title: Prevention of mother-to-child HIV transmission: similar access for sub-Sahara African immigrants and for French women?
abstract: OBJECTIVE
  : To investigate whether mother-to-child transmission (MTCT) management and rate differed between African immigrants and French-born women delivering in France.
  
  
  METHODS
  : MTCT strategies were studied among human immunodeficiency virus type 1-infected women delivering between 1984 and 2007 in the multicenter French Perinatal Cohort, according to geographical origin.
  
  
  RESULTS
  : Among 9245 pregnancies (in 7090 women), the proportion of African mothers increased from 12% in 1984-1986 to 64% in 2003-2004. African women had later access to care than French women, even in recent years (1997-2004). They more often discovered their HIV infection during pregnancy (40.6 vs. 11.5%, P < 0.001), started prenatal care in the third trimester (14.1 vs. 9.8%, P < 0.001) and started antiretroviral therapy after 32 weeks gestation (7.6 vs. 4.1%, P < 0.001). The association with late treatment initiation disappeared when adjusted for late HIV diagnosis and prenatal care (adjusted odds ratio 1.0, 95% confidence interval 0.7-1.4). African and French women did not differ in terms of access to highly active antiretroviral therapy, nor for substandard management such as vaginal delivery with uncontrolled viral load, lack of intrapartum and postpartum treatment or breastfeeding. The MTCT rate was higher for African than for French women receiving antiretroviral therapy (1.8 vs. 0.8%, P = 0.02), but the difference was no longer significant after adjustment for main transmission risk factors (adjusted odds ratio = 1.7, 95% confidence interval 0.8-3.7, P = 0.17). MTCT did not differ among 2110 term deliveries with maternal viral load less than 400 copies/ml, (0.8 vs. 0.6%, P = 0.5).
  
  
  CONCLUSIONS
  : African immigrants more often had late HIV screening in pregnancy than French-born women, but had similar access to MTCT prevention, once the infection was diagnosed.
authors.affiliation: INSERM Unit 822, Le Kremlin-Bicêtre, Paris, France.
authors.forename: Carine
authors.initials: C
authors.lastname: Jasseron
authors.forename: Laurent
authors.initials: L
authors.lastname: Mandelbrot
authors.forename: Roland
authors.initials: R
authors.lastname: Tubiana
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Teglas
authors.forename: Albert
authors.initials: A
authors.lastname: Faye
authors.forename: Catherine
authors.initials: C
authors.lastname: Dollfus
authors.forename: Jerome
authors.initials: J
authors.lastname: Le Chenadec
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
authors.forename: Stephane
authors.initials: S
authors.lastname: Blanche
authors.forename: Josiane
authors.initials: J
authors.lastname: Warszawski
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data*; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000208:ethnology* / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D015497:HIV-1; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008403:Mass Screening / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000208:ethnology* / Q000821:virology; D011295:Prenatal Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents