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Time of HIV Diagnosis and Engagement in Prenatal Care Impact Virologic Outcomes of Pregnant Women with HIV.

Momplaisir FM, Brady KA, Fekete T, Thompson DR, Diez Roux A, Yehia BR - PLoS ONE (2015)

Bottom Line: We performed a retrospective analysis of 836 mother-to-child pairs involving 656 HIV-infected women in Philadelphia, 2005-2013.Overall, 25% of the sample was diagnosed with HIV during pregnancy; 39%, 38%, and 23% were adequately, intermediately, and inadequately engaged in prenatal care.Targeted interventions to diagnose HIV prior to pregnancy and engage HIV-infected women in prenatal care have the potential to improve HIV related outcomes in the perinatal period.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases and HIV Medicine, Drexel University School of Medicine, Philadelphia, Pennsylvania, United States of America.

ABSTRACT

Background: HIV suppression at parturition is beneficial for maternal, fetal and public health. To eliminate mother-to-child transmission of HIV, an understanding of missed opportunities for antiretroviral therapy (ART) use during pregnancy and HIV suppression at delivery is required.

Methodology: We performed a retrospective analysis of 836 mother-to-child pairs involving 656 HIV-infected women in Philadelphia, 2005-2013. Multivariable regression examined associations between patient (age, race/ethnicity, insurance status, drug use) and clinical factors such as adequacy of prenatal care measured by the Kessner index which classifies prenatal care as inadequate, intermediate, or adequate prenatal care; timing of HIV diagnosis; and the outcomes: receipt of ART during pregnancy and viral suppression at delivery.

Results: Overall, 25% of the sample was diagnosed with HIV during pregnancy; 39%, 38%, and 23% were adequately, intermediately, and inadequately engaged in prenatal care. Eight-five percent of mother-to-child pairs received ART during pregnancy but only 52% achieved suppression at delivery. Adjusting for patient factors, pairs diagnosed with HIV during pregnancy were less likely to receive ART (AOR 0.39, 95% CI 0.25-0.61) and achieve viral suppression (AOR 0.70, 95% CI 0.49-1.00) than those diagnosed before pregnancy. Similarly, women with inadequate prenatal care were less likely to receive ART (AOR 0.06, 95% CI 0.03-0.11) and achieve viral suppression (AOR 0.31, 95% CI 0.20-0.47) than those with adequate prenatal care.

Conclusions: Targeted interventions to diagnose HIV prior to pregnancy and engage HIV-infected women in prenatal care have the potential to improve HIV related outcomes in the perinatal period.

No MeSH data available.


Related in: MedlinePlus

Receipt of ART and Viral Suppression by A) Timing of HIV Diagnosis and B) Quality of Prenatal Care. Adequacy of prenatal care was measured using the Kessner Index, a validated index of quality of prenatal care which takes into account timing of entry in prenatal care, the number of prenatal visits and gestational age at infant delivery; ART: antiretroviral; VL: viral load; dx: diagnosis.
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pone.0132262.g001: Receipt of ART and Viral Suppression by A) Timing of HIV Diagnosis and B) Quality of Prenatal Care. Adequacy of prenatal care was measured using the Kessner Index, a validated index of quality of prenatal care which takes into account timing of entry in prenatal care, the number of prenatal visits and gestational age at infant delivery; ART: antiretroviral; VL: viral load; dx: diagnosis.

Mentions: Outcomes differed by timing of HIV diagnosis and engagement in prenatal care. Overall, 89% of mother-to-child pairs diagnosed with HIV before pregnancy received ART and 56% achieved viral suppression at delivery. In contrast, 71% of pairs diagnosed with HIV during pregnancy received ART and only 42% achieved viral suppression at delivery (Fig 1). When considering engagement in prenatal care, 95% of mother-to-child pairs with adequate care engagement received ART and 60% achieved suppression. Corresponding proportions for those intermediately and inadequately engaged in care were 93% and 56% and 53% and 32%, respectively. In multivariate logistic regression models, engagement in prenatal care, timing of HIV diagnosis, and infant birth year were significantly associated with both ART receipt and viral suppression (Table 2). Mother-to-child pairs with inadequate prenatal care were less likely to receive ART (AOR 0.06, 95% CI 0.03–0.11) and achieve viral suppression (AOR 0.31, 95% CI 0.20–0.47) compared to those with adequate prenatal care. The likelihood of ART receipt (AOR 0.39, 95% CI 0.25–0.61) and viral suppression (AOR 0.70, 95% CI 0.49–1.00) were lower among mother-to-child pairs diagnosed with HIV during compared to before pregnancy.


