Perinatal HIV Prevention Outcomes in U.S.-Born Versus Foreign-Born Blacks, PSD Cohort, 1995–2004

Strategies for Prevention of Mother-to-Child Transmission Adopted in the "Real-World" Setting: Data From the Italian Register for HIV-1 Infection in Children

BACKGROUND

Strategies for prevention of HIV-1 mother-to-child transmission (PMTCT) have been continuously optimized. However, cases of vertical transmission continue to occur in high-income countries.

OBJECTIVES

To investigate changes in PMTCT strategies adopted by Italian clinicians over time and to evaluate risk factors for transmission.

METHODS

Data from mother-child pairs prospectively collected by the Italian Register, born in Italy in 1996-2016, were analyzed. Risk factors for MTCT were explored by logistic regression analyses.

RESULTS

Six thousand five hundred three children (348 infections) were included. In our cohort, the proportion of children born to foreign mothers increased from 18.3% (563/3078) in 1996%-2003% to 66.2% (559/857) in 2011-2016 (P < 0.0001). Combination neonatal prophylaxis use significantly (P < 0.0001) increased over time, reaching 6.3% (56/857) after 2010, and it was largely (4.2%) adopted in early preterm infants. The proportion of vaginal deliveries in women with undetectable viral load (VL) increased over time and was 9.9% (85/857) in 2011-2016; no infection occurred among them. In children followed up since birth MTCT, rate was 3.5% (96/2783) in 1996-2003; 1.4% (36/2480) in 2004-2010; and 1.1% (9/835) in 2011-2016. At a multivariate analysis, factors associated with MTCT were vaginal delivery with detectable or missing VL or nonelective caesarean delivery, prematurity, breastfeeding, lack of maternal or neonatal antiretroviral therapy, detectable maternal VL, and age at first observation. Previously described increased risk of offspring of immigrant women was not confirmed.

CONCLUSIONS

Risk of MTCT in Italy is ongoing, even in recent years, underling the need for implementation of the current screening program in pregnancy. Large combination neonatal prophylaxis use in preterm infants was observed, even if data on safety and efficacy in prematures are poor.

A Community-Based Participatory Approach to Understanding HIV/AIDS in the Ethiopian Community

The rate of HIV/AIDS in Washington, D.C remains at epidemic levels and is most prevalent in the black community, with foreign-born blacks accounting for an increasing proportion of HIV infections in the Washington DC area. The Ethiopian community is among the subgroups that are especially impacted by HIV/AIDS. Yet, seldom does research on the epidemiology of HIV/AIDS break data into diverse subgroups, accounting for the distinct needs based on cultural or ethnic differences. This paper reports on the qualitative findings from a community participatory action research study that involved interviewing 60 Ethiopian-immigrants and nine community-based providers about their attitudes toward HIV/AIDS, and to elicit their ideas about how to improve HIV/AIDS prevention, promotion, and treatment approaches targeting the Ethiopian community. Findings show that stigma remains the largest barrier to accessing HIV/AIDS treatment among Ethiopians in the Washington, D.C. area. Therefore, strategies to reduce HIV/AIDS must address stigmatizing beliefs and be met with cultural sensitivity when developing community prevention and treatment outreach programs designed to reduce HIV/AIDS among Ethiopians.

HIV Infection-Related Care Outcomes among U.S.-Born and Non-U.S.-Born Blacks with Diagnosed HIV in 40 U.S. Areas: The National HIV Surveillance System, 2016

HIV care outcomes must be improved to reduce new human immunodeficiency virus (HIV) infections and health disparities. HIV infection-related care outcome measures were examined for U.S.-born and non-U.S.-born black persons aged ≥13 years by using National HIV Surveillance System data from 40 U.S. areas. These measures include late-stage HIV diagnosis, timing of linkage to medical care after HIV diagnosis, retention in care, and viral suppression. Ninety-five percent of non-U.S.-born blacks had been born in Africa or the Caribbean. Compared with U.S.-born blacks, higher percentages of non-U.S.-born blacks with HIV infection diagnosed during 2016 received a late-stage diagnoses (28.3% versus 19.1%) and were linked to care in ≤1 month after HIV infection diagnosis (76.8% versus 71.3%). Among persons with HIV diagnosed in 2014 and who were alive at year-end 2015, a higher percentage of non-U.S.-born blacks were retained in care (67.8% versus 61.1%) and achieved viral suppression (68.7% versus 57.8%). Care outcomes varied between African- and Caribbean-born blacks. Non-U.S.-born blacks achieved higher care outcomes than U.S.-born blacks, despite delayed entry to care. Possible explanations include a late-stage presentation that requires immediate linkage and optimal treatment and care provided through government-funded programs.