Eliminating Mother-to-Child Transmission of HIV: New York State Perspective *

BACKGROUND: Elimination of Mother-to-child-transmission (MTCT) of HIV is defined by the Center for Disease Control and Prevention (CDC) as a transmission rate of less than 1% of exposed infants and less than 1 case per 100,000 live births. New York State Department of Health (NYSDOH) monitors and comprehensively evaluates HIV exposed births. Approximately 500 HIV positive mothers give birth annually in NYS. In addition to universal prenatal HIV testing of pregnant women, all newborns are screened for HIV at birth and exposed infants undergo follow-up testing to determine final infection status.  

METHODS:  Using data from newborn HIV antibody screening, diagnostic testing of exposed infants and medical record review, NYSDOH assesses: 1) prenatal HIV testing of women giving birth; 2) HIV prevalence in women giving birth; 3) MTCT; 4) quality of care in pregnant/delivering HIV-positive women as well as exposed and infected infants; and, 5) identification of missed opportunities to prevent MTCT.

RESULTS:  In 2013, 236,283 live births were recorded in NYS hospitals; 457 HIV-positive women gave birth to 462 infants. Two infants were confirmed HIV-infected, yielding a MTCT rate of 0.5% and 0.85 MTCT cases per 100,000 live births. Prevalence of HIV in childbearing women is higher among Blacks (0.73%) compared to Whites (0.04%) and Hispanics (0.24%). New York City has higher prevalence compared to other areas of NYS (0.3% versus 0.09%). Ninety-six percent of women were aware of their HIV status prior to delivery. Based on medical record review completed on 364 of 457 HIV-positive mothers, substance abuse was documented in 10% of exposed births, including the mother who delivered an infected infant.

CONCLUSIONS:  In 1990, 1,898 HIV-positive women gave birth to an estimated 475 infected infants. Since then, there has been a 99.5% decrease in the number of infected newborns and a 76% decline in the number of HIV-positive women giving birth in NYS. As a result, in 2013, NYS met the CDC definition of elimination of MTCT. The initiatives undertaken: newborn screening law,  increased prenatal testing, expedited testing at delivery, educating providers, linkage and retention in care, as well as reducing the incidence of HIV among women of childbearing age, have fueled the decline in MTCT. Challenges in terms of seroconversion during pregnancy, substance abuse, mental health, and access to care are barriers in meeting the goal annually. In addition to continuing current practice, targeted efforts addressing psychosocial challenges are needed to ensure the goal is continuously met.