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Enhanced Perinatal Surveillance, Georgia 2005-2010

Enhanced Perinatal Surveillance, Georgia 2005-2010 . Background. August 1994 the USPHS Task Force recommends use of ZDV to reduce perinatal transmission

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Enhanced Perinatal Surveillance, Georgia 2005-2010

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  1. Enhanced Perinatal Surveillance, Georgia 2005-2010

  2. Background • August 1994 the USPHS Task Force recommends use of ZDV to reduce perinatal transmission • HIV testing recommendations revised 2006 to include routine opt-out HIV testing all pregnant women, repeat testing in third trimester and rapid testing during delivery • Enhanced Perinatal Surveillance (EPS) begun in 7 states in 1995, increased to 24 jurisdictions in 1999 • Name-based reporting begins in Georgia in 2004 • Georgia funded for EPS 2005-2011 • July 2008 USPHS Task Force recommendations update includes treatment options for HIV-infected pregnant women and for their infants

  3. Overall goals for EPS project • Assist in timely evaluation of perinatal prevention efforts • Monitor the implementation of the USPHS recommendations for testing, use of antiretrovirals, and the effect of implementation of recommendations on perinatal HIV transmission • Establish a surveillance system to collect data to allow states to respond to selected requirements of the Ryan White CARE Act

  4. Methodology for EPS in Georgia • Data collected on HIV-infected pregnant women who gave birth to a live infant 2005-2010 • HIV-infected pregnancies identified through case report forms, birth registry match, and active case surveillance • Eight page data collection form collects information from prenatal, intrapartum and neonatal periods • EPS in Georgia transitioned from a population-based (2005-2006) to a facility-based surveillance system (2007-2010) to focus efforts on the seven tertiary care centers in Georgia

  5. Facility-based sampling, Georgia EPS, 2007-2010

  6. EPS Georgia 2005-2010 • Methodology changed • 2005-2006 EPS review attempted for every HIV-infected pregnancy proved overwhelming • 2007-2009 EPS review limited to seven tertiary care facilities in Georgia doing high risk obstetrics • 2010 close-out year with fewer case investigations • Number of cases investigated decreased • 154 in 2005, 150 in 2006 • 109 (2007), 111 (2008), 118 (2009) • 69 (2010) • Cannot use the number of cases for trend analysis • EPS data in this analysis represents a population based (2005-2006) and facility-based (2007-2010) sample of 695 HIV-infected pregnancies that resulted in 710 live births in Georgia during the years 2005-2010. • Comparison of this Georgia sample is made with a national sample of 8,054 HIV-infected pregnancies from 15 jurisdictions 2005-2008

  7. HIV infected pregnant women giving birth to a live infant, by age group, Georgia, 2005-2010 Georgia sample of 695 pregnancies during 2005-2010

  8. Proportion of HIV infected pregnant women, by age group, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  9. Proportion of HIV-infected pregnant women, by race/ethnicity, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  10. Proportion of HIV-infected pregnant women, by transmission category, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008 Heterosexual contact = heterosexual contact with a person who is HIV infected or in a high risk transmission category (e.g., IDU or MSM)

  11. Proportion of HIV infected pregnant women, by marital status, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  12. Proportion of HIV infected pregnant women, by mother’s country of origin, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  13. Proportion of HIV infected pregnant women receiving prenatal care, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008 Prenatal care = at least one prenatal care visit prior to delivery

