Missed opportunities for prevention of vertical HIV transmission in Canada, 1997–2016: a surveillance study

Bitnun, Ari; Lee, Terry; Brophy, Jason; Samson, Lindy; Kakkar, Fatima; Vaudry, Wendy; Tan, Ben; Money, Deborah; Singer, Joel; Sauvé, Laura; Alimenti, Ariane

doi:10.9778/cmajo.20180016

Cited by 20 publications

(12 citation statements)

References 20 publications

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“…Information on management and health outcomes of pregnant WLWH was abstracted from the CPHSP, a public health surveillance program for vertical transmission of HIV . The CPHSP consists of 22 sites, 19 HIV referral health centres and three health departments from all Canadian provinces and territories.…”

Section: Methodsmentioning

confidence: 99%

Congenital anomalies following antenatal exposure to dolutegravir: a Canadian surveillance study

Money

Lee

O’Brien

et al. 2019

BJOG

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Objective Dolutegravir is recommended worldwide as a first‐line antiretroviral therapy (ART) for individuals living with HIV. A recent study reported increased rates of neural tube defects in infants of dolutegravir‐treated women. This study examined rates of congenital anomalies in infants born to women living with HIV (WLWH) in Canada. Design The Canadian Perinatal HIV Surveillance Programme captures surveillance data on pregnant WLWH and their babies and was analysed to examine the incidence of congenital anomalies. Setting Paediatric HIV clinics. Population Live‐born infants born in Canada to WLWH between 2007 and 2017. Methods Data on mother–infant pairs, including maternal ART use at conception and during pregnancy, are collected by participating sites. Main outcome measures Congenital anomalies. Results Of the 2423 WLWH, 85 (3.5%, 95% CI 2.85–4.36%) had non‐chromosomal congenital anomalies. There was no evidence of a significant difference in rates of congenital anomalies between women who were on ART in their first trimester (3.9%, CI 1.7–7.6%) or later in the pregnancy (3.9%, 95% CI 2.6–5.6%). Four of the 80 (5.0%, 95% CI 1.4–12.3%) neonates born to WLWH on dolutegravir during the first trimester had congenital anomalies, none were neural tube defects (95% CI 0.00–3.10%). Conclusion Despite recent evidence raising a safety concern, this analysis found no signal for increased congenital anomalies. Tweetable abstract Five percent of the infants of Canadian women living with HIV on dolutegravir at conception had congenital anomalies; none had neural tube defects.

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Section: Methodsmentioning

confidence: 99%

Congenital anomalies following antenatal exposure to dolutegravir: a Canadian surveillance study

Money

Lee

O’Brien

et al. 2019

BJOG

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“…Substantial progress has been made with respect to risk reduction of perinatal HIV transmission in Canada. This has been attributed to universal access to antenatal care, routine HIV screening of pregnant women and provision of treatment to those who test positive (16). In 2017, one HIV transmission was confirmed in an infant whose mother was not receiving any perinatal ART and two transmissions were confirmed in infants whose mothers were receiving perinatal ART.…”

