliation(s)
- Somer L Smith
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Correspondence: S. L. Smith, PharmD, BCPS, AAHIVP, 2015 Uppergate Dr., Suite 500, Atlanta, GA 30322 ()
| | - Ann M Chahroudi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Andres F Camacho-Gonzalez
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Scott Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Bridget A Wynn
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Martina L Badell
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Andrea Swartzendruber
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, Maryland
| | - Pascale Wortley
- HIV Epidemiology Section, Georgia Department of Public Health, Atlanta
| | - Rana Chakraborty
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
28
|
O'Donovan K, Emeto TI. Mother-to-child transmission of HIV in Australia and other high-income countries: Trends in perinatal exposure, demography and uptake of prevention strategies. Aust N Z J Obstet Gynaecol 2018; 58:499-505. [PMID: 29787622 DOI: 10.1111/ajo.12825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/08/2018] [Indexed: 11/29/2022]
Abstract
Virtual elimination of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is a global target. A review of the literature was conducted using medical databases and health department websites to examine the current trends related to perinatal HIV exposure and MTCT in Australia in comparison with other high-income countries (HICs). The review discusses the uptake of prevention strategies and barriers that impede MTCT prevention. The literature suggests an increase in the numbers of HIV-exposed deliveries, but a marked decline in the rates of MTCT within HICs. MTCT remains high when the mother's HIV infection is diagnosed late or postpartum. Data supports increasing trends of perinatal HIV exposure in migrant populations from low- and middle-income countries (particularly African women). Increased uptake and earlier initiation of antiretroviral therapy (ART) was associated with overall MTCT decline. Caesarean section remains the main mode of delivery described; however, the numbers of planned vaginal deliveries are increasing over time. Heterogeneity of data periods and outcome measures within published literature made comparisons between countries difficult. Future development should focus on clear national guidelines and a potential national database for perinatal HIV, culturally appropriate service provision, and more evidence on acute infections in pregnancy and the effects that longer duration and increased uptake of ART has on the fetus and resistance to ART.
Collapse
Affiliation(s)
- Kelly O'Donovan
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Theophilus I Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
29
|
Sutton MY, Zhou W, Frazier EL. Unplanned pregnancies and contraceptive use among HIV- positive women in care. PLoS One 2018; 13:e0197216. [PMID: 29771940 PMCID: PMC5957391 DOI: 10.1371/journal.pone.0197216] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/27/2018] [Indexed: 11/18/2022] Open
Abstract
Among 230,360 women with diagnosed HIV in the United States (U.S.), ~ 8,500 give birth annually, and unplanned pregnancies (as with HIV-negative women) are prevalent. However, unplanned pregnancies and contraceptive use among HIV-positive women have been understudied. To examine unplanned pregnancies and contraceptive use among HIV-positive women, we used 2013-2014 data from the Medical Monitoring Project (MMP), an HIV surveillance system that produces national estimates for HIV-positive adults in care in the U.S. (Pregnancy outcome dates were from years 1986-2015 for this cohort of women who were interviewed during 2013-2014; median year of reported pregnancy outcome was year 2003). Women in HIV care and diagnosed with HIV before age 45 (reproductive age) were included. We calculated adjusted prevalence ratios (aPR) of unplanned pregnancies with 95% confidence intervals (CI). For women who were aged 18-44 years at time of interview, we computed weighted prevalences of contraceptive use (previous 12 months) by method, including permanent (i.e., sterilization), short-acting (i.e., pills, depo-progesterone acetate (DMPA)), long-acting reversible contraceptives (LARC) (i.e., implants), and barriers (i.e., condoms). Six hundred seventy-one women met criteria for the unplanned pregnancy analysis; median age at HIV diagnosis = 24.6 years, and 78.1% (CI:74.5-81.7) reported ≥ 1 unplanned pregnancy. Women reporting unplanned pregnancies were more likely to be non-Hispanic white (aPR = 1.20; CI 1.05-1.38) or non-Hispanic black (aPR = 1.14; CI 1.01-1.28) than Hispanic, to be above the poverty level (aPR = 1.09; CI 1.01-1.18), and to have not received care from an OB/GYN in the year before interview (aPR = 1.13; CI 1.04-1.22). Among 1,142 total pregnancies, 795 (69.6%) were live births; 70 (7.8%) were born HIV-positive; 42 (60%) of those born HIV-positive were unplanned pregnancies. For the contraceptives analysis (n = 957 women who were aged 18-44 at time of interview), 90.5% reported using at least one contraceptive, including 59.7% reporting barrier methods, 29.9% reporting permanent sterilization, and 22.8% reporting short-term methods in the previous year. LARC was used by only 5.3% of women. Women who reported use of LARC or DMPA were more likely to be aged 18-29 years (aPR = 3.08; CI 1.61-5.89) or 30-39 years (aPR = 2.86; CI 1.76-4.63) compared with women aged 40-44 years. Unplanned pregnancies were prevalent and LARC use was low; prevention efforts should strengthen pregnancy planning and contraceptive awareness for HIV-positive women during clinical visits.
