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. 2017 Mar;18(3):161-170.
doi: 10.1111/hiv.12410. Epub 2016 Aug 1.

Presentation for care and antenatal management of HIV in the UK, 2009-2014

C E French  1 , C Thorne  1 , L Byrne  1 , M Cortina-Borja  1 , P A Tookey  1
Affiliations

Presentation for care and antenatal management of HIV in the UK, 2009-2014

C E French et al. HIV Med. 2017 Mar.

Abstract

Objectives: Despite very low rates of vertical transmission of HIV in the UK overall, rates are higher among women starting antenatal antiretroviral therapy (ART) late. We investigated the timing of key elements of the care of HIV-positive pregnant women [antenatal care booking, HIV laboratory assessment (CD4 count and HIV viral load) and antenatal ART initiation], to assess whether clinical practice is changing in line with recommendations, and to investigate factors associated with delayed care.

Methods: We used the UK's National Study of HIV in Pregnancy and Childhood for 2009-2014. Data were analysed by fitting logistic regression and Cox proportional hazards models.

Results: A total of 5693 births were reported; 79.5% were in women diagnosed with HIV prior to that pregnancy. Median gestation at antenatal booking was 12.1 weeks [interquartile range (IQR) 10.0-15.6 weeks] and booking was significantly earlier during 2012-2014 vs. 2009-2011 (P < 0.001), although only in previously diagnosed women. Overall, 42.2% of pregnancies were booked late (≥ 13 gestational weeks). Among women not already on treatment, antenatal ART commenced at a median of 21.4 (IQR18.1-24.5) weeks and started significantly earlier in the most recent time period (P < 0.001). Compared with previously diagnosed women, those newly diagnosed during the current pregnancy booked later for antenatal care and started antenatal ART later (both P < 0.001). Multivariable analyses revealed demographic variations in access to or uptake of care, with groups including migrants and parous women initiating care later.

Conclusions: Although women are accessing antenatal and HIV care earlier in pregnancy, some continue to face barriers to timely initiation of antenatal care and ART.

Keywords: HIV; antenatal care; antiretroviral therapy; pregnancy; prevention of mother-to-child transmission.

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Figures

Figure 1
Figure 1
Gestation at antenatal care booking for (a) women diagnosed with HIV prior to that pregnancy and (b) women newly diagnosed with HIV during that pregnancy.
Figure 2
Figure 2
Cumulative probability of initiating antenatal antiretroviral therapy (ART) by gestational week, stratified by timing of HIV diagnosis.
See this image and copyright information in PMC

Comment in

References

    1. Townsend CL, Byrne L, Cortina‐Borja M et al Earlier initiation of ART and further decline in mother‐to‐child HIV transmission rates, 2000–2011. AIDS 2014; 28: 1049–1057. - PubMed
    1. National Study of HIV in Pregnancy and Childhood . Quarterly slide set (data up to end of September 2015), 2015. [Accessed February 2016]. Available from: https://www.ucl.ac.uk/nshpc/slides.
    1. National Institute for Health and Clinical Excellence . Routine antenatal care for the healthy pregnant woman London. UK, National Institute for Clinical Excellence, 2008.
    1. de Ruiter A, Taylor G, Clayden P et al British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review). HIV Med 2014; 15 (Suppl 4): 1–77. - PubMed
    1. World Health Organization . Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva, Switzerland, World Health Organization, 2013.