Progress in prevention of mother-to-child transmission of HIV in New York State: 1988-2008.
OBJECTIVE
To assess the outcomes of efforts to prevent mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) made over the last 2 decades in New York State (NYS), through review of data from multiple sources.


METHODS
Using available surveillance, laboratory, and program monitoring data, the following were examined for NYS: (1) the rate of prenatal HIV testing, (2) HIV prevalence among childbearing women, (3) maternal prenatal and delivery care, (4) care of HIV-exposed infants, and (5) the rate of MTCT. Trends over time and comparisons among groups were assessed.


RESULTS
In NYS, HIV prevalence in childbearing women has declined 70% since its peak in 1989. Rates of prenatal HIV testing have been more than 95% in recent years. Rates of MTCT have decreased significantly; since 2003, transmission in HIV-exposed births has ranged from 1.2% to 2.6% annually. On bivariate analysis, MTCT is more likely to occur with breastfeeding or absence of antiretroviral administration in the prenatal, labor/delivery, and newborn periods.


CONCLUSIONS
Mother-to-child HIV transmission has declined dramatically in all groups in NYS. Universal newborn screening data have provided the foundation for identifying HIV-exposed births and for initiating follow-up to track all aspects of MTCT in NYS. Remaining challenges include universal prenatal care, prevention of acquisition of HIV infection during pregnancy, and adherence to antiretroviral therapy.
Birkhead
Guthrie S
GS
Office of Public Health, New York State Department of Health, Corning Tower, ESP, Albany, NY 12237, USA. gsb02@health.state.ny.us
Pulver
Wendy P
WP
Warren
Barbara L
BL
Klein
Susan J
SJ
Parker
Monica M
MM
Caggana
Michele
M
Smith
Lou C
LC
D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D002648:Child; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015997:Neonatal Screening; D009518:New York; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D011314:Preventive Health Services / Q000706:statistics & numerical data / Q000639:trends; D015397:Program Evaluation; D011634:Public Health