Collapse
Affiliation(s)
- Madeline Y. Sutton
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, GA, United States of America
- * E-mail:
| | - Wen Zhou
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- ICF, Atlanta, GA, United States of America
| | - Emma L. Frazier
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| |
Collapse
|
30
|
Bitnun A, Lee T, Brophy J, Samson LM, Kakkar F, Vaudry W, Tan B, Money DM, Singer J, Sauvé LJ, Alimenti A. Missed opportunities for prevention of vertical HIV transmission in Canada, 1997-2016: a surveillance study. CMAJ Open 2018; 6:E202-E210. [PMID: 29759976 PMCID: PMC7869661 DOI: 10.9778/cmajo.20180016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Vertical HIV transmission has declined in Canada, but missed opportunities for prevention continue to occur. We sought to determine the adequacy, and changes over time in adequacy, of uptake of maternal and neonatal antiretroviral therapy for the prevention of vertical HIV transmission, and to determine the vertical transmission rate over time and according to adequacy of antenatal antiretroviral therapy during the combination antiretroviral therapy era in Canada. METHODS The Canadian Perinatal HIV Surveillance Program collects data annually through retrospective chart review concerning HIV-infected women and their infants. We determined receipt of adequate antiretroviral treatment (antenatal combination antiretroviral treatment for ≥ 4 wk, intrapartum intravenous zidovudine treatment and 4-6 wk of infant oral zidovudine treatment) and predictors of inadequate antenatal combination antiretroviral therapy (none or < 4 wk) in Canada in 1997-2016. RESULTS We identified 3785 mother-infant pairs. Uptake of 4 weeks or more of antenatal combination antiretroviral therapy increased over time across all provinces/territories and regardless of maternal race/ethnicity or risk category (p < 0.001). During 2011-2016, 92 women (6.5%) received no or less than 4 weeks of antenatal combination antiretroviral therapy, 146 women (10.7%) received no intrapartum zidovudine treatment, and 43 infants (3.1%) received less than 4 weeks of zidovudine treatment. In multivariate analysis restricted to 2011-2016, higher uptake of adequate antenatal combination antiretroviral therapy was seen among black women than among Indigenous (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.23-7.26) or white (OR 1.87, 95% CI 0.99-1.27) women and in British Columbia/Yukon Territory than in Alberta (OR 3.31, 95% CI 1.06-10.32), Ontario (OR 3.16, 95% CI 1.08-9.26) or Quebec (OR 3.44, 95% CI 1.09-10.84). Among the 14 vertical HIV transmission events during 2011-2016 (vertical transmission rate 1.0%), maternal HIV infection was diagnosed before the onset of labour in 5 cases, and only 2 women received adequate antenatal combination antiretroviral therapy. INTERPRETATION Efforts to improve timely access to care, HIV screening and treatment for all women, combined with enhanced resources targeting populations at increased risk for HIV infection, will be needed if vertical HIV transmission is to be eliminated in Canada.