Section: Surveillancementioning

confidence: 99%

HIV in Canada—Surveillance Report, 2017

Haddad

Totten

et al. 2018

CCDR

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Background: Human immunodeficiency virus (HIV) is a global public health issue with an estimated 1.8 million people newly infected in 2017. Objective: To provide a descriptive overview of reported cases of HIV in Canada by geographic location, sex, age group, exposure category and race/ethnicity, from 1985-2017, with a focus on the most recent data. Methods: The Public Health Agency of Canada (PHAC) monitors HIV through the national HIV/ AIDS Surveillance System, which is a passive, case-based system that collates non-nominal data voluntarily submitted and validated by all Canadian provinces and territories. Additional data sources presented here include data on immigration-related medical screening for HIV by Immigration, Refugees and Citizenship Canada and data on infants perinatally-exposed to HIV submitted by the Canadian Perinatal HIV Surveillance Program. Data were collated, tables and figures were prepared and descriptive statistics were applied by PHAC and validated by each province and territory. Results: A total of 2,402 new HIV diagnoses were reported in 2017 in Canada; an increase of 3% compared with 2016 and an increase of 17.1% since 2014. The national diagnosis rate increased slightly, from 6.4 per 100,000 population in 2016 to 6.5 per 100,000 population in 2017. In 2017, while Ontario continued to account for the highest number (n=935) and proportion (38.9%) of reported HIV cases, Saskatchewan reported the highest provincial diagnosis rate (15.5 per 100,000 population). In 2017, the diagnostic rate for males at 9.9 per 100,000 population was higher than for females at 3.2 per 100,000 population. As in 2016, the 30-39 year age group had the highest HIV diagnosis rate at 14.8 per 100,000 population. The "gay, bisexual and other men who have sex with men" exposure category continued to represent almost half (46.4%) of all reported HIV cases in adults. In 2017, the absolute number of HIV-positive migrants entering Canada increased to a total number of 835 migrants. One mother-to-child HIV transmission was confirmed in a mother who did not receive any perinatal antiretroviral therapy and two transmissions were confirmed in mothers who did receive perinatal antiretroviral therapy. Conclusion: Similar to the annual changes that have been reported since 2014, the number and rate of reported HIV cases in Canada in 2017 increased slightly compared with 2016. Additional data and analysis are needed to determine the extent to which these findings reflect an increase in HIV transmission, an increase in HIV testing, changes in reporting practices and an increase in the number of HIV-positive people migrating to Canada.

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“…Identification of maternal HIV infection during pregnancy is crucial for timely implementation of antiretroviral prophylaxis, which can both improve the health of the mother and reduce the risk of vertical transmission from 25% (without prophylaxis) to < 5% (Forbes et al 2012;Whitmore et al 2012;Peters et al 2017;Mandelbrot et al 2015;Kimberlin et al 2015;World Health Orgranization (WHO) 2016). A recent national study reported that 14 vertical HIV transmission events occurred between 2011 and 2016 in Canada; however, only five of these pregnant women were diagnosed prior to the onset of labour, indicating that Canadian prenatal care and HIV screening can still be improved (Bitnun et al 2018).…”

Section: Introductionmentioning

confidence: 99%

Examination of a Canadian provincial prenatal HIV screening program: 2010 to 2014

Plitt

Smith

Berry

et al. 2020

Can J Public Health

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Objectives Universal prenatal screening in the Canadian province of Alberta employs an 'opt-out' HIV screening strategy. We examined all women giving birth in the province and determined the frequency and characteristics of women having and not having HIV screening. Methods All livebirths in Alberta from January 1, 2010 to December 31, 2014 were compiled from the Vital Statistics database and linked to HIV screening data to determine maternal demographic and prenatal care characteristics. Correlates associated with prenatal HIV screening, opting out of HIV screening, and not having any prenatal communicable disease screening were determined by multivariable statistics. Results Of the 256,280 live births, 94.2% had prenatal HIV screening, 1.9% declined prenatal HIV screening, and 3.9% had no record of any prenatal communicable disease testing. Compared with those who had HIV screening, those who opted out of prenatal HIV screening were more likely to be over 40 years of age (adjusted odds ratio (AOR), 2.83 [2.12-3.78]) and less likely to be single (AOR,) and First Nations (AOR, 0.67 [0.56-0.82]). Those who received no prenatal communicable disease screening were less likely to be over 40 years of age (AOR, 0.81 [0.69-0.95]) and more likely to be single (AOR,) and have received no prenatal care (AOR,). Both the HIV decliners and prenatal non-testers were more likely to have used a midwife (AOR,] and AOR, 2.44 [2.03-2.92], respectively). Conclusion Demographic and prenatal care characteristics differ by a pregnant woman's prenatal screening status. Policies to improve HIV screening coverage should take these variations into account.

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Missed opportunities for prevention of vertical HIV transmission in Canada, 1997–2016: a surveillance study

Abstract: 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.

Cited by 20 publications

References 20 publications

Congenital anomalies following antenatal exposure to dolutegravir: a Canadian surveillance study

Congenital anomalies following antenatal exposure to dolutegravir: a Canadian surveillance study

HIV in Canada—Surveillance Report, 2017

Examination of a Canadian provincial prenatal HIV screening program: 2010 to 2014

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