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PLoS One. 2015 Jul 1;10(7):e0132262. doi: 10.1371/journal.pone.0132262. eCollection 2015.

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

Author information

1
Division of Infectious Diseases and HIV Medicine, Drexel University School of Medicine, Philadelphia, Pennsylvania, United States of America.
2
AIDS Activities and Coordinating Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, United States of America; Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
3
Division of Infectious Diseases, Temple University Hospital, Philadelphia, Pennsylvania, United States of America.
4
Center for Women's and Children's Health Research, Christiana Care Health System, Greenville, Delaware, United States of America.
5
Drexel University School of Public Health, Philadelphia, Pennsylvania, United States of America.
6
Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, 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.

PMID:
26132142
PMCID:
PMC4489492
DOI:
10.1371/journal.pone.0132262
[Indexed for MEDLINE]
Free PMC Article

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