Collapse
Affiliation(s)
- Ari Bitnun
- Affiliations: Department of Pediatrics (Bitnun), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Lee, Singer), Vancouver, BC; Department of Pediatrics (Brophy, Samson), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Kakkar), Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montréal, Que.; Department of Pediatrics (Vaudry), Stollery Children's Hospital, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Tan), Royal University Hospital, University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics & Gynecology (Money), BC Women's Hospital and Health Centre; School of Population and Public Health (Singer); Oak Tree Clinic (Money, Sauvé, Alimenti), BC Women's Hospital and Health Centre, University of British Columbia; Department of Pediatrics, University of British Columbia, Vancouver, BC (Sauvé, Alimenti)
| | - Terry Lee
- Affiliations: Department of Pediatrics (Bitnun), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Lee, Singer), Vancouver, BC; Department of Pediatrics (Brophy, Samson), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Kakkar), Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montréal, Que.; Department of Pediatrics (Vaudry), Stollery Children's Hospital, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Tan), Royal University Hospital, University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics & Gynecology (Money), BC Women's Hospital and Health Centre; School of Population and Public Health (Singer); Oak Tree Clinic (Money, Sauvé, Alimenti), BC Women's Hospital and Health Centre, University of British Columbia; Department of Pediatrics, University of British Columbia, Vancouver, BC (Sauvé, Alimenti)
| | - Jason Brophy
- Affiliations: Department of Pediatrics (Bitnun), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Lee, Singer), Vancouver, BC; Department of Pediatrics (Brophy, Samson), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Kakkar), Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montréal, Que.; Department of Pediatrics (Vaudry), Stollery Children's Hospital, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Tan), Royal University Hospital, University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics & Gynecology (Money), BC Women's Hospital and Health Centre; School of Population and Public Health (Singer); Oak Tree Clinic (Money, Sauvé, Alimenti), BC Women's Hospital and Health Centre, University of British Columbia; Department of Pediatrics, University of British Columbia, Vancouver, BC (Sauvé, Alimenti)
| | - Lindy M Samson
- Affiliations: Department of Pediatrics (Bitnun), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Lee, Singer), Vancouver, BC; Department of Pediatrics (Brophy, Samson), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Kakkar), Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montréal, Que.; Department of Pediatrics (Vaudry), Stollery Children's Hospital, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Tan), Royal University Hospital, University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics & Gynecology (Money), BC Women's Hospital and Health Centre; School of Population and Public Health (Singer); Oak Tree Clinic (Money, Sauvé, Alimenti), BC Women's Hospital and Health Centre, University of British Columbia; Department of Pediatrics, University of British Columbia, Vancouver, BC (Sauvé, Alimenti)
| | - Fatima Kakkar
- Affiliations: Department of Pediatrics (Bitnun), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Lee, Singer), Vancouver, BC; Department of Pediatrics (Brophy, Samson), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Kakkar), Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montréal, Que.; Department of Pediatrics (Vaudry), Stollery Children's Hospital, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Tan), Royal University Hospital, University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics & Gynecology (Money), BC Women's Hospital and Health Centre; School of Population and Public Health (Singer); Oak Tree Clinic (Money, Sauvé, Alimenti), BC Women's Hospital and Health Centre, University of British Columbia; Department of Pediatrics, University of British Columbia, Vancouver, BC (Sauvé, Alimenti)
| | - Wendy Vaudry
- Affiliations: Department of Pediatrics (Bitnun), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Lee, Singer), Vancouver, BC; Department of Pediatrics (Brophy, Samson), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Kakkar), Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montréal, Que.; Department of Pediatrics (Vaudry), Stollery Children's Hospital, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Tan), Royal University Hospital, University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics & Gynecology (Money), BC Women's Hospital and Health Centre; School of Population and Public Health (Singer); Oak Tree Clinic (Money, Sauvé, Alimenti), BC Women's Hospital and Health Centre, University of British Columbia; Department of Pediatrics, University of British Columbia, Vancouver, BC (Sauvé, Alimenti)
