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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. [PMID: 38864110 DOI: 10.1089/jwh.2023.0835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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.
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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
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Pagano-Therrien J, Griswold MK, Amoah RK. "Go With the Flow": A Qualitative Description of Infant Feeding Experiences Among Women With HIV in the United States. J Assoc Nurses AIDS Care 2023; 34:376-388. [PMID: 37199426 DOI: 10.1097/jnc.0000000000000411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
ABSTRACT Breastfeeding affords numerous health benefits to mothers and children, but for women with HIV in the United States, avoidance of breastfeeding is recommended. Evidence from low-income countries demonstrates low risk of HIV transmission during breastfeeding with antiretroviral therapy, and the World Health Organization recommends exclusive breastfeeding and shared decision making about infant feeding options in low-income and middle-income countries. In the United States, gaps in knowledge exist surrounding the experiences, beliefs, and feelings of women with HIV surrounding infant feeding decisions. Undergirded by a framework of person-centered care, this study describes the experiences, beliefs, and feelings of women with HIV in the United States surrounding recommendations for breastfeeding avoidance. Although no participants reported consideration of breastfeeding, multiple gaps were identified with implications for the clinical care and counseling of the mother-infant dyad.
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Affiliation(s)
- Jesica Pagano-Therrien
- Jesica Pagano-Therrien, PhD, RN, CPNP-PC is an Associate Professor, Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA. Michele K. Griswold, PhD, MPH, RN, IBCLC is an Assistant Professor, Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, Connecticut, USA. Rita Amoah, PhD, RN, is an Assistant Professor, Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA
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Cardenas MC, Farnan S, Hamel BL, Mejia Plazas MC, Sintim-Aboagye E, Littlefield DR, Behl S, Punia S, Enninga EAL, Johnson E, Temesgen Z, Theiler R, Gray CM, Chakraborty R. Prevention of the Vertical Transmission of HIV; A Recap of the Journey so Far. Viruses 2023; 15:v15040849. [PMID: 37112830 PMCID: PMC10142818 DOI: 10.3390/v15040849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
In 1989, one in four (25%) infants born to women living with HIV were infected; by the age of 2 years, there was 25% mortality among them due to HIV. These and other pieces of data prompted the development of interventions to offset vertical transmission, including the landmark Pediatric AIDS Clinical Trial Group Study (PACTG 076) in 1994. This study reported a 67.5% reduction in perinatal HIV transmission with prophylactic antenatal, intrapartum, and postnatal zidovudine. Numerous studies since then have provided compelling evidence to further optimize interventions, such that annual transmission rates of 0% are now reported by many health departments in the US and elimination has been validated in several countries around the world. Despite this success, the elimination of HIV’s vertical transmission on the global scale remains a work in progress, limited by socioeconomic factors such as the prohibitive cost of antiretrovirals. Here, we review some of the key trials underpinning the development of guidelines in the US as well as globally, and discuss the evidence through a historic lens.
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Affiliation(s)
- Maria Camila Cardenas
- Pediatric Residency Program, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sheila Farnan
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin L. Hamel
- Pediatric Residency Program, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Maria Camila Mejia Plazas
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Pediatric Residency Program, Nicklaus Children’s Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA
| | - Elise Sintim-Aboagye
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Dawn R. Littlefield
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Supriya Behl
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sohan Punia
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Elizabeth Ann L Enninga
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 33155, USA
| | - Erica Johnson
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Zelalem Temesgen
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Regan Theiler
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 33155, USA
| | - Clive M. Gray
- Division of Molecular Biology and Human Genetics, Biomedical Research Institute, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7600, South Africa
| | - Rana Chakraborty
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: ; Tel.: +1-507-293-9531
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4
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Sibiude J, Le Chenadec J, Mandelbrot L, Hoctin A, Dollfus C, Faye A, Bui E, Pannier E, Ghosn J, Garrait V, Avettand-Fenoel V, Frange P, Warszawski J, Tubiana R. Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery. Clin Infect Dis 2023; 76:e590-e598. [PMID: 36037040 DOI: 10.1093/cid/ciac703] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/04/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) is remarkably effective in preventing perinatal transmission (PT) of HIV-1. We evaluated the PT rate in a population of women with widespread access to ART before conception. METHODS The analysis included 14 630 women with HIV-1 who delivered from 2000 to 2017 at centers participating in the nationwide prospective multicenter French Perinatal Cohort (ANRS-EPF). PT was analyzed according to time period, timing of ART initiation, maternal plasma viral load (pVL), and gestational age at birth. No infants were breastfed, and all received neonatal prophylaxis. RESULTS PT decreased between 3 periods, from 1.1% in 2000-2005 (58/5123) to 0.7% in 2006-2010 (30/4600) and to 0.2% in 2011-2017 (10/4907; P < .001). Restriction of the analysis to the 6316/14 630 (43%) women on ART at conception, PT decreased from 0.42% (6/1434) in 2000-2005 to 0.03% (1/3117) in 2011-2017 (P = .007). Among women treated at conception, if maternal pVL was undetectable near delivery, no PT was observed regardless of the ART combination [95%CI 0-0.07] (0/5482). Among women who started ART during pregnancy and with undetectable pVL near delivery, PT was 0.57% [95%CI 0.37-0.83] (26/4596). Among women treated at conception but with a detectable pVL near delivery, PT was 1.08% [95%CI 0.49-2.04] (9/834). We also qualitatively described 10 cases of transmission that occurred during the 2011-2017 period. CONCLUSIONS In a setting with free access to ART, monthly pVL assessment, infant ART prophylaxis, and in the absence of breastfeeding, suppressive ART initiated before pregnancy and continued throughout pregnancy can reduce PT of HIV to almost zero.
