Perinatal HIV Prevention in New York

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Perinatal HIV Prevention in New York

• Roberta Glaros
• New York State Department of Health, AIDS
  Institute
• March 1, 2004

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OVERVIEW
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NYS Survey of Childbearing WomenHIV Prevalence
by Year of Delivery 1988 - 2001
Since 1990, there has been a 60 decline in the
number of HIV-infected women giving birth in NYS
(1,898 in 1990 to 744 in 2002)
Source New York State Perinatal HIV Surveillance
Program
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HIV Counseling and Testing of Pregnant Women and
Newborns in New York State
Regulatory requirement HIV counseling of all
pregnant women with HIV testing
strongly recommended
Newborn HIV Screening Program
Regulatory requirement expedited HIV testing in
labor, delivery with results available within 12
hours
No HIV test history documented
Mother Consent required Newborn No consent
required
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Birth Facility Reporting System
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Maternal/Newborn HIV Test History Assessment (1)

• Prenatal Test History Categories
• A. Tested negative during this pregnancy
• B. Tested positive
• C. Not tested during this pregnancy
• D. Test history unknown/not documented
• No further testing required for A and B
• In-hospital testing indicated for C and D

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Maternal/Newborn HIV Test History Assessment (2)

• In-hospital Test History Categories
• E. Mother tested with consent
• F. Newborn tested
• G. Testing not needed (A and B boxes)

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Reports to DOH

• Transfer maternal/newborn test history to DOH on
  the Newborn Screening Blood Collection Form
  (A-G boxes replicated)
• Report all preliminary positive test results to
  DOH on the Report on Preliminary Positive HIV
  Test Results form

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Report on Preliminary Positive Test Results

• In hospital test history - mother or baby tested
• Date and time of mothers admission
• Date and time of specimen collection
• HIV screening test(s) used and results
• Date and time results received
• Date and time of initiation of therapy
• Confirmatory test result

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DATA ANALYSIS 2002
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Comprehensive Newborn HIV Testing Program - 2002
(1)

• Of the 249,537 specimens submitted to the Newborn
  Screening Program
• 94.2 (235,187) of mothers had been tested during
  this pregnancy
• 5.8 (14,350) were eligible for expedited testing
  in labor and delivery

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Comprehensive Newborn HIV Testing Program - 2002
(2)

• Of the 14,350 eligible for expedited testing in
  labor and delivery
• 75.5 (10,841) testing on mother
• 11.1 (1,587) testing on newborn
• 13.4 (1,922) missed
• Among the 1,922 missed were 3 HIV-exposed
  infants who were identified through the Newborn
  Screening Program

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Expedited Testing2001-2002 (1)

• Regulation allowed a maximum turnaround time of
  48 hours
• 1400 HIV-infected women gave birth in this
  period
• 100 mother/infant pairs were identified as
  HIV-infected/exposed through expedited testing
• 2.5 hours median time from admission to ET
  specimen collection

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Expedited Testing2001-2002 (2)

• 20 hour median time from specimen collection to
  return of preliminary positive results
• 22.5 hour median time from birth to ART for 96
  infants who received therapy

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Expedited Testing2001-2002 (3)

• 100 HIV-infected mothers and 103 exposed infants
  (3 sets of twins)
• 37 (36) received timely ARV
• 13 (12.6) received intrapartum and newborn ARV
• 24 (23.3) received newborn ARV within 12 hours
  of birth

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Expedited Testing2001-2002 (4)

• 9 of the 103 infants (8.7) were HIV-infected
• 5.4 transmission rate for the 37 infants who
  received intrapartum ARV or newborn within 12
  hours
• 10.6 for the 66 infants who received newborn ARV
  after 12 hours of life

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FROM DATA TO INTERVENTIONS
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USES OF DATA

• Performance improvement
• Program evaluation
• Regulatory action
• Targeting of resources
• Changes in policy

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Policy Change

• Emergency regulation effective 11/1/03 changes
  maximum turnaround time for expedited testing in
  L D from 48 hours to 12 hours after the
  mothers consent or birth of child
• Rationale for the change
• Availability of rapid test
• Data on performance of expedited testing

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Regulatory Monitoring12-Hour Turn-Around-Time

• Chart reviews targeted to
• Birth facilities with high rates of expedited
  testing (based on hospital reports)
• Facilities which have already been cited for
  non-compliance with expedited testing
• Review of policies and procedures from facilities
  with extremely low rates of expedited testing

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Conclusions

• New York has a comprehensive statewide data
  collection system due to
• the seriousness of the statewide pediatric HIV
  epidemic
• the need to monitor regulatory compliance
• Less comprehensive systems, e.g. reports from
  sentinel hospitals, special studies, etc. can
  also yield useful data