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 - PowerPoint PPT PresentationTRANSCRIPT
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
Facility City Health District
Emory Crawford Long Hospital Atlanta 3-2 Grady Memorial Hospital Atlanta 3-2 Medical Center of Central Georgia Macon 5-2 Medical College of Georgia Augusta 6 Memorial Health University Savanna
h 9-1
Phoebe Putney Memorial Hospital Albany 8-2 The Medical Center Columbu
s 7
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
13-19 20-24 25-34 >=350
50100150200250300350400
48
199
347
101
Mother’s age at delivery
Num
ber
of c
ases
Georgia sample of 695 pregnancies during 2005-2010
Proportion of HIV infected pregnant women, by age group,
Georgia and US
13-19 20-24 25-34 >=35 Unknown0
102030405060
7
29
50
15
06
21
49
19
5
GA 2005-2010 15 areas US 2005-2008
Mother’s age at delivery
Perc
ent
of to
tal
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV-infected pregnant women, by race/ethnicity, Georgia
and US
Black Hispanic/Latino
White Other raceUnknown
0102030405060708090 85
6 7 2 1
65
239
2 1
GA 2005-2010 15 areas US 2005-2008
Perc
ent o
f tot
al
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV-infected pregnant women, by
transmission category, Georgia and US
Heterosexual contact
Injection Drug Use
(IDU)
Other Unknown0
10203040506070
37
2 3
58 46
8 8
37
GA 2005-2010 15 areas US 2005-2008
Perc
ent
of to
tal
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008Heterosexual 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
Single Married SeparatedDivorced Widowed Unknown0
1020304050607080
70
21
1 2 1 5
55
15
1 1 0
28
GA 2005-2010 15 areas US 2005-2008
Perc
ent o
f tot
al
Georgia sample of 695 pregnancies during 2005-2010US 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
US Outside US Unknown0
1020304050607080 76
12 12
54
13
33
GA 2005-2010 15 areas US 2005-2008
Perc
ent
of to
tal
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected pregnant women receiving
prenatal care, Georgia and US
Prenatal care No prenatal care Unknown0
102030405060708090
100 90
4 6
90
7 3
GA 2005-2010
Perc
ent o
f tot
al
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008Prenatal care = at least one prenatal care visit prior to delivery
Proportion of HIV infected pregnant women, by timing of HIV
diagnosis, Georgia and US
Before pregnancy
During pregnancy
At delivery After birth Unknown0
1020304050607080
64
32
1 1 2
68
26
3 1 2
GA 2005-2010 15 areas US 2005-2008
Perc
ent o
f tot
al
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected pregnant women receiving prenatal ART*, Georgia and
US
Prenatal ART No prenatal ART Unknown0
102030405060708090 81
5 14
84
124
GA 2005-2010 15 areas US 2005-2008
Perc
ent
of to
tal
*ART = antiretroviral therapyGeorgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected pregnant women receiving intrapartum ART*,
Georgia and US
Intrapartum ART No intrapartum ART
Unknown0
102030405060708090 83
5 12
85
114
GA 2005-2010 15 areas US 2005-2008
Perc
ent o
f tot
al
*ART = antiretroviral therapyGeorgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV exposed infants receiving ART* during
neonatal period, Georgia and US
Neonatal ART No neonatal ART Unknown0
20
40
60
80
100
120
87
1 12
96
2 3
GA 2005-2010 15 areas US 2005-2008
Perc
ent
of to
tal
*ART = antiretroviral therapyGeorgia sample of 710 infants from 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected pregnancies by delivery type,
Georgia and US
Vagin
al
Electi
ve C-se
ction
Non-el
ective
C-secti
on
C-secti
on, u
nkno
wn typ
e
Unkno
wn0
204060
31
59
5 3 3
40 40
152 2
GA 2005-2010 15 areas US 2005-2008
Perc
ent
of to
tal
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected women reporting illicit drug use during pregnancy, Georgia and
US
Illicit drug use No illicit drug use Unknown0
10
20
30
40
50
60
70
12
62
26 28
65
7
GA 2005-2010 15 areas US 2005-2008
Perc
ent o
f tot
al
Georgia sample of 695 pregnancies during 2005-2010US 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
020406080
2 11 2
59
26 1
143
82
0
GA 2005-2010 15 areas US 2005-2008
Perc
ent
of to
tal
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of toxicology screen results among HIV infected
women, Georgia and US
Positive result Negative result
Not done Unknown0
1020304050607080
10
36
2
53
10 9 11
70
GA 2005-2010 15 areas US 2005-2008
Perc
ent
of to
tal
Georgia sample of 695 pregnancies during 2005-2010US 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
Group B Strep screen
No Group B Strep screen
Unknown0
10203040506070 62
3
36
55
8
37
GA 2005-2010
Perc
ent o
f tot
al
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected pregnant women receiving Hepatitis B screen,
Georgia and US
Hepatitis B screen No hepatitis B screen
