Hospital Infrastructure Gaps May Contribute to Mother-to-Child HIV Transmission

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Prevention programs of mother-to-child transmission of HIV require sequential and coordinated interventions antenatally, during labor and delivery, and after birth.
Prevention programs of mother-to-child transmission of HIV require sequential and coordinated interventions antenatally, during labor and delivery, and after birth.

Hospital infrastructure for the prevention of mother-to-child transmission has limitations that may contribute to perinatal HIV transmissions, according to results published in the Journal of the Pediatric Infectious Diseases Society.

The results indicate the need to address healthcare gaps to eliminate mother-to-child transmission of HIV.

The study included 71 healthcare providers in 11 hospitals that deliver 40,000 infants annually, representing 70% of all deliveries in the Atlanta metropolitan area, from March 2015 to March 2016. The researchers surveyed hospital assessments and individual knowledge and practice, including questions about HIV testing for mother-infant pairs, test result turnaround times, policies and procedures for prevention of mother-to-child transmission, opt-out vs opt-in testing, availability of rapid point-of-care testing on labor and delivery units, and postnatal prophylaxis.

The results indicated that 73% (n=8) of the hospitals had limitations in their prevention of mother-to-child transmission infrastructure, with 36% (n=4) reporting that they had no standardized policies for the care of HIV-infected women.

Opt-in HIV testing of women was reported by 3 labor and delivery units, and 3 hospitals reported nucleic acid testing of HIV-exposed infants. Rapid point-of-test testing was available in 2 of 11 labor and delivery units. All hospitals had oral zidovudine available to treat infant prophylaxis, but 7 hospitals did not stock nevirapine.

Of the obstetricians surveyed, 75% (23 of 44) did not routinely offer rapid testing at delivery in patients who did not have a third-trimester HIV test, and 93% (41 of 44) did not offer testing at delivery if the woman declined antenatal testing.

Only 50% (8 of 16) of neonatologists and neonatal nurses reported performing routine virologic diagnostic testing at birth for infants exposed to HIV who were at high risk for perinatal transmission. Of the total neonatologists, 33% (2 of 6) and 50% (3 of 6) did not identify correct dosing for zidovudine and nevirapine, respectively.

“There is an urgent need to close the healthcare gaps identified in Georgia and in the United States, assuming the situation is similar nationally, if we are to eliminate [mother-to-child transmission] of HIV in the United States,” the researchers wrote. “Strong state and national leadership, particularly in public health departments, is necessary to disseminate evidence-based guidelines and to implement infrastructure changes in the many delivery units across the United States.”

Reference

Smith SL, Charoudi AM, Camacho-Gonzalez AF, et al. Evaluating facility infrastructure for prevention of mother-to-child transmission of HIV—a 2015 assessment of major delivery hospitals in Atlanta, Georgia [published July 6, 2018]. J Pediatric Infect Dis Soc. doi:10.1093/jpids/piy058

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