| | - Ben Tan
- Affiliations: Department of Pediatrics (Bitnun), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Lee, Singer), Vancouver, BC; Department of Pediatrics (Brophy, Samson), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Kakkar), Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montréal, Que.; Department of Pediatrics (Vaudry), Stollery Children's Hospital, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Tan), Royal University Hospital, University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics & Gynecology (Money), BC Women's Hospital and Health Centre; School of Population and Public Health (Singer); Oak Tree Clinic (Money, Sauvé, Alimenti), BC Women's Hospital and Health Centre, University of British Columbia; Department of Pediatrics, University of British Columbia, Vancouver, BC (Sauvé, Alimenti)
| | - Deborah M Money
- Affiliations: Department of Pediatrics (Bitnun), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Lee, Singer), Vancouver, BC; Department of Pediatrics (Brophy, Samson), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Kakkar), Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montréal, Que.; Department of Pediatrics (Vaudry), Stollery Children's Hospital, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Tan), Royal University Hospital, University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics & Gynecology (Money), BC Women's Hospital and Health Centre; School of Population and Public Health (Singer); Oak Tree Clinic (Money, Sauvé, Alimenti), BC Women's Hospital and Health Centre, University of British Columbia; Department of Pediatrics, University of British Columbia, Vancouver, BC (Sauvé, Alimenti)
| | - Joel Singer
- Affiliations: Department of Pediatrics (Bitnun), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Lee, Singer), Vancouver, BC; Department of Pediatrics (Brophy, Samson), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Kakkar), Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montréal, Que.; Department of Pediatrics (Vaudry), Stollery Children's Hospital, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Tan), Royal University Hospital, University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics & Gynecology (Money), BC Women's Hospital and Health Centre; School of Population and Public Health (Singer); Oak Tree Clinic (Money, Sauvé, Alimenti), BC Women's Hospital and Health Centre, University of British Columbia; Department of Pediatrics, University of British Columbia, Vancouver, BC (Sauvé, Alimenti)
| | - Laura J Sauvé
- Affiliations: Department of Pediatrics (Bitnun), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Lee, Singer), Vancouver, BC; Department of Pediatrics (Brophy, Samson), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Kakkar), Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montréal, Que.; Department of Pediatrics (Vaudry), Stollery Children's Hospital, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Tan), Royal University Hospital, University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics & Gynecology (Money), BC Women's Hospital and Health Centre; School of Population and Public Health (Singer); Oak Tree Clinic (Money, Sauvé, Alimenti), BC Women's Hospital and Health Centre, University of British Columbia; Department of Pediatrics, University of British Columbia, Vancouver, BC (Sauvé, Alimenti)
| | - Ariane Alimenti
- Affiliations: Department of Pediatrics (Bitnun), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Lee, Singer), Vancouver, BC; Department of Pediatrics (Brophy, Samson), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Kakkar), Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montréal, Que.; Department of Pediatrics (Vaudry), Stollery Children's Hospital, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Tan), Royal University Hospital, University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics & Gynecology (Money), BC Women's Hospital and Health Centre; School of Population and Public Health (Singer); Oak Tree Clinic (Money, Sauvé, Alimenti), BC Women's Hospital and Health Centre, University of British Columbia; Department of Pediatrics, University of British Columbia, Vancouver, BC (Sauvé, Alimenti)
| |
Collapse
|
31
|
