title: Missed opportunities for prevention of mother-to-child transmission in the United States.
abstract: OBJECTIVE
  To describe system failures potentially contributing to perinatal HIV transmission in the state of Georgia, United States, between 2005 and 2012.
  
  
  METHODS
  A retrospective chart review of antenatal and postnatal records of HIV-infected infants between 1 January 2005 and 31 December 2012.
  
  
  METHODS
  Study participants included all HIV-infected infants referred for specialized management to the Ponce Family and Youth Clinic within Grady Health Systems in Atlanta. Main outcomes included identification of maternal, perinatal, and neonatal risk factors associated with vertical transmission.
  
  
  RESULTS
  Twenty-seven cases were identified; 89% of mothers were African-American between 16 and 30 years of age. Seventy-four percent of women knew their HIV status prior to pregnancy, 44% had no prenatal care, and 52% did not receive combination antiretroviral therapy during pregnancy or intrapartum zidovudine. HIV-1 RNA near the time of delivery was available in only 10 of 27 mothers, and of those, only three had an undetectable HIV-1 RNA level. Caesarean section was performed in 70% of women. Of the 27 children, the mean gestational age was 37 (SD: 2.9) weeks, with 33% requiring neonatal ICU admission. Fifty-nine percent were men, and only 67% received postnatal zidovudine prophylaxis.
  
  
  CONCLUSIONS
  Mother-to-child transmission of HIV continues to occur in Georgia at unacceptable levels. Increased education with adherence to existing national guidelines, as well as coordinated efforts between healthcare and public health providers to improve linkage and retention in medical care are urgently needed to prevent further vertical transmission events in Georgia.
authors.affiliation: aDivision of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine; Children's Healthcare of Atlanta bPonce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems cDepartment of Epidemiology and Biostatistics, Georgia State University, Atlanta, Georgia, USA.
authors.forename: Andres F
authors.initials: AF
authors.lastname: Camacho-Gonzalez
authors.forename: Marie-Huguette
authors.initials: MH
authors.lastname: Kingbo
authors.forename: Ashley
authors.initials: A
authors.lastname: Boylan
authors.forename: Allison Ross
authors.initials: AR
authors.lastname: Eckard
authors.forename: Ann
authors.initials: A
authors.lastname: Chahroudi
authors.forename: Rana
authors.initials: R
authors.lastname: Chakraborty
mesh_terms: D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D005260:Female; D005845:Georgia / Q000453:epidemiology; D019983:Guideline Adherence; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult