In the Journals

Atlanta hospitals reveal limitations in preventing mother-to-child HIV transmission

Researchers have identified several limitations in preventing mother-to-child transmission of HIV in major delivery units in the Atlanta metropolitan area, according to published study results in the Journal of the Pediatric Infectious Diseases Society.

“The elimination of mother-to-child transmission (MTCT) of HIV is achievable if each step of the perinatal HIV prevention cascade is followed,” the researchers wrote. “To reach the elimination goal, the CDC has called for standardization of medical interventions and policies across all major delivery units.”

The researchers noted that Georgia was ranked fifth nationally in 2014 in total number of new diagnoses of HIV infection, with approximately 25% occurring in women.

“Applying birth rates to the number of women living with HIV in Georgia, the Georgia Department of Public Health estimates that 250 to 300 HIV-infected women give birth annually,” they wrote. “Thirty-four infants born in Georgia were diagnosed with HIV infection between the years 2010 and 2015, which reflects missed opportunities for [prevention of MTCT [PMTCT]).”

The study included 11 labor and delivery hospitals in the Atlanta metropolitan statistical area (MSA) with the highest number of annual deliveries. These hospitals deliver 40,000 infants annually, representing 70% of all deliveries in the metropolitan area.

The researchers conducted interviews with labor and delivery and pharmacy department and microbiology laboratory representatives of the hospitals. They surveyed 71 health care providers from the hospitals between March 2015 and March 2016 and included questions about HIV testing for mother-infant dyads, turnaround times for test results, polices and procedures for PMTCT of HIV, opt in vs. opt out testing, labor and delivery units’ availability of rapid point-of-care testing, and postnatal prophylaxis.

Interview results showed that eight of the 11 hospitals (73%) had a deficit in their PMTCT infrastructure, defined as missing one of seven national recommendations for the PMTCT care continuum. Four of the hospitals (36%) did not have standardized policies for caring for HIV-infected women.

Three hospital labor and delivery units had a policy of opt-in testing for women, the researchers said. Only three hospitals reported nucleic acid testing of HIV-exposed infants. Although all hospitals reported offering oral zidovudine for infant prophylaxis, most (64%) did not have a stock of nevirapine.

Most obstetricians surveyed did not routinely offer rapid HIV testing at the time of delivery to women who had not undergone a third-trimester HIV test — which is recommended in national guidelines, the researchers noted — nor did the majority offer testing at delivery to women who had declined antenatal HIV testing.

The hospital in the study with the largest number of annual births reported not having rapid testing in delivery units for women whose HIV status was unknown.

“The results of this study suggest that some obstetric and pediatric centers in the Atlanta MSA do not follow standard-of-care guidelines, which include assessment of maternal HIV status during labor by performing rapid testing,” the researchers wrote.

“The PMTCT of HIV requires a series of sequential and coordinated interventions targeted to women and their infants antenatally, during labor and delivery, and after birth,” the researchers concluded. “Unless delivery units and prenatal clinics across Georgia can reach the majority of pregnant women and each step along the pathway to prevention is carried out with more than 95% reliability, the goal of eliminating transmission will not be reached.”   by Bruce Thiel

Disclosures:  The authors report no relevant financial disclosures.

Researchers have identified several limitations in preventing mother-to-child transmission of HIV in major delivery units in the Atlanta metropolitan area, according to published study results in the Journal of the Pediatric Infectious Diseases Society.

“The elimination of mother-to-child transmission (MTCT) of HIV is achievable if each step of the perinatal HIV prevention cascade is followed,” the researchers wrote. “To reach the elimination goal, the CDC has called for standardization of medical interventions and policies across all major delivery units.”

The researchers noted that Georgia was ranked fifth nationally in 2014 in total number of new diagnoses of HIV infection, with approximately 25% occurring in women.

“Applying birth rates to the number of women living with HIV in Georgia, the Georgia Department of Public Health estimates that 250 to 300 HIV-infected women give birth annually,” they wrote. “Thirty-four infants born in Georgia were diagnosed with HIV infection between the years 2010 and 2015, which reflects missed opportunities for [prevention of MTCT [PMTCT]).”

The study included 11 labor and delivery hospitals in the Atlanta metropolitan statistical area (MSA) with the highest number of annual deliveries. These hospitals deliver 40,000 infants annually, representing 70% of all deliveries in the metropolitan area.

The researchers conducted interviews with labor and delivery and pharmacy department and microbiology laboratory representatives of the hospitals. They surveyed 71 health care providers from the hospitals between March 2015 and March 2016 and included questions about HIV testing for mother-infant dyads, turnaround times for test results, polices and procedures for PMTCT of HIV, opt in vs. opt out testing, labor and delivery units’ availability of rapid point-of-care testing, and postnatal prophylaxis.

Interview results showed that eight of the 11 hospitals (73%) had a deficit in their PMTCT infrastructure, defined as missing one of seven national recommendations for the PMTCT care continuum. Four of the hospitals (36%) did not have standardized policies for caring for HIV-infected women.

Three hospital labor and delivery units had a policy of opt-in testing for women, the researchers said. Only three hospitals reported nucleic acid testing of HIV-exposed infants. Although all hospitals reported offering oral zidovudine for infant prophylaxis, most (64%) did not have a stock of nevirapine.

Most obstetricians surveyed did not routinely offer rapid HIV testing at the time of delivery to women who had not undergone a third-trimester HIV test — which is recommended in national guidelines, the researchers noted — nor did the majority offer testing at delivery to women who had declined antenatal HIV testing.

The hospital in the study with the largest number of annual births reported not having rapid testing in delivery units for women whose HIV status was unknown.

“The results of this study suggest that some obstetric and pediatric centers in the Atlanta MSA do not follow standard-of-care guidelines, which include assessment of maternal HIV status during labor by performing rapid testing,” the researchers wrote.

“The PMTCT of HIV requires a series of sequential and coordinated interventions targeted to women and their infants antenatally, during labor and delivery, and after birth,” the researchers concluded. “Unless delivery units and prenatal clinics across Georgia can reach the majority of pregnant women and each step along the pathway to prevention is carried out with more than 95% reliability, the goal of eliminating transmission will not be reached.”   by Bruce Thiel

Disclosures:  The authors report no relevant financial disclosures.