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Affiliation(s)
- Jeanne Sibiude
- Department of Gynecology-Obstetrics, Assistance Publique des Hôpitaux de Paris Hôpital Louis Mourier, Colombes, France.,Université de Paris, Infection, Antimicrobials, Modelling, Evolution UMR 1137, Institut national de la santé et de la recherche médicale, Paris, France
| | - Jérôme Le Chenadec
- Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France
| | - Laurent Mandelbrot
- Université de Paris, Infection, Antimicrobials, Modelling, Evolution UMR 1137, Institut national de la santé et de la recherche médicale, Paris, France
| | - Alexandre Hoctin
- Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France
| | - Catherine Dollfus
- Department of Pediatric Hematology-oncology, Assistance Publique des Hôpitaux de Paris Hôpital Trousseau, Paris, France
| | - Albert Faye
- Department of Pediatrics and Infectious Diseases, Assistance Publique des Hôpitaux de Paris Hôpital Robert Debré, Paris, France.,Université de Paris, Institut national de la santé et de la recherche médicale, U1123, Paris, France
| | - Eida Bui
- Department of Gynécology-Obstetrics, Assistance Publique des Hôpitaux de Paris Hôpital Trousseau, Paris, France
| | - Emmanuelle Pannier
- Department of Gynecology and Obstetrics, Assistance Publique des Hôpitaux de Paris, Maternité Port Royal, Paris, France
| | - Jade Ghosn
- Department of Infectious and Tropical Diseases, Assistance Publique des Hôpitaux de Paris, Nord, Hôpital Bichat - Claude Bernard, Paris, France
| | - Valerie Garrait
- Department of infectious diseases, Centre Hospitalier inter-communal de Créteil, Créteil, France
| | - Véronique Avettand-Fenoel
- Department of Clinical Microbiology, Assistance Publique des Hôpitaux de Paris Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.,Institut national de la santé et de la recherche médicale U1016, Centre national de la recherche scientifique UMR8104, Institut Cochin, Paris, France
| | - Pierre Frange
- EHU 7328 PACT, Institut Imagine, Université de Paris, Paris, France
| | - Josiane Warszawski
- Department of Epidemiology and Public Health, Assistance Publique des Hôpitaux de Paris Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France
| | - Roland Tubiana
- Department of Infectious and Tropical Diseases, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France.,Institut national de la santé et de la recherche médicale, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
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5
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Brandon O, Chakravarti S, Hemelaar J. Trends in management and outcomes of pregnant women living with HIV between 2008–2013 and 2014–2019: A retrospective cohort study. Front Med (Lausanne) 2022; 9:970175. [DOI: 10.3389/fmed.2022.970175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDespite major advances in the care of pregnant women living with HIV (WLHIV), they remain at increased risk of adverse pregnancy outcomes. This study assesses recent developments in management and outcomes of pregnant WLHIV at a tertiary obstetric unit in the United Kingdom.MethodsWe conducted a retrospective cohort study of WLHIV delivering at the John Radcliffe Hospital, Oxford, during 2008–2019. Detailed data was collected for maternal, virological, obstetric, and perinatal characteristics. To determine changes over time, data from the periods 2008–13 and 2014–19 were compared.ResultsWe identified 116 pregnancies in 94 WLHIV. Between 2008–2013 and 2014–2019, the rate of preconception HIV diagnosis increased from 73 to 90% (p = 0.021) and the proportion of WLHIV on combination ART (cART) at conception increased from 54 to 84% (p = 0.001). The median gestation at which cART was initiated antenatally decreased from 22+1 to 17+1 weeks (p = 0.003). In 2014-2019, 41% of WLHIV received non-nucleoside reverse transcriptase inhibitor-based cART, 37% protease inhibitor-based cART, and 22% of cART regimens contained an integrase inhibitor. The proportion of WLHIV with a viral load <50 copies/mL at delivery rose from 87 to 94% (p = 0.235). Sixty-six percent of WLHIV delivered by Cesarean section, with a significant decrease over time in the rate of both planned (62–39%, p = 0.016) and actual (49–31%, p = 0.044) elective Cesarean. Perinatal outcomes included one case of perinatal HIV transmission (0.86%), 11% preterm birth, 15% small-for-gestational-age, and 2% stillbirth. There was an association between a viral load >50 copies/mL at delivery and preterm delivery (p = 0.0004).ConclusionVirological, obstetric, and perinatal outcomes of WLHIV improved during the study period. Implementation of national guidance has led to an increase in preconception diagnosis and treatment, earlier initiation of antenatal treatment, a reduction in the number of women with a detectable viral load at delivery, and an increase in vaginal deliveries.
