title: Time of HIV Diagnosis and Engagement in Prenatal Care Impact Virologic Outcomes of Pregnant Women with HIV.
abstract: BACKGROUND
  HIV suppression at parturition is beneficial for maternal, fetal and public health. To eliminate mother-to-child transmission of HIV, an understanding of missed opportunities for antiretroviral therapy (ART) use during pregnancy and HIV suppression at delivery is required.
  
  
  METHODS
  We performed a retrospective analysis of 836 mother-to-child pairs involving 656 HIV-infected women in Philadelphia, 2005-2013. Multivariable regression examined associations between patient (age, race/ethnicity, insurance status, drug use) and clinical factors such as adequacy of prenatal care measured by the Kessner index which classifies prenatal care as inadequate, intermediate, or adequate prenatal care; timing of HIV diagnosis; and the outcomes: receipt of ART during pregnancy and viral suppression at delivery.
  
  
  RESULTS
  Overall, 25% of the sample was diagnosed with HIV during pregnancy; 39%, 38%, and 23% were adequately, intermediately, and inadequately engaged in prenatal care. Eight-five percent of mother-to-child pairs received ART during pregnancy but only 52% achieved suppression at delivery. Adjusting for patient factors, pairs diagnosed with HIV during pregnancy were less likely to receive ART (AOR 0.39, 95% CI 0.25-0.61) and achieve viral suppression (AOR 0.70, 95% CI 0.49-1.00) than those diagnosed before pregnancy. Similarly, women with inadequate prenatal care were less likely to receive ART (AOR 0.06, 95% CI 0.03-0.11) and achieve viral suppression (AOR 0.31, 95% CI 0.20-0.47) than those with adequate prenatal care.
  
  
  CONCLUSIONS
  Targeted interventions to diagnose HIV prior to pregnancy and engage HIV-infected women in prenatal care have the potential to improve HIV related outcomes in the perinatal period.
authors.affiliation: Division of Infectious Diseases and HIV Medicine, Drexel University School of Medicine, Philadelphia, Pennsylvania, United States of America.
authors.forename: Florence M
authors.initials: FM
authors.lastname: Momplaisir
authors.affiliation: AIDS Activities and Coordinating Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, United States of America; Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Brady
authors.affiliation: Division of Infectious Diseases, Temple University Hospital, Philadelphia, Pennsylvania, United States of America.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fekete
authors.affiliation: Center for Women's and Children's Health Research, Christiana Care Health System, Greenville, Delaware, United States of America.
authors.forename: Dana R
authors.initials: DR
authors.lastname: Thompson
authors.affiliation: Drexel University School of Public Health, Philadelphia, Pennsylvania, United States of America.
authors.forename: Ana
authors.initials: A
authors.lastname: Diez Roux
authors.affiliation: Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
authors.forename: Baligh R
authors.initials: BR
authors.lastname: Yehia
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015897:Comorbidity; D036861:Delivery, Obstetric; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000151:congenital / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D015143:Philadelphia / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D011256:Pregnancy Outcome; D011295:Prenatal Care; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology; D016896:Treatment Outcome; D019562:Viral Load; D014766:Viremia / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents