Barriers to universal prenatal HIV testing in 4 US locations in 1997 (original) (raw)
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Evidence-based Healthcare, 1999
The objectives of this study were to assess the effect of British Columbia's June 1994 guidelines for prenatal HIV screening on the rate of maternalfetal HIV transmission and to estimate the cost-effectiveness of such screening. Methods: The authors conducted a retrospective review of pregnancy and delivery statistics, HIV screening practices, laboratory testing volume, prenatal and labour management decisions of HIV-positive women, maternal-fetal transmission rates and associated costs. Results: Over 1995 and 1996, 135 681 women were pregnant and 92 645 carried to term. The rate of HIV testing increased from 55% to 76% of pregnancies on chart review at one hospital between November 1995 and November 1996. On the basis of seroprevalence studies, an estimated 50.2 pregnancies and 34.3 (95% confidence interval 17.6 to 51.0) live births to HIV-positive women were expected. Of 42 identified mother-infant pairs with an estimated date of delivery during 1995 or 1996, 25 were known only through screening. Of these 25 cases, there were 10 terminations, 1 spontaneous abortion and 14 cases in which the woman elected to carry the pregnancy to term with antiretroviral therapy. There was one stillbirth. One instance of maternal-fetal HIV transmission occurred among the 13 live births. The net savings attributable to prevented infections among babies carried to term were 165586,withasavingperpreventedcaseof165 586, with a saving per prevented case of 165586,withasavingperpreventedcaseof75 266. Interpretation: A routine offer of pregnancy screening for HIV in a low-prevalence setting reduces the rate of maternal-fetal HIV transmission and may rival other widely accepted health care expenditures in terms of cost-effectiveness. Résumé Contexte : Cette étude visait à évaluer l'effet des lignes directrices relatives au dépistage prénatal du VIH adoptées en juin 1994 par la Colombie-Britannique sur le taux de transmission du VIH de la mère au foetus et à évaluer l'efficacité des coûts du dépistage. Méthodes : Les auteurs ont procédé à une étude rétrospective des statistiques sur la grossesse et l'accouchement, des pratiques de dépistage du VIH, du volume des tests de laboratoire, des décisions relatives au suivi prénatal et à la prise en charge du travail de femmes infectées par le VIH, des taux de transmission de la mère au foetus et des coûts connexes. Résultats : En 1995 et 1996, 135 681 femmes étaient enceintes et 92 645 ont accouché à terme. Un examen des dossiers réalisé à un hôpital entre novembre 1995 et novembre 1996 révèle que le taux des tests de dépistage du VIH est passé de 55 % à 76 % des grossesses. D'après les études de séroprévalence, on estimait attendre 50,2 grossesses et 34,3 (intervalle de confiance à 95 % de 17,6 à 51,0) naissances vivantes chez les femmes infectées par le VIH. Sur 42 paires mère-nourrisson identifiées dont la date prévue d'accouchement se situait en 1995 ou 1996, 25 cas ont été repérés par le dépistage seulement. Parmi ces 25 cas, il y a eu 10 avortements, un avortement spontané et 14 cas où la femme a
Preventing perinatal transmission of human immunodeficiency virus in the United States
1999
Abstract Prenatal human immunodeficiency virus (HIV) testing and treatment instituted in the 1990s is responsible for a substantial reduction in the number of children diagnosed with AIDS, yet the number of children born with HIV infection remains unacceptably high. To prevent perinatal transmission of HIV, the United States must adopt a goal to test all pregnant women for HIV and to provide optimal treatment for women who test positive and their children.