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6
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Ibrahim SA, Reynolds KA, Poon E, Alam M. The evidence base for US joint commission hospital accreditation standards: cross sectional study. BMJ 2022; 377:e063064. [PMID: 35738660 PMCID: PMC9215261 DOI: 10.1136/bmj-2020-063064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the evidence upon which standards for hospital accreditation by The Joint Commission on Accreditation of Healthcare Organizations (the Joint Commission) are based. DESIGN Cross sectional study. SETTING United States. PARTICIPANTS Four Joint Commission R3 (requirement, rationale, and reference) reports released by July 2018 and intended to become effective between 1 July 2018 and 1 July 2019. INTERVENTIONS From each R3 report the associated standard and its specific elements of performance (or actionable standards) were extracted. If an actionable standard enumerated multiple requirements, these were separated into distinct components. Two investigators reviewed full text references, and each actionable standard was classified as either completely supported, partly supported, or not supported; Oxford evidence quality ratings were assigned; and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the strength of recommendations. MAIN OUTCOME MEASURE Strengths of recommendation for actionable standards. RESULTS 20 actionable standards with 76 distinct components were accompanied by 48 references. Of the 20 actionable standards, six (30%) were completely supported by cited references, six were partly supported (30%), and eight (40%) were not supported. Of the six directly supported actionable standards, one (17%) cited at least one reference of level 1 or 2 evidence, none cited at least one reference of level 3 evidence, and five (83%) cited references of level 4 or 5 evidence. Of the completely supported actionable standards, strength of recommendation in five was deemed GRADE D and in one was GRADE B. CONCLUSIONS In general, recent actionable standards issued by The Joint Commission are seldom supported by high quality data referenced within the issuing documents. The Joint Commission might consider being more transparent about the quality of evidence and underlying rationale supporting each of its recommendations, including clarifying when and why in certain instances it determines that lower level evidence is sufficient.
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Affiliation(s)
- Sarah A Ibrahim
- Rush Medical College, Chicago, IL, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kelly A Reynolds
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Murad Alam
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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7
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Olakunde BO, Pharr JR, Adeyinka DA. HIV testing among pregnant women with prenatal care in the United States: An analysis of the 2011-2017 National Survey of Family Growth. Int J STD AIDS 2020; 31:680-688. [PMID: 32538331 DOI: 10.1177/0956462420921715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although there has been significant progress in reducing perinatal human immunodeficiency virus (HIV) transmission, the United States is yet to meet the proposed elimination goal of less than one infection per 100,000 live births. Failure to screen all pregnant women for HIV as recommended by the Centers for Disease Control and Prevention can result in missed opportunities for preventing vertical transmission of HIV with antiretroviral drugs. Using the 2011-2017 National Survey of Family Growth, this study examined HIV testing among pregnant women during prenatal care. We estimated the weighted proportion of self-reported HIV testing among women whose last pregnancy ended within 12 months prior to the interview. Logistic regression models were used to determine the factors associated with HIV testing. Of the 1566 women included in the study, 76.4% (95% confidence intervals [CI] = 72.8-80.0) reported receiving an HIV test during prenatal care. In the multivariable regression model, high school diploma (adjusted odds ratio [aOR] = 1.9, 95% CI = 1.1-3.1), two completed pregnancies (aOR = 1.7, 95% CI = 1.1-2.7), health insurance coverage in the last 12 months (aOR = 1.6, 95% CI = 1.0-2.6), Hispanic race/ethnicity (aOR = 2.8, 95% CI = 1.8-4.4), and non-Hispanic black race/ethnicity (aOR = 2.2, 95% CI = 1.3-3.8) were associated with higher odds of reporting being tested for HIV. However, household income of 300% or more of the federal poverty level (aOR = 0.6, 95% CI = 0.3-0.9) and urban residence (aOR = 0.5, 95% CI = 0.3-0.9) were associated with lower odds of reporting HIV testing. These findings suggest that HIV testing among pregnant women during prenatal care is not universal and may affect achieving the goal of elimination of mother-to-child transmission of HIV in the United States.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Daniel A Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
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8
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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: 0] [Impact Index Per Article: 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.
