Missed Opportunities to Prevent Perinatal Human Immunodeficiency Virus Transmission in 15 Jurisdictions in the United States During 2005–2008

Abstract

The objective of this study was to identify factors related to failure to receive recommended interventions for the prevention of mother-to-child HIV transmission among HIV-infected pregnant women in the United States. Using Enhanced Perinatal Surveillance data from 2005 through 2008, we identified characteristics of HIV-infected women (n = 5,391) that increased their odds of missing an opportunity to prevent perinatal HIV transmission. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were calculated by using backward step-wise logistic regression analyses to determine the relationship between demographic variables and missed opportunities. Of 4,220 HIV-infected pregnant women with complete data, 2,545 (60%) did not receive all of the recommended interventions. Missed opportunities for prevention occurred more often among HIV-infected women aged 25-34 years (aOR = 1.9, 95% CI = 1.4-2.5), and greater than 34 years (aOR = 2.0, 95% CI = 1.5-2.7) compared to those 13-19 years and among injection drug users (aOR = 1.3, CI = 1.0-1.5) compared to women infected with HIV through heterosexual contact. Clinicians can decrease missed opportunities by routinely providing recommended interventions, especially among HIV-infected women who are injection drug users or aged 25 years or older.

Missed opportunities for prevention of mother‐to‐child transmission of HIV‐1 in the NISDI Perinatal and LILAC cohorts

“…The results of the present study are consistent with previous studies of MTCT of HIV-1 conducted over the past 8 years in Europe [8,9], the USA [10,11], Africa [12], and Latin America and the Caribbean [2,13]. These studies identified various missed opportunities for prevention of infection, which included late or no HIV-1 testing [10–12]; late or no initiation of prenatal care or maternal antiretrovirals [2,8,10,11]; limited or no use of maternal antiretroviral regimens [2,9,11,13]; poor control of maternal VL during pregnancy [2]; and lack of ECD [2,11].…”

“…These studies identified various missed opportunities for prevention of infection, which included late or no HIV-1 testing [10–12]; late or no initiation of prenatal care or maternal antiretrovirals [2,8,10,11]; limited or no use of maternal antiretroviral regimens [2,9,11,13]; poor control of maternal VL during pregnancy [2]; and lack of ECD [2,11]. …”

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

“…The importance of substance abuse as a predictor of late diagnosis, suboptimal antiretroviral therapy and vertical HIV transmission was also shown by several studies from the United States and Europe. 3,7,9,[14][15][16] The observed lower uptake of antenatal combination antiretroviral therapy in the adjusted analysis for Ontario and Quebec compared to British Columbia/Yukon Territory may reflect, in part, the low uptake of such therapy among women who injected drugs in Ontario and Quebec. In this regard, it is noteworthy that the uptake of antenatal combination antiretroviral therapy was relatively uniform across maternal risk categories for all provinces except Ontario and Quebec.…”

HIV-1 mother-to-child transmission and drug resistance among Brazilian pregnant women with high access to diagnosis and prophylactic measures

“…Nevertheless, missing opportunities can jeopardize preventive measures. 8 In Goias State, central western Brazil, a special public health prenatal program ("Program for the Protection of Pregnant Women/PPPW") implemented in 2003 screens ∼70,000 pregnant women/year from ∼240 municipalities. Serological screening includes HIV-1, hepatitis B/C, Human T-LymphotropicVirus, syphilis, toxoplasmosis, rubella, Chagas' disease and Cytomegalovirus.…”