Enhanced perinatal surveillance georgia 2005 2010
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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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Enhanced Perinatal Surveillance, Georgia 2005-2010


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


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


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


Facility-based sampling, Georgia EPS, 2007-2010


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


HIV infected pregnant women giving birth to a live infant, by age group, Georgia, 2005-2010

Georgia sample of 695 pregnancies during 2005-2010


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


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


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)


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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%


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


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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