Presentation for care and antenatal management of HIV in the UK, 2009−2014

Abstract

ObjectivesDespite very low rates of vertical transmission of HIV in the UK overall, rates are higher among women starting antenatal antiretroviral therapy (ART) late. We investigated the timing of key elements of the care of HIV‐positive pregnant women [antenatal care booking, HIV laboratory assessment (CD4 count and HIV viral load) and antenatal ART initiation], to assess whether clinical practice is changing in line with recommendations, and to investigate factors associated with delayed care.MethodsWe used the UK's National Study of HIV in Pregnancy and Childhood for 2009−2014. Data were analysed by fitting logistic regression and Cox proportional hazards models.ResultsA total of 5693 births were reported; 79.5% were in women diagnosed with HIV prior to that pregnancy. Median gestation at antenatal booking was 12.1 weeks [interquartile range (IQR) 10.0–15.6 weeks] and booking was significantly earlier during 2012–2014 vs. 2009–2011 (P < 0.001), although only in previously diagnosed women. Overall, 42.2% of pregnancies were booked late (≥ 13 gestational weeks). Among women not already on treatment, antenatal ART commenced at a median of 21.4 (IQR18.1–24.5) weeks and started significantly earlier in the most recent time period (P < 0.001). Compared with previously diagnosed women, those newly diagnosed during the current pregnancy booked later for antenatal care and started antenatal ART later (both P < 0.001). Multivariable analyses revealed demographic variations in access to or uptake of care, with groups including migrants and parous women initiating care later.ConclusionsAlthough women are accessing antenatal and HIV care earlier in pregnancy, some continue to face barriers to timely initiation of antenatal care and ART.

Comprehensive nationwide analysis of mother-to-child HIV transmission in Finland from 1983 to 2013

“…In our study, the proportions of diagnosis during earlier in the pregnancy, ART coverage during the second trimester, virological treatment results and proportion on ART at the time of conception were similar between these groups. In a recent study from the UK [18], immigrants, especially from sub-Saharan Africa, booked late for an antenatal visit and those newly diagnosed started ART later than natives, which is in contrast to our results.…”

UK Mother-to-Child HIV Transmission Rates Continue to Decline: 2012–2014

“…However, women need continued support with adherence to treatment postnatally, particularly when ART is started during pregnancy [5]. Among the 15% of women diagnosed as a result of screening in pregnancy, earlier initiation of ART in recent years is likely to have contributed to the declining transmission rates, although some migrant groups and parous women continue to access services late [6]. The changing population of pregnant women with HIV in the UK, including increasing numbers of those aged ≥40 years and of vertically-infected pregnant women, has additional implications for pregnancy management to optimize maternal and child health [7,8].…”

Missed opportunities to prevent mother‐to‐child transmission of HIV in Italy

“…In previous studies, MTCT was linked to inadequate (or absent) prenatal care, and late booking of prenatal care was correlated with being foreign‐born . However, in our study, about 40% of women were Italian, highlighting that prenatal care and serological screening need to be optimized universally.…”

“…Despite prevention programmes and active screening being largely available in these countries, 125 HIV‐infected children were born in Spain between 2004 and 2013 and 48 in France between 2006 and 2012 . Moreover, according to the data of the National Study of HIV in Pregnancy and Childhood in the UK, HIV status was reported for only 3988 of the 5641 children born to HIV‐infected mothers, and 16 of these children acquired HIV perinatally despite known maternal diagnosis .…”