title: HIV infection and prevention of mother-to-child transmission in childbearing women: La Romana, Dominican Republic, 2002-2006.
abstract: OBJECTIVE
  To strengthen prevention of mother-to-child HIV transmission (pMTCT) program implementation in La Romana (LR) province, by estimating HIV prevalence and identifying characteristics associated with HIV infection in parturients.
  
  
  METHODS
  Umbilical cord blood samples were collected at seven obstetrical sites where over 95% of LR's deliveries occur during four phases (pilot, expanded pilot, full study, and pMTCT program monitoring) from 2 August 2002 to 30 September 2006. Results were linked to data abstracted from delivery records.
  
  
  RESULTS
  HIV seroprevalence was 2.6% (263/10 040 overall; 114/4 452, full-study phase (95% confidence interval = 2.1%-3.1%)). Most HIV-infected parturients were Dominican (68.9%) and urban (64.0%). However, prevalence was higher among Haitians (3.7%) than Dominicans (2.3% (p < 0.001)), especially those aged 21-25 years (5.2% vs. 2.3% (p < 0.001)), and among rural, batey, and peri-urban (vs. urban) parturients (3.4% vs. 2.3%, (p = 0.003)). HIV prevalence was associated with commercial sex work (reported by only 0.4%), and prior pregnancy. In logistic regression analysis, commercial sex work, Haitian nationality, and prior pregnancy were independently associated with HIV infection. Caesarean deliveries were more frequent, and rose in the last years of the study, among HIV seropositives; however, most deliveries among seropositives (57.5%) were vaginal.
  
  
  CONCLUSIONS
  HIV prevalence among LR parturients was higher than the estimated prevalence in the Dominican Republic (0.8%-1.0%) and, in contrast to past studies, predominantly affected urban Dominicans. HIV prevalence among LR Haitian parturients was higher than among Dominican counterparts and prenatal clinic attendees in Haiti (who had a rate of 3.1%). Consistently implemented, targeted pMTCT interventions are needed.
authors.affiliation: Clínica de Familia MIR, La Romana, Dominican Republic.
authors.forename: José
authors.initials: J
authors.lastname: Román-Poueriet
authors.forename: Aracelis D
authors.initials: AD
authors.lastname: Fernandez
authors.forename: Consuelo M
authors.initials: CM
authors.lastname: Beck-Sagué
authors.forename: René
authors.initials: R
authors.lastname: García Szabó
authors.forename: Fermin
authors.initials: F
authors.lastname: Mercedes
authors.forename: William
authors.initials: W
authors.lastname: Duke
authors.forename: Anny
authors.initials: A
authors.lastname: Martinez
authors.forename: Stephen
authors.initials: S
authors.lastname: Nicholas
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004293:Dominican Republic; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008875:Middle Aged; D015995:Prevalence; D013997:Time Factors; D055815:Young Adult