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National HIV Prevention Conference
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[TITLE:] RESIDUAL PERINATAL HIV TRANSMISSIONS IN 25 BIRTHS OCCURRING IN NEW YORK STATE (NYS)
Natl HIV Prev Conf. 2005 Jun 12-15 (abstract no. T2-B0903)
Warren, B; Glaros, R; Hackel, S; Kowalski, E; Smith, L; Pulver, W; Birkhead, G
New York State Department of Health, AIDS Institute, Albany, NY
ISSUE: The efforts of health care providers in NYS and the New York State Department of Health (NYSDOH) have resulted in a dramatic decline in perinatal HIV transmission - from 10.9% in 1997 to 2.4% in 2002. To develop strategies for further reducing mother-to-child HIV transmission, the NYSDOH needed further information on the factors associated with residual perinatal HIV transmission in births occurring in NYS.
SETTING: NYSDOH personnel conducted onsite medical record reviews of 25 of the 34 confirmed mother-to-child transmissions identified in NYS births occurring in calendar years 2002, 2003 and 2004 (to date).
PROJECT: The NYSDOH PCR Testing Laboratory of Wadsworth Center identified perinatal HIV transmissions among children born in NYS between 2002 and 2004. Using a standard tool designed for this project, AIDS Institute staff then reviewed each available medical record (prenatal, labor, delivery, and newborn) for 25 of these births. Data were analyzed to detect common themes in the social and health histories of the mothers.
RESULTS: In the 25 cases included in this study, factors in the transmission of HIV from mother to child were identified, including: {1} psychosocial/ behavioral issues, which compromise health and the management of HIV disease [substance use (13 women), mental health disorders (5 women), difficulty adhering to antiretroviral therapy (11 women), homelessness (2 women)], {2} limited or no prenatal care (8 women), and/or {3} seroconversion during pregnancy (6 women). All cases could be linked to one or more of the factors that contribute to perinatal HIV disease transmission.
LESSONS LEARNED: New York State has achieved a substantial reduction in perinatal HIV transmission; however, maintaining and further reducing a perinatal transmission rate of 3% or less will require continual monitoring and infusion of resources and flexible programming to address factors associated with residual transmission. Enhanced outreach to bring pregnant women at high risk of HIV infection into prenatal care programs is key to further reductions in transmission. In addition, HIV-positive pregnant women should be cared for at specialty centers, or in consultation with specialty centers, that provide state-of-the-art medical care, adherence support, retention in care and closely linked mental health and substance abuse services. Repeat testing in the third trimester and rapid testing in labor and delivery will further reduce but not eliminate mother-to-child HIV transmission. Additional study is needed to determine the effect of viral resistance on residual perinatal HIV transmission.
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T2-B0903
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