Variable uptake of recommended interventions to reduce mother-to-child transmission of HIV in Australia, 1982-2005.
OBJECTIVE
To analyse the uptake of interventions known to reduce the risk of perinatal HIV transmission among Australian women with HIV infection (who knew their HIV status before delivery), and identify predictors of uptake.


METHODS
Retrospective analysis of perinatal HIV surveillance data in Australia.


METHODS
Women reported as having HIV infection and having given birth to a child (1982-2005) were identified through three mechanisms: an informal network of clinicians (1982-1993); an active surveillance program through paediatricians (since 1993); and state health department reports of children born to women newly diagnosed with HIV (since 1995).


METHODS
Uptake of interventions - avoidance of breastfeeding (after 1985), use of zidovudine during pregnancy (after 1994), and elective caesarean section (after 1999). Factors associated with uptake of these interventions were identified by univariate and multivariate analyses.


RESULTS
367 live births were reported in 291 women with HIV infection. Among the subgroup diagnosed with HIV infection before delivery, 4/255 (1.6%) elected to breastfeed (post 1985), 44/185 (24%) did not receive zidovudine (after 1994), and 41/118 (35%) did not have an elective caesarean section (after 1999). In multivariate analysis, there were significant differences in uptake of zidovudine and elective caesarean section according to year of birth and state in which the birth took place.


CONCLUSIONS
In Australia between 1982 and 2005, uptake of interventions to reduce mother-to-child transmission of HIV was high. There were significant differences associated with use of zidovudine and mode of delivery according to location of delivery and year of birth.
Giles
Michelle L
ML
Department of Medicine, Monash University, Melbourne, VIC, Australia. michelle.giles@burnet.edu.au
McDonald
Ann M
AM
Elliott
Elizabeth J
EJ
Ziegler
John B
JB
Hellard
Margaret E
ME
Lewin
Sharon R
SR
Kaldor
John M
JM
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D001942:Breast Feeding / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012189:Retrospective Studies; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D015215:Zidovudine