  14. Proportion of HIV infected pregnant women, by timing of HIV diagnosis, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  15. Proportion of HIV infected pregnant women receiving prenatal ART*, Georgia and US *ART = antiretroviral therapy Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  16. Proportion of HIV infected pregnant women receiving intrapartum ART*, Georgia and US *ART = antiretroviral therapy Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  17. Proportion of HIV exposed infants receiving ART* during neonatal period, Georgia and US *ART = antiretroviral therapy Georgia sample of 710 infants from 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  18. Proportion of HIV infected pregnancies by delivery type, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  19. Proportion of HIV infected women reporting illicit drug use during pregnancy, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  20. Proportion of HIV infected women reporting alcohol and/or tobacco use during pregnancy, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  21. Proportion of toxicology screen results among HIV infected women, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  22. Proportion of HIV infected pregnant women receiving Group B Strep (GBS) screen, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  23. Proportion of HIV infected pregnant women receiving Hepatitis B screen, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  24. Proportion of HIV infected pregnant women receiving Rubella screen, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  25. Proportion of HIV-infected pregnant women receiving Syphilis screen, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  26. Proportion of HIV infected pregnant women with an STD*, Georgia and US *Includes presumptive or definitive diagnosis during pregnancy of Chlamydia, genital herpes, Gonorrhea, hepatitis B, syphilis and/or Trichomonas Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  27. Proportion of HIV infected pregnant women receiving prenatal care, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  28. Proportion of HIV infected Black, non-Hispanic women receiving prenatal care, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  29. Proportion of HIV infected Hispanic/Latino women receiving prenatal care, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  30. Proportion of HIV infected white, non-Hispanic women receiving prenatal care, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  31. Proportion of HIV infected Black, non-Hispanic pregnant women, by timing of HIV diagnosis, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  32. Proportion of HIV infected Hispanic/Latino pregnant women, by timing of HIV diagnosis, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  33. Proportion of HIV infected white, non-Hispanic pregnant women, by timing of HIV diagnosis, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  34. Proportion of HIV infected Black, non-Hispanic women receiving perinatal ART, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  35. Proportion of HIV infected Black, non-Hispanic women receiving intrapartum ART, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  36. Proportion of HIV exposed Black, non-Hispanic infants given neonatal ART, Georgia and US Georgia sample of 710 infants from 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  37. Proportion of HIV infected Hispanic/Latino women receiving prenatal ART, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  38. Proportion of HIV infected Hispanic/Latino women receiving intrapartum ART, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  39. Proportion of HIV exposedHispanic/Latino infants given neonatal ART, Georgia and US Georgia sample of 710 infants from 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  40. Proportion of HIV infected white, non-Hispanic women receiving prenatal ART, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  41. Proportion of HIV infected white, non-Hispanic women receiving intrapartum ART, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  42. Proportion of HIV exposedwhite, non-Hispanic infants given neonatal ART, Georgia and US Georgia sample of 710 infants from 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  43. Proportion of HIV-exposed infants receiving Pneumocystis prophylaxis during first year of life, Georgia and US Georgia sample of 710 infants from 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  44. Proportion of infants infected with HIV through mother-to-child transmission, Georgia and US *Indeterminate includes cases missing infant’s HIV status Georgia sample of 710 infants from 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

  45. Highlights • Higher proportions of HIV infected women in Georgia EPS were Black, non-Hispanic (85%) vs. national sample (65%) • Majority (58%) of HIV infected pregnant women in Georgia had an unknown transmission category vs. nationally (37%) • Almost all (90%) had at least one prenatal care visit in both the Georgia and national sample • The proportion receiving prenatal care in Georgia was comparable across races with at least one prenatal visit documented for 90% Black, 93% Hispanic/Latino and 89% white women

  46. Highlights (continued) • Almost all (97%) HIV infected pregnant women in Georgia were diagnosed with HIV before (63%) or during (34%) pregnancy, comparable to the national rates • Most HIV infected Georgia women received prenatal ART (79%) and/or intrapartum ART (82%) • Comparisons with national data are limited by missing data (15% and 12% for prenatal and intrapartum ART use in Georgia) • Most (85%) HIV exposed infants in Georgia received neonatal ART, with 12% missing data • Most (58%) HIV infected pregnant women in Georgia delivered by elective C-section compared to 40% nationally

  47. Highlights (continued) • Based on this sample of 710 HIV infected pregnancies in Georgia, 2.5% (18/710) resulted in mother-to-child (MTC) HIV transmission, comparable to the national sample rate of 2%

  48. Limitations • Facility-based sample may not accurately reflect HIV perinatal care for all Georgia • Large proportion of unknown values for some variables limits comparisons within category and to the national sample • Large proportion of indeterminate HIV status for HIV exposed infants limits calculation of MTC transmission in Georgia • Definition of heterosexual contact as sexual contact with a man known to be HIV infected or in a high risk transmission category (MSM or IDU) contributes to the high proportion of unknown transmission category

  49. For more information on Perinatal Surveillance visit http://dph.georgia.gov/enhanced-perinatal-hivaids-surveillance-eps For information on HIV prevention visit http://dph.georgia.gov/hiv-prevention-program For more information on HIV surveillance in Georgia, visit http://dph.georgia.gov/georgias-hivaids-epidemiology-surveillance-section

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