Trends in Women With an HIV Diagnosis at Delivery Hospitalization in the United States, 2006-2014

Abstract

<jats:sec><jats:title>Objectives</jats:title><jats:p> The risk of mother-to-child HIV transmission can be reduced to ≤0.5% if the mother’s HIV status is known before delivery. This study describes 2006-2014 trends in diagnosed HIV infection documented on delivery discharge records and associated sociodemographic characteristics among women who gave birth in US hospitals. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We analyzed data from the 2006-2014 National Inpatient Sample and identified delivery discharges and women with diagnosed HIV infection by using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We used a generalized linear model with log link and binomial distribution to assess trends and the association of sociodemographic characteristics with an HIV diagnosis on delivery discharge records. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> During 2006-2014, an HIV diagnosis was documented on approximately 3900-4400 delivery discharge records annually. The probability of having an HIV diagnosis on delivery discharge records decreased 3% per year (adjusted relative risk [aRR] = 0.97; 95% CI, 0.94-0.99), with significant declines identified among white women aged 25-34 (aRR = 0.93; 95% CI, 0.88-0.97) or those using Medicaid (aRR = 0.93; 95% CI, 0.90-0.97); among black women aged 25-34 (aRR = 0.95; 95% CI, 0.92-0.99); and among privately insured women who were black (aRR = 0.96; 95% CI, 0.92-0.99), Hispanic (aRR = 0.92; 95% CI, 0.86-0.98), or aged 25-34 (aRR = 0.96; 95% CI, 0.92-0.99). The probability of having an HIV diagnosis on delivery discharge records was greater for women who were black (aRR = 8.45; 95% CI, 7.56-9.44) or Hispanic (aRR = 1.56; 95% CI, 1.33-1.83) than white; for women aged 25-34 (aRR = 2.33; 95% CI, 2.12-2.55) or aged ≥35 (aRR = 3.04; 95% CI, 2.79-3.31) than for women aged 13-24; and for Medicaid recipients (aRR = 2.70; 95% CI, 2.45-2.98) or the uninsured (aRR = 1.87; 95% CI, 1.60-2.19) than for privately insured patients. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> During 2006-2014, the probability of having an HIV diagnosis declined among select sociodemographic groups of women delivering neonates. High-impact prevention efforts tailored to women remaining at higher risk for HIV infection can reduce the risk of mother-to-child HIV transmission. </jats:p></jats:sec>

Prevented perinatal HIV infections in the era of antiretroviral prophylaxis and treatment, United States, 1994–2020

“…First, we have nearly a decade of additional experience with perinatal HIV prevention and ARV treatment interventions. Second, we have better data about two important aspects: (1) since 2011, we have been able to report the annual numbers of infants born with HIV in the US from as far back as 2008 (the year by which all states had adopted name‐based HIV reporting); (2) we also have an annual nationally representative estimate of hospital‐based live births to women with HIV from HCUP; 18 this is the first nationally representative data source of such deliveries since CDC's Survey of Childbearing Women (SCBW) ended in 1994 20 . In addition, a number of other factors have contributed to the prevention of perinatal HIV (Table 3).…”

“…These surveillance sources used a variety of methods to create their estimates, including back‐calculation and unlinked anonymous heel‐stick testing of newborns. The estimated annual numbers of live births to women with HIV after 2005 are from the National (Nationwide) Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP), a nationally representative sample of US hospital discharges 18,19 . When no sources were available for a particular year or group of years, we produced estimates via linear interpolation from the nearest neighboring years with data.…”

“…In conclusion, when the US achieved both of its perinatal HIV transmission elimination goals for the first time in 2019, the total • HIV incidence among women (number per 100 000) 22 • Women of childbearing age newly diagnosed with HIV (n) 23 • Women of childbearing age living with diagnosed HIV infection (n) 23 • Annual live births to women living with diagnosed HIV infection (n) 2,18 Increase in: • Birth rate of women with HIV; now nearly equal that of the general population. 36 • Pregnant women with HIV whose diagnosis was made prior to pregnancy (%).…”

“…22 Among women of childbearing age, the number of new diagnoses 23 and the number of women living with HIV has decreased, 23 accompanied by a decrease in the annual number of live births to women with HIV. 18 Conversely, there have been increases in the percentages of women with HIV who are aware of their diagnosis, 24 who are linked to care and who are virally suppressed, 24 who are diagnosed prior to pregnancy, 25,26 and who receive ARVs during pregnancy. 27,28 Biomedically, improvements in perinatal HIV prevention have been achieved due to the availability of more sensitive HIV antigen/antibody tests, 29 the adoption of "treatment as prevention" strategies, 30 ARV regimens for peripartum and infant post-exposure prophylaxis if the mother has not received prenatal ARVs, 31 and recommendations for ARV pre-exposure prophylaxis.…”

Achieving Elimination of Perinatal HIV in the United States

“…Perinatal HIV transmission rates from 2010 to 2019 were calculated by using estimates of live births to women with an HIV diagnosis from the National Inpatient Sample, Healthcare Cost and Utilization Project. 3 The annual estimated number of live births to women with diagnosed HIV ranged from 4587 in 2010 3 to 3525 in 2019, and the reported number of US-born infants with perinatally acquired HIV ranged from 74 in 2010 to 32 in 2019 2 ( Fig 1 , Table 1 ).…”