Uptake of interventions to reduce mother-to-child transmission of HIV in the United Kingdom and Ireland

Abstract

Although detection of previously undiagnosed HIV infection in pregnancy remains low in the United Kingdom, and particularly in London, HIV-infected pregnant women who are aware of their status are increasingly active in taking up interventions to reduce transmission to their infants. If all HIV-infected women attending for antenatal care in London consented to testing and took up interventions and termination of pregnancy at the rates observed in this study, the number of vertically infected babies born in London each year could be reduced from an estimated 41 to 13.

Would Universal Antenatal Screening for HIV Infection Be Cost‐Effective in a Setting of Very Low Prevalence? Modelling the Data for Australia

“…Although the literature suggests that the figure might be as high as 20% [59], this finding was derived from data obtained between 1990 and 1995, a time before the effectiveness of antiretroviral therapies had been fully realized and when the risks of vertical transmission were still considerable. The value that we used was obtained from data obtained in 1999 and, we argue, is a more accurate reflection of current practice.…”

“…However, for all scenarios, we assumed that the uptake of screening would remain at 95% and that informed consent would be obtained in an ethical manner. The literature [45,59,[66][67][68][69][70][71][72][73][74][75] suggests that high compliance and ethical screening is determined by careful and sensitive pretest counselling, the level of training for each health-care professional, a need to take particular care when English is not the first language (in countries where English is the most commonly spoken language), and the age, attitudes, and experience of the health-care professionals. On the basis of this, we recommend that appropriate investments be made in continuing professional education.…”

Safe Abortion for HIV-Positive Women with Unwanted Pregnancy: A Reproductive Right

“…22 A UK/Ireland study found that pregnancy termination rates among HIV-positive women remained steady before and after the introduction of PMTCT programmes. 23 Still other research has shown that more HIV-positive women are now choosing to carry pregnancies to term. One US study compared women's decisions to have a tubal ligation or abortion before and after the introduction of PMTCT; while sterilisation rates remained unchanged, fewer women chose to terminate their pregnancies after antiretroviral therapy became available during pregnancy.…”

Antenatal screening for HIV in the UK: what is to be done?

“…However, uptake of testing is no diVerent between black and white women in London, 20 and failing to oVer testing to black African women is discriminatory in denying those who are the most likely to benefit. 21 Currently, in London, antenatal testing is rarely routine. 22 Unlike for other infections, such as rubella, syphilis, and, now, hepatitis B, 23 testing has to be explicitly sought or oVered and is often contingent on discussion of the risk factors.…”