HIV seroprevalence, uptake of interventions to reduce mother-to-child transmission and birth outcomes in greater Kingston, Jamaica.
BACKGROUND
The seroprevalence of HIV among pregnant women in the Caribbean is 2-3% and increasing. The Kingston Paediatric and Perinatal HIV Programme is developing and implementing a unified programme to eliminate mother-to-child transmission (MTCT) of HIV in Kingston, Jamaica.


METHODS
Pregnant women presenting to Kingston Metropolitan Antenatal Clinics, Victoria Jubilee Hospital, Spanish Town Hospital and the University Hospital of the West Indies had HIV serology performed by ELISA, or by the new Determine Rapid Test after receiving group counselling. HIV-positive women were referred to High Risk Antenatal Clinics. Antiretroviral prophylaxis with zidovudine (AZT), or nevirapine was given. Care was administered using a standard protocol by a multi-disciplinary team of public and academic healthcare personnel.


RESULTS
In year one, 19,414 women delivered Among 14,054 women who started antenatal care for this period, 5,558 (40%) received group counselling and 7,383 (53%) received HIV-testing. During the fourth quarter of follow-up, these comparative rates were 66% (2049/3 118) and 72% (2260/3118) respectively. HIV seroprevalence overall was 2.1% (152/7 383). One hundred and seven HIV+ women at varying gestational ages were identified in the programme, 72 had so far received AZT and nine nevirapine (76%). 0f 84 deliveries, birth outcomes were 75 live births (89%), six neonatal deaths and four maternal deaths (all from HIV/AIDS). Major challenges include repeat pregnancies of 36% despite prior knowledge of HIV seropositivity and poor partner notification with only 30% (32) having a HIV-test. Although rates of HIV testing in pregnant women in Greater Kingston are increasing, rates of testing overall remain sub-optimal. On the labour ward, there was sub-optimal identification of the HIV+ pregnant woman and administration of AZT chemoprophylaxis, along with issues of patient confidentiality and stigma.


CONCLUSIONS
This programme needs strengthening in order to reduce maternal-fetal transmission of HIV in Greater Kingston, Jamaica "pMTCT-PLUS, or comprehensive family-centred care, is the next step".
Johnson
N
N
Kingston Paediatric and Perinatal HIV/AIDS Programme, The University of the West Indies, Kingston 7, Jamaica, West Indies.
Mullings
A A
AA
Harvey
K M
KM
Alexander
G
G
McDonald
D
D
Smikle
M F
MF
Williams
E
E
Palmer
P
P
Whorms
S
S
Figueroa
J P
JP
Christie
C D C
CD
D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006679:HIV Seropositivity; D015528:HIV Seroprevalence; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007563:Jamaica / Q000453:epidemiology; D019829:Nevirapine / Q000008:administration & dosage; D018743:Perinatal Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011295:Prenatal Care; D015397:Program Evaluation; D015215:Zidovudine / Q000008:administration & dosage
D015215:Zidovudine; D019829:Nevirapine