title: Adequacy of prenatal care among women living with human immunodeficiency virus: a population-based study.
abstract: BACKGROUND
  Prenatal care reduces perinatal morbidity. However, there are no population-based studies examining the adequacy of prenatal care among women living with HIV. Accordingly, we compared the prevalence of adequate prenatal care among women living with and without HIV infection in Ontario, Canada.
  
  
  METHODS
  Using administrative data in a universal single-payer setting, we determined the proportions of women initiating care in the first trimester and receiving adequate prenatal care according to the Revised-Graduated Prenatal Care Utilization Index . We also determined the proportion of women with HIV receiving adequate prenatal care by immigration status. We used generalized estimating equations with a logit link function to derive adjusted odds ratios (aORs) and 95% confidence intervals (CI) for all analyses.
  
  
  RESULTS
  Between April 1, 2002 and March 31, 2011, a total of 1,132,135 pregnancies were available for analysis, of which 634 (0.06%) were among women living with HIV. Following multivariable adjustment, women living with HIV were less likely to receive adequate prenatal care (36.1% versus 43.3%; aOR 0.74, 95% CI 0.62 to 0.88) or initiate prenatal care in the first trimester (50.8% versus 70.0%; aOR 0.51, 95% CI 0.43 to 0.60) than women without HIV. Among women with HIV, recent (i.e. ≤ 5 years) immigrants from Africa and the Caribbean were less likely to receive adequate prenatal care (25.5% versus 38.5%; adjusted odds ratio 0.51; 95% CI, 0.32 to 0.81) than Canadian-born women.
  
  
  CONCLUSIONS
  Despite universal health care, disparities exist in the receipt of adequate prenatal care between women living with and without HIV. Interventions are required to ensure that women with HIV receive timely and adequate prenatal care.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. ryan.ng@ices.on.ca.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ng
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. erin.macdonald@ices.on.ca.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Macdonald
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. mona.loutfy@wchospital.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. mona.loutfy@wchospital.ca.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada. mona.loutfy@wchospital.ca.|Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada. mona.loutfy@wchospital.ca.
authors.forename: Mona R
authors.initials: MR
authors.lastname: Loutfy
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. yudinm@smh.ca.|Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada. yudinm@smh.ca.|Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. yudinm@smh.ca.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Yudin
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. janet@raboud.net.|Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada. janet@raboud.net.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. janet@raboud.net.
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada. miss_irene509@hotmail.com.
authors.forename: Khatundi-Irene
authors.initials: KI
authors.lastname: Masinde
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. ahmed.bayoumi@utoronto.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. ahmed.bayoumi@utoronto.ca.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada. ahmed.bayoumi@utoronto.ca.|Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. ahmed.bayoumi@utoronto.ca.|Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada. ahmed.bayoumi@utoronto.ca.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bayoumi
authors.affiliation: Women's Health in Women's Hands Community Health Centre, Toronto, Ontario, Canada. wangari@whiwh.com.
authors.forename: Wangari E
authors.initials: WE
authors.lastname: Tharao
authors.affiliation: Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada. JBrophy@cheo.on.ca.
authors.forename: Jason
authors.initials: J
authors.lastname: Brophy
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. rick.glazier@ices.on.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. rick.glazier@ices.on.ca.|Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. rick.glazier@ices.on.ca.|Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada. rick.glazier@ices.on.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. rick.glazier@ices.on.ca.|Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. rick.glazier@ices.on.ca.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. tantoniou@smh.ca.|Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. tantoniou@smh.ca.|Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. tantoniou@smh.ca.
authors.forename: Tony
authors.initials: T
authors.lastname: Antoniou
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D002170:Canada; D017691:Caribbean Region / Q000208:ethnology; D054242:Emigrants and Immigrants; D005260:Female; D006679:HIV Seropositivity / Q000208:ethnology*; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D011247:Pregnancy; D011295:Prenatal Care; D015995:Prevalence; D055815:Young Adult