Routine prenatal screening for HIV in a low-prevalence setting
PubMed, 1998
Background: The objectives of this study were to assess the effect of British Columbia's June 1994 guidelines for prenatal HIV screening on the rate of maternal-fetal HIV transmission and to estimate the cost-effectiveness of such screening. Methods: The authors conducted a retrospective review of pregnancy and delivery statistics, HIV screening practices, laboratory testing volume, prenatal and labour management decisions of HIV-positive women, maternal-fetal transmission rates and associated costs. Results: Over 1995 and 1996, 135,681 women were pregnant and 92,645 carried to term. The rate of HIV testing increased from 55% to 76% of pregnancies on chart review at one hospital between November 1995 and November 1996. On the basis of seroprevalence studies, an estimated 50.2 pregnancies and 34.3 (95% confidence interval 17.6 to 51.0) live births to HIV-positive women were expected. Of 42 identified mother-infant pairs with an estimated date of delivery during 1995 or 1996, 25 were known only through screening. Of these 25 cases, there were 10 terminations, 1 spontaneous abortion and 14 cases in which the woman elected to carry the pregnancy to term with antiretroviral therapy. There was one stillbirth. One instance of maternal-fetal HIV transmission occurred among the 13 live births. The net savings attributable to prevented infections among babies carried to term were 165,586,withasavingperpreventedcaseof165,586, with a saving per prevented case of 165,586,withasavingperpreventedcaseof75,266. Interpretation: A routine offer of pregnancy screening for HIV in a low-prevalence setting reduces the rate of maternal-fetal HIV transmission and may rival other widely accepted health care expenditures in terms of cost-effectiveness.
Maternal and Child Health Journal, 2000
Objectives: To describe prenatal care utilization among women with HIV-1 in 4 US states, and to determine whether the adequacy of prenatal care utilization is associated with the implementation of prenatal, intrapartum, and postnatal HIV antiretroviral therapy (ARV). Methods: Three-hundred three women completed a prenatal interview. Prenatal, labor and delivery, and infant medical records were reviewed. Results: Thirty-nine percent of women did not receive adequate prenatal care; nearly one quarter of women did not begin care within the recommended timeframe, and approximately one-fifth of women received fewer than the recommended number of prenatal care visits from the time of entry into care until delivery. Those classified as less than adequate in terms of receipt of recommended visits were at increased risk for not receiving ARV during the prenatal care period and during labor and delivery, and were more likely to have had an infant subsequently diagnosed with HIV infection. Conclusion: Although women with HIV require adequate prenatal care for their own health as well as to improve perinatal outcomes, many are at risk for not receiving this care. Lower adherence to prenatal care appointments is an important risk factor for not receiving full HIV prophylactic regimens. KEY WORDS: HIV transmission; adequacy of prenatal care; HIV prevention.
Mothers on the margins: Implications for eradicating perinatal HIV
Social Science & Medicine, 2006
Tactics aimed at reducing perinatal transmission of HIV are proving ineffective at accomplishing complete eradication: a group of women with HIV remain at very high risk for transmitting the virus to their newborns. This study engaged a uniquely high-risk group of HIV-infected mothers as expert informants on childbearing with HIV to inform strategies to eradicate perinatal HIV transmission.
Maternal and Child Health Journal, 2011
Pregnant women who do not receive prenatal care and may not be aware of their HIV status are at greatest risk of transmitting HIV to their newborn. A multicomponent intervention was designed and implemented to increase the use of rapid HIV testing among pregnant women with no prenatal care at labor and delivery in two county hospitals in Houston/Harris County, Texas. The intervention involved establishing a local task force including representatives from each hospital, assessing each hospital's readiness to implement rapid testing, providing educational presentations and materials, and offering individualized follow-up. Outcomes data were obtained and included the number of patients presenting with no prenatal care who received rapid HIV testing on admission. Before the intervention, both hospitals had rapid test kits available but were not using them consistently. Following the intervention, we observed a significant increase in the use of rapid HIV testing at both institutions (P \ 0.001). In the 3 months immediately following the intervention, use of rapid testing at Hospital 1 increased from 7.4 to 35.3% and at Hospital 2 from 27.4 to 41.5%. At 1 year, almost 100% of women with no prenatal care at both hospitals received rapid testing. Educating staff and clinicians and implementing system-wide changes may facilitate behavior change regarding prenatal HIV testing.