Venkatesh KK, Morrison L, Livingston EG, Stek A, Read JS, Shapiro DE, Tuomala RE. Changing Patterns and Factors Associated With Mode of Delivery Among Pregnant Women With Human Immunodeficiency Virus Infection in the United States. Obstet Gynecol 2018; 131:879-890. [PMID: 29630021 PMCID: PMC6075712 DOI: 10.1097/aog.0000000000002566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To describe patterns and factors associated with mode of delivery among pregnant women with human immunodeficiency virus (HIV) infection in the United States in relation to evolving HIV-in-pregnancy guidelines. METHODS We conducted an analysis of two observational studies, Pediatric AIDS Clinical Trials Group and International Maternal Pediatric Adolescent AIDS Clinical Trials Network Protocol P1025, which enrolled pregnant women with HIV infection from 1998 to 2013 at more than 60 U.S. acquired immunodeficiency syndrome clinical research sites. Multivariable analyses of factors associated with an HIV-indicated cesarean delivery (ie, for prevention of mother-to-child transmission) compared with other indications were conducted and compared according to prespecified time periods of evolving HIV-in-pregnancy guidelines: 1998-1999, 2000-2008, and 2009-2013. RESULTS Among 6,444 pregnant women with HIV infection, 21% delivered in 1998-1999, 58% in 2000-2008, and 21% in 2009-2013; 3,025 (47%) delivered by cesarean. Cesarean delivery increased from 30% in 1998 to 48% in 2013. Of all cesarean deliveries, repeat cesarean deliveries increased from 16% in 1998 to 42% in 2013; HIV-indicated cesarean deliveries peaked at 48% in 2004 and then dropped to 12% by 2013. In multivariable analyses, an HIV diagnosis during pregnancy, initiation of antiretroviral therapy in the third trimester, a plasma viral load 500 copies/mL or greater, and delivery between 37 and 40 weeks of gestation increased the likelihood of an HIV-indicated cesarean delivery. In analyses by time period, an HIV diagnosis during pregnancy, initiation of antiretroviral therapy in the third trimester, and a plasma viral load of 500 copies/mL or greater were progressively more likely to be associated with an HIV-indicated cesarean delivery over time. CONCLUSION Almost 50% of pregnant women with HIV infection underwent cesarean delivery. Over time, the rate of repeat cesarean deliveries increased, whereas the rate of HIV-indicated cesarean deliveries decreased; cesarean deliveries were more likely to be performed in women at high risk of mother-to-child transmission. These findings reinforce the need for both early diagnosis and treatment of HIV infection in pregnancy and the option of vaginal delivery after cesarean among pregnant women with HIV infection.
Collapse
Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina (Chapel Hill, NC)
| | - Leavitt Morrison
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health (Boston, MA)
| | - Elizabeth G Livingston
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University (Durham, NC)
| | - Alice Stek
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California (Los Angeles, CA)
| | - Jennifer S Read
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - David E Shapiro
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health (Boston, MA)
| | - Ruth E Tuomala
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School (Boston, MA)
| |
Collapse
|
32
|
Country of Birth of Children With Diagnosed HIV Infection in the United States, 2008-2014. J Acquir Immune Defic Syndr 2017; 77:23-30. [PMID: 29040167 DOI: 10.1097/qai.0000000000001572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Diagnoses of HIV infection among children in the United States have been declining; however, a notable percentage of diagnoses are among those born outside the United States. The impact of foreign birth among children with diagnosed infections has not been examined in the United States. METHODS Using the Centers for Disease Control and Prevention National HIV Surveillance System, we analyzed data for children aged <13 years with diagnosed HIV infection ("children") in the United States (reported from 50 states and the District of Columbia) during 2008-2014, by place of birth and selected characteristics. RESULTS There were 1516 children [726 US born (47.9%) and 676 foreign born (44.6%)]. US-born children accounted for 70.0% in 2008, declining to 32.3% in 2013, and 40.9% in 2014. Foreign-born children have exceeded US-born children in number since 2011. Age at diagnosis was younger for US-born than foreign-born children (0-18 months: 72.6% vs. 9.8%; 5-12 years: 16.9% vs. 60.3%). HIV diagnoses in mothers of US-born children were made more often before pregnancy (49.7% vs. 21.4%), or during pregnancy (16.6% vs. 13.9%), and less often after birth (23.7% vs. 41%). Custodians of US-born children were more often biological parents (71.9% vs. 43.2%) and less likely to be foster or nonrelated adoptive parents (10.4% vs. 55.1%). Of 676 foreign-born children with known place of birth, 65.5% were born in sub-Saharan Africa and 14.3% in Eastern Europe. The top countries of birth were Ethiopia, Ukraine, Uganda, Haiti, and Russia. CONCLUSIONS The increasing number of foreign-born children with diagnosed HIV infection in the United States requires specific considerations for care and treatment.
