Repeat third trimester HIV testing: An opportunity to prevent maternal to child transmission
Description: The statewide Perinatal HIV Hotline receives reports of positive HIV tests in pregnancy. Hotline reports between 2007-2014 were reviewed to identify cases of seroconversion in pregnancy. Cases were defined by a documented negative maternal HIV test during pregnancy followed by a confirmed positive HIV test later in pregnancy or at delivery. Women with postpartum diagnoses were determined to have seroconverted during pregnancy based upon HIV infection in the child in the absence of sustained breastfeeding. Fourteen cases (13 known and 1 suspected) of maternal seroconversion were identified.
Lessons Learned: Maternal HIV seroconversion in pregnancy is rare but can be missed without repeated testing and poses a high risk for MTCT. In 7 of 14 (50%) seroconversion cases, MTCT occurred. Diagnosis antenatally can mitigate this risk. Of the five maternal HIV diagnoses discovered before delivery, none resulted in infant HIV infection.
Recommendations: Identification of HIV acquisition during pregnancy is critical to achieving perinatal HIV elimination. Universal repeat third trimester HIV testing can identify maternal HIV seroconversion and prevent ongoing cases of MTCT. Mandated repeat testing should be recommended for all pregnant women in Illinois.
Learning Areas:Planning of health education strategies, interventions, and programs
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Explain the relationship between maternal acquisition of HIV during pregnancy and maternal to child transmission of HIV. Describe the role of third trimester repeat HIV testing in identifying maternal seroconversion during pregnancy and prevention of perinatal HIV transmission. Identify one policy initiative to support identification of women who acquire HIV during pregnancy.
Keyword(s): Women and HIV/AIDS, Perinatal Health
Qualified on the content I am responsible for because: I have been the Administrator of the only statewide Perinatal HIV Hotline since its inception in 2005. In this role, I play a key part in perinatal HIV prevention efforts in Illinois. I am an active member and subcommittee chair of Illinoisâ Fetal Infant Mortality Review-HIV continuous quality improvement project that identifies missed opportunities in perinatal HIV prevention. Among my public health interests has been identifying strategies to strengthen Illinoisâ perinatal HIV prevention activities.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.