Antenatal screening for HIV, hepatitis B and syphilis in the Netherlands is effective

Abstract

BackgroundA screening programme for pregnant women has been in place since the 1950s in the Netherlands. In 2004 universal HIV screening according to opting out was implemented. Here, we describe the evaluation of the effectiveness of antenatal screening in the Netherlands for 2006-2008 for HIV, hepatitis B virus (HBV) and syphilis in preventing mother-to-child transmission, by using various data sources.MethodsThe results of antenatal screening (2006-2008) were compared with data from pregnant women and newborns from other data sources.ResultsEach year, around 185,000 pregnant women were screened for HIV, HBV and syphilis. Refusal rates for the screening tests were low, and were highest (0.2%) for HIV. The estimated annual prevalence of HIV among pregnant women was 0.05%.Prior to the introduction of screening, 5-10 children were born with HIV annually After the introduction of screening in 2004, only 4 children were born with HIV (an average of 1 per year). Two of these mothers had become pregnant prior to 2004; the third mother was HIV negative at screening and probably became infected after screening; the fourth mother's background was unknown. Congenital syphilis was diagnosed in fewer than 5 newborns annually and 5 children were infected with HBV. In 3 of these, the mothers were HBeAg positive (a marker for high infectivity). We estimated that 5-10 HIV, 50-75 HBV and 10 syphilis cases in newborns had been prevented annually as a result of screening.ConclusionsThe screening programme was effective in detecting HIV, HBV and syphilis in pregnant women and in preventing transmission to the child. Since the introduction of the HIV screening the number of children born with HIV has fallen dramatically.Previous publication[Translation from: 'Prenatale screening op hiv, hepatitis B en syphilis in Nederland effectief', published in 'The Dutch Journal of Medicine ' (NTVG, in Dutch)]

Is Adding HCV Screening to the Antenatal National Screening Program in Amsterdam, The Netherlands, Cost-Effective?

“…Since first-generation non-Western migrants comprise a large proportion of the undiagnosed HCV-infected population in the Netherlands, this risk group should be targeted for screening [3]. This, together with the high screening uptake of 99.8% [24] in the existing routine should argue for implementation of HCV screening for first-generation non-Western women. In addition, the best-case analysis shows potential for an ICER below the €20,000 per LYG.…”

A knowledge survey of obstetrics and gynecology staff on the prevention of mother-to-child transmission of hepatitis B virus

“…Antenatal screening for HBV serologic markers during pregnancy is of great significance in the prevention of HBV mother-to-infant transmission [19]. Given the possibility that some pregnant women may not tell the true histories of HBV infection because of their worries about the potential discrimination against HBV carriers, and that ad-hoc infection may occur during the pregnancy, Obs/Gyn physicians cannot exclude HBV infection in pregnant women only based on the history or pre-pregnancy testing results.…”

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

“…Other testing strategies included routine testing (n = 32) [20,21,24,25,32,35,36,43,61,64,65,69,74,77,78,[92][93][94][95][96]98,104,111,[115][116][117]120,125,130,135,137,147], provision of HIV testing as a component of an integrated testing programme (n = 29) [22,23,32,35,37,38,47,50,52,55,62,63,70,72,74,79,[92][93][94]96,...…”