Time of HIV Diagnosis and Engagement in Prenatal Care Impact Virologic Outcomes of Pregnant Women with HIV.

Momplaisir FM, Brady KA, Fekete T, Thompson DR, Diez Roux A, Yehia BR - PLoS ONE (2015)

Receipt of ART and Viral Suppression by A) Timing of HIV Diagnosis and B) Quality of Prenatal Care. Adequacy of prenatal care was measured using the Kessner Index, a validated index of quality of prenatal care which takes into account timing of entry in prenatal care, the number of prenatal visits and gestational age at infant delivery; ART: antiretroviral; VL: viral load; dx: diagnosis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4489492&req=5

pone.0132262.g001: Receipt of ART and Viral Suppression by A) Timing of HIV Diagnosis and B) Quality of Prenatal Care. Adequacy of prenatal care was measured using the Kessner Index, a validated index of quality of prenatal care which takes into account timing of entry in prenatal care, the number of prenatal visits and gestational age at infant delivery; ART: antiretroviral; VL: viral load; dx: diagnosis.
Mentions: Outcomes differed by timing of HIV diagnosis and engagement in prenatal care. Overall, 89% of mother-to-child pairs diagnosed with HIV before pregnancy received ART and 56% achieved viral suppression at delivery. In contrast, 71% of pairs diagnosed with HIV during pregnancy received ART and only 42% achieved viral suppression at delivery (Fig 1). When considering engagement in prenatal care, 95% of mother-to-child pairs with adequate care engagement received ART and 60% achieved suppression. Corresponding proportions for those intermediately and inadequately engaged in care were 93% and 56% and 53% and 32%, respectively. In multivariate logistic regression models, engagement in prenatal care, timing of HIV diagnosis, and infant birth year were significantly associated with both ART receipt and viral suppression (Table 2). Mother-to-child pairs with inadequate prenatal care were less likely to receive ART (AOR 0.06, 95% CI 0.03–0.11) and achieve viral suppression (AOR 0.31, 95% CI 0.20–0.47) compared to those with adequate prenatal care. The likelihood of ART receipt (AOR 0.39, 95% CI 0.25–0.61) and viral suppression (AOR 0.70, 95% CI 0.49–1.00) were lower among mother-to-child pairs diagnosed with HIV during compared to before pregnancy.

Bottom Line: We performed a retrospective analysis of 836 mother-to-child pairs involving 656 HIV-infected women in Philadelphia, 2005-2013.Overall, 25% of the sample was diagnosed with HIV during pregnancy; 39%, 38%, and 23% were adequately, intermediately, and inadequately engaged in prenatal care.Targeted interventions to diagnose HIV prior to pregnancy and engage HIV-infected women in prenatal care have the potential to improve HIV related outcomes in the perinatal period.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases and HIV Medicine, Drexel University School of Medicine, Philadelphia, Pennsylvania, United States of America.

ABSTRACT

Background: HIV suppression at parturition is beneficial for maternal, fetal and public health. To eliminate mother-to-child transmission of HIV, an understanding of missed opportunities for antiretroviral therapy (ART) use during pregnancy and HIV suppression at delivery is required.

Methodology: We performed a retrospective analysis of 836 mother-to-child pairs involving 656 HIV-infected women in Philadelphia, 2005-2013. Multivariable regression examined associations between patient (age, race/ethnicity, insurance status, drug use) and clinical factors such as adequacy of prenatal care measured by the Kessner index which classifies prenatal care as inadequate, intermediate, or adequate prenatal care; timing of HIV diagnosis; and the outcomes: receipt of ART during pregnancy and viral suppression at delivery.

Results: Overall, 25% of the sample was diagnosed with HIV during pregnancy; 39%, 38%, and 23% were adequately, intermediately, and inadequately engaged in prenatal care. Eight-five percent of mother-to-child pairs received ART during pregnancy but only 52% achieved suppression at delivery. Adjusting for patient factors, pairs diagnosed with HIV during pregnancy were less likely to receive ART (AOR 0.39, 95% CI 0.25-0.61) and achieve viral suppression (AOR 0.70, 95% CI 0.49-1.00) than those diagnosed before pregnancy. Similarly, women with inadequate prenatal care were less likely to receive ART (AOR 0.06, 95% CI 0.03-0.11) and achieve viral suppression (AOR 0.31, 95% CI 0.20-0.47) than those with adequate prenatal care.

Conclusions: Targeted interventions to diagnose HIV prior to pregnancy and engage HIV-infected women in prenatal care have the potential to improve HIV related outcomes in the perinatal period.

No MeSH data available.


Related in: MedlinePlus