Prevention of Perinatal HIV Transmission in an Area of High HIV Prevalence in the United States

Eliminating perinatal transmission of HIV and improving the care of childbearing women living with HIV in the United States require public health and clinical leadership. The Comprehensive Care Workgroup of the Elimination of Perinatal HIV Transmission Stakeholders Group, sponsored by the Centers for Disease Control and Prevention, developed a concept of perinatal HIV service coordination (PHSC) and identified 6 core functions through (1) semistructured exploratory interviews with contacts in 11 state or city health departments from April 2011 through February 2012, (2) literature review and summary of data on gaps in services and outcomes, and (3) group meetings from August 2010 through June 2017. We discuss leadership strategies for implementing the core functions of PHSC: strategic planning, access to services, real-time case finding, care coordination, comprehensive care, and data and case reviews. PHSC provides a systematic approach to optimize services and close gaps in perinatal HIV prevention and the HIV care continuum for childbearing women that can be individualized for jurisdictions with varying needs.

Download Full-text

Homelessness and HIV Transmission

10.1093/med/9780199392742.003.0030 ◽

2017 ◽

Author(s):

Kimberly Livingstone ◽

Daniel B. Herman ◽

Naomi Adler ◽

Ezra S. Susser

Keyword(s):

United States ◽

Antiretroviral Therapy ◽

Cause Of Death ◽

Hiv Transmission ◽

The United States ◽

Homeless Persons ◽

Hiv Prevalence ◽

Morbidity And Mortality ◽

Treatment And Prevention ◽

Hiv Aids

Homelessness is associated with both poorer health and higher risk of morbidity and mortality. Recent research suggests that with growing availability of antiretroviral therapy and the expansion of housing alternatives for chronically homeless persons, HIV is no longer a leading cause of death among the homeless. Nonetheless, HIV prevalence is significantly higher among homeless persons than among their housed counterparts. This chapter examines the association between HIV/AIDS and homelessness in the United States. After providing a brief overview of homelessness and the characteristics of specific homeless subpopulations, we discuss HIV prevalence, transmission, treatment and prevention among people who are homeless in the United States.

Download Full-text

HIV transmission Prevention of Perinatal HIV-1 Transmission in the United States

NeoReviews ◽

10.1542/neo.2-4-e83 ◽

2001 ◽

Vol 2 (4) ◽

pp. 83e-93 ◽

Cited By ~ 1

Author(s):

A. K. Shetty ◽

Y. Maldonado

Keyword(s):

United States ◽

Hiv Transmission ◽

The United States ◽

Perinatal Hiv ◽

Transmission Prevention ◽

Hiv 1 ◽

Hiv Transmission Prevention

Download Full-text

Management of HIV Infection during Pregnancy in the United States: Updated Evidence-Based Recommendations and Future Potential Practices

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2016/7594306 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Bassam H. Rimawi ◽

Lisa Haddad ◽

Martina L. Badell ◽

Rana Chakraborty

Keyword(s):

United States ◽

Hiv Infection ◽

Hiv Transmission ◽

The United States ◽

Maternal Serum ◽

World Health ◽

Screening Tests ◽

Virologic Suppression ◽

Perinatal Hiv ◽

Health Organization

All HIV-infected women contemplating pregnancy should initiate combination antiretroviral therapy (cART), with a goal to achieve a maternal serum HIV RNA viral load beneath the laboratory level of detection prior to conceiving, as well as throughout their pregnancy. Successfully identifying HIV infection during pregnancy through screening tests is essential in order to preventin uteroand intrapartum transmission of HIV. Perinatal HIV transmission can be less than 1% when effective cART, associated with virologic suppression of HIV, is given during the ante-, intra-, and postpartum periods. Perinatal HIV guidelines, developed by organizations such as the World Health Organization, American College of Obstetricians and Gynecologists, and the US Department of Health and Human Services, are constantly evolving, and hence the aim of our review is to provide a useful concise review for medical providers caring for HIV-infected pregnant women, summarizing the latest and current recommendations in the United States.

