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Missed Opportunities for Preventing Perinatal Transmission of Human Immunodeficiency Virus, Florida, 2007-2014
Mary Jo Trepka1, Soumyadeep Mukherjee1, Consuelo Beck-Sagué1
1From the Departments of Epidemiology and Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, the HIV/AIDS Section, and the Maternal and Child Health Section, Florida Department of Health, Tallahassee, and the Florida Consortium for HIV/AIDS Research, The AIDS Institute, Tampa.
Insights
Late diagnosis of maternal human immunodeficiency virus (HIV) infection during pregnancy or after birth significantly increases perinatal HIV transmission. Improved prenatal care and early HIV detection are crucial for prevention.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Maternal-Child Health
Background:
- Despite overall declines, a rise in perinatal HIV infections occurred between 2011-2013.
- Identifying missed prevention opportunities is critical to curb transmission.
Purpose of the Study:
- To investigate factors associated with perinatal HIV transmission.
- To identify missed opportunities in preventing mother-to-child HIV transmission in Florida.
Main Methods:
- Analysis of deidentified records of HIV-exposed infants born in Florida (2007-2014).
- Calculation of relative risks (RRs) and 95% confidence intervals (CIs) for transmission factors.
- Examination of maternal HIV diagnosis timing and prenatal care utilization.
Main Results:
- 1.6% (70/4337) of HIV-exposed infants were perinatally infected.
- Late maternal HIV diagnosis (during labor/delivery or postpartum) strongly correlated with transmission (RR 5.66 and 26.50, respectively).
- Among infected infants born to undiagnosed mothers, inadequate prenatal care and acute maternal infections were common.
Conclusions:
- Late diagnosis of maternal HIV is a primary driver of perinatal transmission.
- Enhanced prenatal care access and early detection of acute maternal HIV infections are essential.
- Targeted public health programs are needed in Florida to improve HIV prevention in pregnant individuals.
Objectives:
Despite declining numbers of perinatally exposed infants, an increase in perinatal human immunodeficiency virus (HIV) infections from 2011 to 2013 prompted this study to identify missed perinatal HIV prevention opportunities.
Methods:
Deidentified records of children born from 2007 through 2014, exposed to HIV perinatally, and reported to the Florida Department of Health were obtained. Crude relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with perinatal transmission, nondiagnosis of maternal HIV infection, and nonreceipt of antiretroviral medication were calculated.
Results:
Of the 4337 known singleton births exposed to maternal HIV infection, 70 (1.6%) were perinatally infected. Among perinatal transmission cases, more than one-third of mothers used illegal drugs or acquired a sexually transmitted infection during pregnancy. Perinatal transmission was most strongly associated with maternal HIV diagnosis during labor and delivery (RR 5.66, 95% CI 2.31-13.91) or after birth (RR 26.50, 95% CI 15.44-45.49) compared with antenatally or prenatally. Among the 29 women whose infection was not known before pregnancy and whose child was perinatally infected, 18 were not diagnosed during pregnancy; 12 had evidence of an acute HIV infection, and 6 had no prenatal care.
Conclusions:
Late diagnosis of maternal HIV infection appeared to be primarily the result of acute maternal infections and inadequate prenatal care. In Florida, effective programs to improve utilization of prenatal care and detection and primary prevention of prenatal acute infection are needed.