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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
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9
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Butters O, Lew J, Lawrence R, Washam M, Bhatt A, Lossius M, Ryan KA. Failure to Thrive in an Infant With a High-Risk Social Situation. Clin Pediatr (Phila) 2020; 59:827-830. [PMID: 32028791 DOI: 10.1177/0009922820903519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Judy Lew
- University of Florida, Gainesville, FL, USA
| | | | | | - Avni Bhatt
- University of Florida, Gainesville, FL, USA
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10
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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.
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11
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Di Biagio A, Taramasso L, Gustinetti G, Burastero G, Giacomet V, La Rovere D, Genovese O, Giaquinto C, Rampon O, Carloni I, Hyppolite TK, Palandri L, Bernardi S, Bruzzese E, Badolato R, Gabiano C, Chiappini E, De Martino M, Galli L. Missed opportunities to prevent mother-to-child transmission of HIV in Italy. HIV Med 2019; 20:330-336. [PMID: 30924576 DOI: 10.1111/hiv.12728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Vertical transmission of HIV can be effectively controlled through antenatal screening, antiretroviral treatment and the services provided during and after childbirth for mother and newborn. In Italy, the National Health Service guarantees universal access to prenatal care for all women, including women with HIV infection. Despite this, children are diagnosed with HIV infection every year. The aim of the study was to identify missed opportunities for prevention of mother-to-child transmission of HIV. METHODS The Italian Register for HIV Infection in Children, which was started in 1985 and involves 106 hospitals throughout the country, collects data on all new cases of HIV infection in children. For this analysis, we reviewed the database for the period 2005 to 2015. RESULTS We found 79 HIV-1-infected children newly diagnosed after birth in Italy. Thirty-two of the mothers were Italian. During the pregnancy, only 15 of 19 women with a known HIV diagnosis were treated with antiretroviral treatment, while, of 34 women who had received an HIV diagnosis before labour began, only 23 delivered by caesarean section and 17 received intrapartum prophylaxis. In 25 mothers, HIV infection was diagnosed during pregnancy or in the peripartum period. Thirty-one newborns received antiretroviral prophylaxis and 39 received infant formula. CONCLUSIONS We found an unacceptable number of missed opportunities to prevent mother-to-child transmission (MCTC). Eliminating HIV MTCT is a universal World Health Organization goal. Elucidating organization failures in Italy over the past decade should help to improve early diagnosis and to reach the zero transmission target in newborns.
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Affiliation(s)
- A Di Biagio
- Infectious Diseases Unit, Department of Internal Medicine, Policlinico San Martino Hospital, Genoa, Italy
| | - L Taramasso
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Policlinico San Martino Hospital, Genoa, Italy.,Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Gustinetti
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Policlinico San Martino Hospital, Genoa, Italy
| | - G Burastero
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Policlinico San Martino Hospital, Genoa, Italy
| | - V Giacomet
- Department of Pediatrics, University of Milan, L. Sacco Hospital, Milan, Italy
| | - D La Rovere
- Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - O Genovese
- Pediatric Intensive Care Unit, A. Gemelli Hospital, Catholic University of Rome, Rome, Italy
| | - C Giaquinto
- Department of Child's and Woman's Health, University of Padova, Padova, Italy
| | - O Rampon
- Department of Child's and Woman's Health, University of Padova, Padova, Italy
| | - I Carloni
- Pediatric Unit, Department of Child and Mother Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - T K Hyppolite
- Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - L Palandri
- Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - S Bernardi
- Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - E Bruzzese
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - R Badolato
- Department of Clinical and Experimental Sciences, Institute of Molecular Medicine 'Angelo Nocivelli', University of Brescia, Brescia, Italy
| | - C Gabiano
- SC Pediatric Unit, Regina Margherita Hospital, Turin, Italy
| | - E Chiappini
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - M De Martino
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - L Galli
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
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12
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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.
