BACKGROUND: The Centers for Disease Control and Prevention (CDC) notes many prevention challenges with respect to perinatal HIV transmission including limited family planning services and primary HIV prevention for women of reproductive age. This study describes antenatal and perinatal HIV surveillance undertaken by the Tennessee Department of Health (TDH) to identify how many live births occurred within a five year birth cohort of HIV-positive women as well as when HIV-positive parous women in Tennessee were diagnosed relative to a recent pregnancy.
METHODS: Data were extracted for all HIV-positive females within the Tennessee Enhanced HIV/AIDS Reporting System (eHARS) as of July 9, 2014, including HIV diagnosis dates. Data for all live births in Tennessee from 2009-2013 were aggregated from vital records. This birth cohort was selected for two reasons: 1) the historical mobility of the HIV-positive population in Tennessee and 2) the most recent five-year vital records data available. Data were matched by the mother’s information using a seven-element scheme. To determine timing of HIV diagnosis relative to pregnancy, conception date was estimated using child’s date of birth and number of gestation days (calculated by multiplying number of gestation weeks by seven). Data were cleaned, de-identified, and aggregated using Statistical Analysis Software (SAS) 9.3 (SAS Institute Inc., Cary, NC).
RESULTS: There were 7,658 HIV-positive women in eHARS (incident and prevalent cases, and decedents since 2009) and 429,798 live births in Tennessee for the five-year birth cohort. There were 518 births matched with 432 HIV-positive women. Of these women, 358 gave birth once, 63 gave birth twice, 10 gave birth three times, and one gave birth four times. Not all births in this cohort were singleton as there were 8 sets of twins. Of the 432 women, 280 were diagnosed prior to conception in the five-year cohort; yet 84 women were diagnosed during their antenatal period, 9 at delivery or within 48 hours of childbirth. Additionally, 59 women were excluded as they were diagnosed with HIV ≥ 3 days after giving birth.
CONCLUSIONS: These results suggest HIV prevention and screening interventions and family-planning counseling targeting birth spacing and birth control may require improved implementation in Tennessee. Enhancing HIV prevention strategies directed at women of reproductive age to include family planning services is critical. It is also essential to enhance statewide provider education on the importance of screening for HIV before, during, and after pregnancy to avoid vertical transmission of HIV.