Download Full-text

Reconsidering the Number of Women With HIV Infection Who Give Birth Annually in the United States

Public Health Reports ◽

10.1177/0033354918800466 ◽

2018 ◽

Vol 133 (6) ◽

pp. 637-643 ◽

Cited By ~ 10

Author(s):

Steven R. Nesheim ◽

Lauren F. FitzHarris ◽

Margaret A. Lampe ◽

Kristen Mahle Gray

Keyword(s):

United States ◽

Hiv Infection ◽

Birth Rate ◽

Hiv Transmission ◽

The United States ◽

Annual Number ◽

Childbearing Age ◽

Perinatal Hiv ◽

Women With Hiv ◽

Living With Hiv

Objectives: The annual number of women with HIV infection who delivered infants in the United States was estimated to be 8700 in 2006. An accurate, current estimate is important for guiding perinatal HIV prevention efforts. Our objective was to analyze whether the 2006 estimate was consistent with the number of infants with HIV infection observed in the United States and with other data on perinatal HIV transmission. Methods: We compared the number of infants born with HIV in 2015 (n = 53) with data on interventions to prevent perinatal HIV transmission (eg, maternal HIV diagnosis before and during pregnancy and prenatal antiretroviral use). We also estimated the annual number of deliveries to women living with HIV by using the number of women of childbearing age living with HIV during 2008-2014 and the estimated birth rate among these women. Finally, we determined any changes in the annual number of infants born to women with HIV from 2007-2015, among 19 states that reported these data. Results: The low number of infants born in the United States with HIV infection and the uptake of interventions to prevent perinatal HIV transmission were not consistent with the 2006 estimate (n = 8700), even with the best uptake of interventions to prevent perinatal HIV transmission. Given the birth rate among women with HIV (estimated at 7%) and the number of women aged 13-44 living with HIV during 2008-2014 (n = 111 273 in 2008, n = 96 363 in 2014), no more than about 5000 women with HIV would be giving birth. Among states consistently reporting the annual number of births to women with HIV, the number declined about 14% from 2008 to 2014. Conclusion: The current annual number of women with HIV infection delivering infants in the United States is about 5000, which is substantially lower than the 2006 estimate. More accurate estimates would require comprehensive reporting of perinatal HIV exposure.

Download Full-text

Incremental Cost-Effectiveness of Two Zidovudine Regimens to Prevent Perinatal HIV Transmission in the United States

Preventive Medicine ◽

10.1006/pmed.1999.0601 ◽

2000 ◽

Vol 30 (1) ◽

pp. 64-69 ◽

Cited By ~ 7

Author(s):

Steven D. Pinkerton ◽

David R. Holtgrave ◽

Peter M. Layde

Keyword(s):

United States ◽

Cost Effectiveness ◽

Incremental Cost ◽

Hiv Transmission ◽

The United States ◽

Perinatal Hiv

Download Full-text

Heroin Type, Injecting Behavior, and HIV Transmission. A Simulation Model of HIV Incidence and Prevalence

10.1101/591180 ◽

2019 ◽

Author(s):

Georgiy V. Bobashev ◽

Sarah Mars ◽

Nicholas Murphy ◽

Clinton Dreisbach ◽

William Zule ◽

...

Keyword(s):

United States ◽

High Risk ◽

Hiv Transmission ◽

Simulation Analysis ◽

The United States ◽

Hiv Prevalence ◽

Low Risk ◽

Transmission Risk ◽

Model Parameters ◽

The Impact

ABSTRACTBackground and AimsUsing mathematical modeling to illustrate and predict how different heroin source-forms: “black tar” (BTH) and powder heroin (PH) can affect HIV transmission in the context of contrasting injecting practices. By quantifying HIV risk by these two heroin source-types we show how each affects the incidence and prevalence of HIV over time. From 1997 to 2010 PH reaching the United States was manufactured overwhelmingly by Colombian suppliers and distributed in the eastern states of the United States. Recently Mexican cartels that supply the western U.S. states have started to produce PH too, replacing Colombian distribution to the east. This raises the possibility that BTH in the western U.S. may be replaced by PH in the future.DesignWe used an agent-based model to evaluate the impact of use of different heroin formulations in high- and low-risk injecting drug user populations who use different types of syringes (high vs. low dead space) and injecting practices. We obtained model parameters from peer-reviewed publications and ethnographic research.ResultsHeating of BTH, additional syringe rinsing, and subcutaneous injection can substantially decrease the risk of HIV transmission. Simulation analysis shows that HIV transmission risk may be strongly affected by the type of heroin used. We reproduced historic differences in HIV prevalence and incidence. The protective effect of BTH is much stronger in high-risk compared with low-risk populations. Simulation of future outbreaks show that when PH replaces BTH we expect a long-term overall increase in HIV prevalence. In a population of injectors with mixed low- and high-risk clusters we find that local HIV outbreaks can occur even when the overall prevalence and incidence are low. The results are dependent on evidence-supported assumptions.ConclusionsThe results support harm-reduction measures focused on a reduction in syringe sharing and promoting protective measures of syringe rinsing and drug solution heating.

Download Full-text