Collapse
|
33
|
Nesheim SR, Wiener J, Fitz Harris LF, Lampe MA, Weidle PJ. Brief Report: Estimated Incidence of Perinatally Acquired HIV Infection in the United States, 1978-2013. J Acquir Immune Defic Syndr 2017; 76:461-464. [PMID: 28991886 PMCID: PMC6267853 DOI: 10.1097/qai.0000000000001552] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND An incidence of perinatally acquired HIV infection less than 1:100,000 live births is one of the Centers for Disease Control and Prevention (CDC) goals of the United States. Such an estimate has only been possible in recent years because regular nationwide data were lacking. METHOD Using previously published CDC estimates of the number of infants born with HIV infection in the United States (interpolating for years for which there was no published estimate), and census data on the annual number of live-born infants, estimated incidence was calculated for 1978-2013. Exact 95% confidence intervals (CIs) were calculated using the Poisson distribution. RESULTS Estimated incidence of perinatally acquired HIV infection peaked at 43.1 (95% CI: 41.1 to 45.1) in 1992 and declined rapidly after the use of zidovudine prophylaxis was recommended in 1994. In 2013, estimated incidence of perinatally acquired HIV infection in the United States was 1.8 (95% CI: 1.4 to 2.2), a 96% decline since the peak. CONCLUSION Estimated incidence of perinatally acquired HIV infection in the United States in 2013 was 1.8/100,000 live births.
Collapse
Affiliation(s)
- Steven R. Nesheim
- Centers for Disease Control and Prevention/National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention/Division of HIV/AIDS Prevention/Epidemiology Branch
| | - Jeffrey Wiener
- Centers for Disease Control and Prevention/National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention/Division of HIV/AIDS Prevention, Quantitative, Statistical and Data Management Branch
| | - Lauren F. Fitz Harris
- Centers for Disease Control and Prevention/National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention/Division of HIV/AIDS Prevention/Epidemiology Branch
- Centers for Disease Control and Prevention/National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention/Division of HIV/AIDS Prevention/Epidemiology Branch, ICF International
| | - Margaret A. Lampe
- Centers for Disease Control and Prevention/National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention/Division of HIV/AIDS Prevention/Epidemiology Branch
| | - Paul J. Weidle
- Centers for Disease Control and Prevention/National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention/Division of HIV/AIDS Prevention/Epidemiology Branch
| |
Collapse
|
34
|
A Missed Opportunity for U.S. Perinatal Human Immunodeficiency Virus Elimination: Pre-exposure Prophylaxis During Pregnancy. Obstet Gynecol 2017; 130:703-709. [PMID: 28885420 DOI: 10.1097/aog.0000000000002258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the proportion of women at increased risk of sexual human immunodeficiency virus (HIV) acquisition during pregnancy in a high HIV incidence urban setting to identify those who may be eligible for pre-exposure prophylaxis. METHODS We conducted a retrospective cohort study of women who received prenatal care at a large academic center in 2012. Univariable analyses and multiple logistic regression models were built to identify correlates for pre-exposure prophylaxis eligibility. RESULTS Among 1,637 pregnant women, mean age was 27.6 years (SD 6.3), 59.7% were African American, and 56.0% were single. Based on the Centers for Disease Control and Prevention's guidelines, more than 10% of women were at increased risk for HIV acquisition during pregnancy and eligible for pre-exposure prophylaxis. Younger [adjusted odds ratio (OR) 0.9/1-year increase, 95% CI 0.8-0.9], single (adjusted OR 2.4, 95% CI 1.2-4.8), African American women (adjusted OR 3.3, 95% CI 1.6-6.7) with higher parity (adjusted OR 1.3/one-child increase, 95% CI 1.1-1.5), and who smoked regularly during pregnancy (adjusted OR 1.8, 95% CI 1.0-3.0) had greater odds of being eligible for pre-exposure prophylaxis at any time during pregnancy. CONCLUSIONS Pregnancy is a vulnerable period during which some heterosexual women in urban settings have a high risk for HIV acquisition and stand to benefit from pre-exposure prophylaxis.
Collapse
|