scholarly journals Implementation of universal rapid human immunodeficiency virus screening on labor and delivery

2018 ◽  
Vol 5 (2) ◽  
pp. 47-54
Author(s):  
Stacia Crochet ◽  
Chun-Chih Huang ◽  
Melissa Fries ◽  
Rachel K. Scott
Keyword(s):  
Medical Center ◽  
Negative Relationship ◽  
Washington Dc ◽  
Hiv Diagnosis ◽  
Opt Out ◽  
Immunodeficiency Virus ◽  
Mtct Rate ◽  
Human Immunodeficiency Virus Screening ◽  
Low Incidence ◽  
Mother To Child

Background: A case of mother to child transmission (MTCT) of HIV at a medical center in Washington, DC, resulted in the implementation of universal opt-out rapid testing of patients admitted for delivery. This article evaluates the policy’s efficacy and implementation. Methods: We evaluated the implementation using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results: We could not evaluate decrease in MTCT rate secondary to low sample size ( n = 3324) and no true-positive results. Patients not tested ( n = 458) were predominately secondary to physician omission (93.7%) and were more likely to be White ( p < 0.01) and older ( p < 0.01). There was a negative relationship with physician omission over time. Conclusion: The policy was successfully implemented with decreasing proportions of patients not tested. Earlier inclusion of testing into standard admission orders and nurse-based approach may have expedited adoption. Given the low incidence of new HIV diagnosis in labor, we were unable to assess decrease in MTCT.

Mother-to-Child HIV Transmission among Pregnant Women in a City with the Highest Rates of HIV in Brazil

2021 ◽  
Author(s):  
Mariana Menegotto ◽  
Amanda M. Magdaleno ◽  
Carmem L.O. da Silva ◽  
Luciana Friedrich ◽  
Clécio H. da Silva
Keyword(s):  
Viral Load ◽  
High Risk ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Porto Alegre ◽  
Hiv Diagnosis ◽  
Factors Associated ◽  
Mtct Rate ◽  
Peripartum Period ◽  
Mother To Child

Objective Most of the HIV pediatric infections are acquired through mother-to-child transmission (MTCT). Porto Alegre is a state capital of Brazil that had a HIV MTCT rate of 4.1% in 2013 and the highest rate of HIV-infected pregnant women in the country during 2018. Zidovudine and nevirapine have been used in Brazil for high-risk newborns since 2012. The aim of the study was to investigate HIV MTCT rate and the factors associated with HIV transmission at a hospital that is a reference center for HIV-infected mothers in Porto Alegre, after the introduction of this policy. Study Design This retrospective cohort study included all HIV-exposed infants born between February 2013 and December 2016 at the Hospital de Clínicas de Porto Alegre. Student's t-test or Fisher's exact test was used to compare variables between HIV-infected and uninfected groups of newborns. Poisson's regression with robust variance was used to determine the factors associated with HIV MTCT. Results A total of 375 newborns were exposed to HIV, with an outpatient loss of 14.4% (n = 54). The HIV MTCT rate was 2.18% (n = 7), with four infected during the intrauterine period. The risk factors for MTCT were no prenatal care (relative risk [RR] = 9.4; 95% confidence interval [CI]: 2.0–44.3), late maternal HIV diagnosis in the peripartum period (RR = 16.3; 95% CI: 3.6–73.0), syphilis infection during pregnancy (RR = 9.3; 95% CI: 2.1–40.3), maternal viral load >1,000 copies/mL in the third trimester or peripartum period (RR = 9.5; 95% CI: 1.7–50.5), and lack of or inappropriate antiretroviral therapy during pregnancy (RR = 8.2; 95% CI: 1.6–41.4). Conclusion MTCT rate was 2.18%. With the institution of two-drug prophylaxis for high-risk newborns, persistent cases HIV MTCT were predominantly found among women with absence of antenatal care, late HIV diagnosis, syphilis coinfection, high viral load, and inadequate ARV therapy during pregnancy. Although zidovudine and nevirapine were administered postnatally to high-risk newborns, this regimen could not prevent transplacental transmission. Key Points

scholarly journals Preventing mother to child transmission of HIV: lessons learned from China

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yu Dong ◽  
Wei Guo ◽  
Xien Gui ◽  
Yanbin Liu ◽  
Yajun Yan ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Lessons Learned ◽  
Post Exposure Prophylaxis ◽  
Protective Effects ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Immunodeficiency Virus ◽  
Mtct Rate ◽  
Exposure Prophylaxis ◽  
Mother To Child

Abstract Background The program for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) was launched in 2003 in China, but few studies have been conducted to describe the panorama of PMTCT. We investigated the rate and associated factors of mother-to-child transmission (MTCT) in China from 2004 to 2018. Methods HIV-infected pregnant women from two areas in China between 2004 and 2018 were enrolled. Antiretrovirals (ARVs) were provided to the mothers and their babies, and the children were followed and tested for HIV. Results In total, 857 mothers and their 899 children were enrolled, and the overall MTCT rate was 6.6% (95% CI 5.0–8.2). The MTCT rates of nonintervention, only formula feeding (FF), infant prophylaxis (IP) + FF, single dosage antiretrovirals (sdARVs) + IP + FF, zidovudine (AZT) alone+IP + FF and prenatal combination antiretroviral therapy (cART) + IP + FF were 36.4, 9.4, 10.0, 5.7, 3.8 and 0.3%, respectively. The MTCT rate declined over time. No ARVs, CD4 count < 200/μL, low birth weight, and breastfeeding were associated with MTCT of HIV. For different ARVs, a higher MTCT rate was observed for AZT alone, sdARVs, and no ARVs compared to cART for pregnant women. Conclusions Although the overall MTCT rate remains relatively high, the real-world effect of prenatal cART+IP + FF in China has exerted the same protective effects in high-income countries. With the extension of prenatal cART for pregnant women with HIV, the MTCT rate of HIV has gradually declined in China. However, the coverage of prenatal cART for pregnant women should be further improved. The effect of only post-exposure prophylaxis for infants was limited.

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