HIV Screening During Pregnancy in a U.S. HIV Epicenter

Abstract

Background. The CDC and ACOG have issued guidelines for HIV screening in pregnancy for patients living in areas with high prevalence of HIV in order to minimize perinatal vertical transmission. There is a lack of data examining providers’ compliance with these guidelines in at-risk patient populations in the United States. Objective. To evaluate if HIV screening in pregnant women was performed according to guidelines at a large, urban, tertiary care medical center in South Florida. Study Design. A retrospective review was performed on 1270 prenatal and intrapartum records from women who delivered a live infant in 2015 at a single institution. Demographic and outcome data were chart abstracted and analyzed using arithmetic means and standard deviations. Results. Of the 1270 patients who met inclusion criteria, 1090 patients initiated prenatal care in the first or second trimester and delivered in the third trimester. 1000 (91.7%) patients were screened in the first or second trimester; however, only 822 (82.2%) of these were retested in the third trimester during prenatal care. Among the 178 patients lacking a third trimester test, 159 (89.3%) received rapid HIV testing upon admission for delivery. Of the 1090 patients who initiated prenatal care in the first or second trimester and delivered in the third trimester, 982 (90.1%) were screened in accordance with recommended guidelines. Of the 1270 patients initiating care in any trimester, 24 (1.9%) had no documented prenatal HIV test during prenatal care, however 22 (91.7%) had a rapid HIV test on admission for delivery. Two (0.16%) patients were not tested prenatally or prior to delivery. Conclusion. Despite 99.8% of women having at least one HIV screening test during pregnancy, there is room for improvement in routine prenatal screening in both early pregnancy and third trimester prior to onset of labor in this high-risk population.

Management Strategies in Perinatal HIV

“…Repeat testing should not be neglected as it has been demonstrated that a higher percentage of perinatal transmissions occur after 36 weeks' gestation [7]. In a US Epicenter for HIV, only about 80% of mothers were retested in their third trimester [8]. Furthermore, a study of pregnant women living with HIV in South Africa showed that only 11% of women were receiving all recommended tests throughout the perinatal period [9].…”

“…If efficacy and safety data were more comprehensive for the pregnant and neonatal populations, this would likely have a profound effect on achieving the elimination of MTCT. Additionally, opportunities exist for utilizing HIV testing during pregnancy and surrounding the time of delivery [8,9]. Adhering to the current recommendations for HIV screening would shorten the time to treatment and potentially reduce viral exposure to the newborn [8].…”

“…Additionally, opportunities exist for utilizing HIV testing during pregnancy and surrounding the time of delivery [8,9]. Adhering to the current recommendations for HIV screening would shorten the time to treatment and potentially reduce viral exposure to the newborn [8].…”

“…Several studies have demonstrated that maternal HIV testing may be underutilized [8,9]. In a study conducted in a US epicenter for HIV, about 20% of women did not receive a second HIV test during their 3rd trimester.…”

“…Providers should be aware of the local prevalence of HIV infections and recommendations for HIV screening during all trimesters. Furthermore, conducting nonbiased social and sexual health histories during pregnancy would be useful to identify high-risk women who may benefit from a repeat HIV screening test in the third trimester [8].…”