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Presenter: Nguyen Thi Kim Chi CDC

Late maternal HIV testing, HCMC 2007-2011 Chi K. Nguyen 1 , Haily T. Pham 2 , ThuVan T. Tieu 2 , Chinh Q. Nguyen 3 , Nhung T. Vu 4 , Hao T. Duong 1 , Binh T. Le 1 , Michelle McConnell 1 , Marta Ackers 1. Presenter: Nguyen Thi Kim Chi CDC.

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Presenter: Nguyen Thi Kim Chi CDC

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  1. Late maternal HIV testing, HCMC 2007-2011Chi K. Nguyen1, Haily T. Pham2,ThuVan T. Tieu2, Chinh Q. Nguyen3, Nhung T. Vu4,Hao T. Duong1, Binh T. Le1, Michelle McConnell1, Marta Ackers1 Presenter: Nguyen Thi Kim Chi CDC 1HHS/ CDC Vietnam, 2Provincial AIDS Committee, Ho Chi Minh City, Vietnam, 3Reproductive Health Center, Ho Chi Minh City, Vietnam, 4Hung Vuong OB/GYN hospital, Ho Chi Minh City, Vietnam

  2. Content Background Objectives Methods Results & Discussions Conclusions Recommendations

  3. Background: PMTCT in HCMC * HCMC PAC PMTCT program report • City program started in 2004 • 120,000 pregnant women annually • 30-40% from other provinces* • 600-700 (0.5%) HIV+ pregnant women identified* • MTCT rate: 4-7%* • Late maternal ARV uptake or none at labor and delivery (L&D) high (30% in 2011)* • To further reduce MTCT need to identify HIV+ women and provide ARVs earlier

  4. Objectives Identify proportion of women receiving late maternal HIV testing at labor and delivery Describe associations between maternal characteristics and late maternal testing Determine MTCT rate and risk factors for pediatric HIV infection Recommend solutions to improve program

  5. Methods • Retrospective cohort • HIV+ women who delivered live infants from 2007-2011 in HCMC and their HIV-exposed infants • Late maternal testing defined as HIV testing at labor and delivery (L&D) • Data collection: • Chart abstraction from maternity medical records at 9 hospitals and 2 pediatric outpatient clinics • Timing of maternal testing • Pediatric HIV infection (documentation of PCR test results) • Linked maternal and infant data using the maternal HIV testing code

  6. Data Analysis • Descriptive analysis • Calculate proportions and mean (±sd) • Pearson’s Chi-square or Fisher’s exact test to compare proportions • t-test or ANOVA to compare means • Multivariate logistic regression with adjusted odds ratios, aOR, and 95% confidence intervals (CI 95%), used to assess associations between maternal characteristics and late maternal testing or MTCT

  7. Schematic of Study Participants

  8. Characteristic of women n=3,066 • 26 years median maternal age, range 23-29 • 45% employed • 37% residents of other provinces • 57% with secondary school or better • 7% IDU • HIV testing • 42% maternal testing at ANC • 35% maternal HIV testing at L&D • 23% before ANC • 16% no ARVs for PMTCT

  9. Timing of receipt of maternal HIV test, by year, HCMC (n= 3,066) n=521 n= 622 n= 666 n= 683 n=574 21 weeks 25.4 weeks

  10. Characteristics associated with late HIV testing (n=3,066) aOR 3.06 (1.97-4.74) aOR 2.10 (1.72 – 2.54) *controlling for residence, education and facility of delivery

  11. Characteristics associated with late HIV testing (n=3,066) aOR=0.65 (0.52 – 0.81) aOR=0.43 (0.32 – 0.57) *multivariate

  12. HIV testing and maternal ARV use (n=3,066)

  13. MTCT, 2007-2011, HCMC p-value >0.05

  14. Maternal risk factors for pediatric HIV infection (n=2,034) * bivariate MTCT 8.6% 8.8% 3.4% 3.9% 0.9%

  15. Conclusions • Late maternal testing reduced but still 24% in 2011 • Residents of other provinces, low education level and delivery at a general/district hospital associated with late maternal testing • Women with late maternal testing, less likely to get most efficacious PMTCT ARV regimen • MTCT rate unchanged over time • Late or no ARV use significantly associated with pediatric HIV infection

  16. Recommendations • Develop strategies to increase early HIV testing and ARV uptake, specifically targeting women at lower education levels and residents of other provinces • Strengthen documentation of HIV testing, linkage to ARV services, and communication of testing and treatment results among facilities

  17. Limitations • Early HIV testing data based on self-report • HIV+ women may have been reluctant to disclose • Missing information in medical records • Other potential associations or risk factors could not be captured • MTCT based only on PCR results from infants who enrolled in care at two hospitals • 31% of infants did not enroll at 2 pediatric hospitals and their PCR results were not available  

  18. Acknowledgments HCMC PAC leaders and key staff Faculties of HCMC Medical & Phar. University MCH leaders Staff at PMTCT sites and Pediatric Outpatient Clinics US Centers for Disease Control and Prevention (CDC)

  19. Thank you for your attention

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