title: Why are Children Still Being Infected with HIV? Impact of an Integrated Public Health and Clinical Practice Intervention on Mother-to-Child HIV Transmission in Las Vegas, Nevada, 2007-2012.
abstract: BACKGROUND
  During a 9 months period, September 2005 through June 2006, Nevada documented six cases of pediatric HIV acquired through mother-to-child transmission. Subsequently, a community-based approach to the care of women and children living with or exposed to HIV was implemented.
  
  
  METHODS
  A detailed review of mother-infant pairs where HIV transmission occurred was performed to identify missed opportunities for prevention of mother-to-child HIV transmission. An intervention program was developed and implemented using the six-step process. Data were collected prospectively over a 6 years period (2007-2012) and were evaluated for six core outcomes measures: (1) adequacy of prenatal care (2) HIV diagnoses of expectant mothers prior to delivery (3) appropriate use of antiretroviral (ARV) therapy before delivery (4) appropriate use of cesarean section for delivery (5) adequacy of zidovudine prophylaxis to newborn (6) HIV transmission rate.
  
  
  RESULTS
  Twenty-six infants were born to HIV-infected mothers from July 2005 to June 2006 with 6 documented infections. One hundred and five infants were born to HIV infected mothers from January 2007 to December 2012. Postimplementation, adequacy of prenatal care increased from 58% (15/26) to 85% (89/105); appropriate use of ARV therapy before delivery increased from 73% (19/26) to 86% (90/105); cesarean section as the method for delivery increased from 62% (16/26) to 74% (78/105); adequacy of zidovudine prophylaxis to newborn increased from 54% (14/26) to 87% (91/105). HIV transmission rate dropped from 23% (6/26) to 0%.
  
  
  CONCLUSIONS
  Integrating public health and clinical services in the care of HIV-infected pregnant women and exposed infants leads to better coordination of care and improved quality of care.
authors.affiliation: Department of Pediatrics Las Vegas, University of Nevada School of Medicine, NV 89154, USA.
authors.forename: E E
authors.initials: EE
authors.lastname: Ezeanolue
authors.affiliation: Department of Environmental and Occupational Health, University of Nevada Las Vegas, NV 89154, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Pharr
authors.affiliation: Department of Pediatrics Las Vegas, University of Nevada School of Medicine, NV 89154, USA.
authors.forename: A
authors.initials: A
authors.lastname: Hunt
authors.affiliation: Department of Pediatrics Las Vegas, University of Nevada School of Medicine, NV 89154, USA.
authors.forename: D
authors.initials: D
authors.lastname: Patel
authors.affiliation: Department of Pediatrics Las Vegas, University of Nevada School of Medicine, NV 89154, USA.
authors.forename: D
authors.initials: D
authors.lastname: Jackson
keywords: HIV transmission; Implementation; Mother-to-child; Primary care; Public health