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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
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13
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Perceived Barriers to Antepartum HIV Medication Adherence in HIV Infected Pregnant Women. Infect Dis Obstet Gynecol 2018; 2018:4049212. [PMID: 30410301 PMCID: PMC6206578 DOI: 10.1155/2018/4049212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Although rare, perinatal HIV transmission still occurs in the United States and most transmissions are preventable. We aim to identify patient barriers to antiretroviral therapy (ART) adherence during pregnancy and assess patient understanding of perinatal transmission. Methods This cross-sectional survey recruited HIV positive postpartum women at a large safety net hospital in Atlanta, Georgia, between January 2016 and February 2018. Survey questions included demographic characteristics, HIV history, knowledge of perinatal transmission, and ART adherence. Perinatal and HIV outcomes were assessed using chart abstraction. Results Of the 70 HIV infected postpartum women delivered at a large safety net hospital in Atlanta, GA, 45 women were eligible and consented to participate. Participating women were aged 18 to 40 years with an average age of 29 years old, 93% of participants were African-American, and 68% had ≥3 pregnancies. The majority of participants (75%) reported daily ART adherence. "Forgetting" was the most frequent reason for missing pills (57%). Thirteen women had a detectable viral load at the time of delivery and nine of those women had a viral load greater than 1000 copies/mL. Approximately 85% of women who correctly stated ART medications decrease perinatal transmission risk reported daily adherence compared with 50% of women without that knowledge (OR 5.6, 95% CI 1.17, 26.7). Almost half of women (40%) either did not know or believed a vaginal delivery, regardless of viral load, would increase their risk of perinatal transmission. Conclusion Overall, women who were diagnosed with HIV during the current pregnancy, those with planned pregnancies, and those who were on medications prior to pregnancy were more likely to report daily ART adherence. Detectable viral load at delivery is the greatest risk factor for perinatal transmission; therefore strategies to increase ART adherence are needed.
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14
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Nesheim SR, FitzHarris LF, Lampe MA, Gray KM. Reconsidering the Number of Women With HIV Infection Who Give Birth Annually in the United States. Public Health Rep 2018; 133:637-643. [PMID: 30265616 DOI: 10.1177/0033354918800466] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The annual number of women with HIV infection who delivered infants in the United States was estimated to be 8700 in 2006. An accurate, current estimate is important for guiding perinatal HIV prevention efforts. Our objective was to analyze whether the 2006 estimate was consistent with the number of infants with HIV infection observed in the United States and with other data on perinatal HIV transmission. METHODS We compared the number of infants born with HIV in 2015 (n = 53) with data on interventions to prevent perinatal HIV transmission (eg, maternal HIV diagnosis before and during pregnancy and prenatal antiretroviral use). We also estimated the annual number of deliveries to women living with HIV by using the number of women of childbearing age living with HIV during 2008-2014 and the estimated birth rate among these women. Finally, we determined any changes in the annual number of infants born to women with HIV from 2007-2015, among 19 states that reported these data. RESULTS The low number of infants born in the United States with HIV infection and the uptake of interventions to prevent perinatal HIV transmission were not consistent with the 2006 estimate (n = 8700), even with the best uptake of interventions to prevent perinatal HIV transmission. Given the birth rate among women with HIV (estimated at 7%) and the number of women aged 13-44 living with HIV during 2008-2014 (n = 111 273 in 2008, n = 96 363 in 2014), no more than about 5000 women with HIV would be giving birth. Among states consistently reporting the annual number of births to women with HIV, the number declined about 14% from 2008 to 2014. CONCLUSION The current annual number of women with HIV infection delivering infants in the United States is about 5000, which is substantially lower than the 2006 estimate. More accurate estimates would require comprehensive reporting of perinatal HIV exposure.
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Affiliation(s)
- Steven R Nesheim
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,2 Epidemiology Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren F FitzHarris
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,2 Epidemiology Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,3 ICF, Atlanta, GA, USA
| | - Margaret A Lampe
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,2 Epidemiology Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristen Mahle Gray
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,4 HIV Incidence and Case Surveillance Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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15
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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 DOI: 10.1177/0033354918789912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [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.
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Affiliation(s)
- Mary-Margaret Andrews
- 1 Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Deborah S Storm
- 2 François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Carolyn K Burr
- 2 François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Erika Aaron
- 3 Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.,4 AIDS Activities Coordination Office, Philadelphia Department of Health, Philadelphia, PA, USA
| | - Mary Jo Hoyt
- 2 François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Anne Statton
- 5 Pediatric AIDS Chicago Prevention Initiative, Chicago, IL, USA
| | - Shannon Weber
- 6 Perinatal HIV Hotline, HIVE, University of California San Francisco, San Francisco, CA, USA
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16
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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.
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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)
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