Unknown0
102030405060708090 85
0
15
71
2
27
GA 2005-2010 15 areas US 2005-2008
Perc
ent
of to
tal
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected pregnant women receiving Rubella screen, Georgia and US
Rubella screen No Rubella screen Unknown0
102030405060708090 85
0
15
68
3
29
GA 2005-2010 15 areas US 2005-2008
Perc
ent o
f tot
al
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV-infected pregnant women receiving
Syphilis screen, Georgia and US
Syphilis screen No Syphilis screen Unknown0
102030405060708090 82
0
18
71
2
27
GA 2005-2010 15 areas US 2005-2008
Perc
ent
of to
tal
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected pregnant women with an STD*, Georgia and US
STD No STD or Unknown0
102030405060708090
31
69
23
77
GA 2005-2010 15 areas US 2005-2008
Perc
ent o
f tot
al
*Includes presumptive or definitive diagnosis during pregnancy of Chlamydia, genital herpes, Gonorrhea, hepatitis B, syphilis and/or Trichomonas
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected pregnant women receiving prenatal care,
Georgia and US
Prenatal care No prenatal care Unknown0
102030405060708090
100 90
4 6
90
6 4
GA 2005-2010 15 areas US 2005-2008
Perc
ent o
f tot
al
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected Black, non-Hispanic women receiving prenatal care, Georgia and US
90%
4%6%Georgia
Prenatal care
No prenatal care
Unknown90%
7% 3% US
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected Hispanic/Latino women receiving
prenatal care, Georgia and US
93%
2%5%Georgia
Prenatal care
No prenatal care
Unknown92%
6% 2% US
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected white, non-Hispanic women receiving prenatal care, Georgia and US
89%
7%4%Georgia
Prenatal care
No prenatal care
Unknown89%
6% 5% US
Georgia sample of 695 pregnancies during 2005-2010US 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
Before pregnancy
During pregnancy
At delivery
After birth
Unknown
0 10 20 30 40 50 60 70 8063
34
1
2
68
26
3
1
2
USGeorgia
Percent
Georgia sample of 695 pregnancies during 2005-2010US 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
Before pregnancy
During pregnancy
At delivery
After birth
Unknown
0 10 20 30 40 50 60 70 8063
33
3
3
67
27
3
2
1
USGeorgia
Percent
Georgia sample of 695 pregnancies during 2005-2010US 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
Before pregnancy
During pregnancy
At delivery
After birth
Unknown
0 10 20 30 40 50 60 70 8074
17
2
2
71
23
2
1
3
USGeorgia
Percent
4
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected Black, non-Hispanic women receiving perinatal ART, Georgia and US
80%
5%
15%
Georgia
Prenatal ARTNo prenatal ARTUnknown
84%
12%
4%US
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected Black, non-Hispanic women receiving
intrapartum ART, Georgia and US
83%
5%
12%Georgia
Intrapartum ARTNo intra-partum ARTUnknown
86%
9%5%
US
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV exposed Black, non-Hispanic infants given
neonatal ART, Georgia and US
88%
1%
11%Georgia
Neonatal ARTNo neonatal ARTUnknown
96%
2% 2%US
Georgia sample of 710 infants from 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected Hispanic/Latino women receiving
prenatal ART, Georgia and US
83%
2%
15%
Georgia
Prenatal ARTNo prenatal ARTUnknown
87%
10% 3%
US
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected Hispanic/Latino women receiving intrapartum ART, Georgia and US
75%
5%
20%
Georgia
Intrapartum ARTNo intra-partum ARTUnknown
86%
11% 3%
US
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV exposed Hispanic/Latino infants given neonatal ART, Georgia and US
73%
27%
Georgia
Neonatal ARTNo neonatal ARTUnknown
96%
2% 2%
US
Georgia sample of 710 infants from 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected white, non-Hispanic women receiving prenatal ART, Georgia and US
85%
11%
4%Georgia
Prenatal ARTNo prenatal ARTUnknown
87%
9% 4%US
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV infected white, non-Hispanic women receiving intrapartum ART,
Georgia and US
89%
7% 4%
Georgia
Intrapartum ARTNo intra-partum ARTUnknown
86%
9%5%
US
Georgia sample of 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of HIV exposed white, non-Hispanic infants given neonatal ART, Georgia
and US
89%
11%Georgia
Neonatal ARTNo neonatal ARTUnknown
97%
1% 2%US
Georgia sample of 710 infants from 695 pregnancies during 2005-2010US 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
020406080
19 7
74 45
24 31
GA 2005-2010 15 areas US 2005-2008
Perc
ent o
f tot
al
Georgia sample of 710 infants from 695 pregnancies during 2005-2010US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008
Proportion of infants infected with HIV through mother-to-child
transmission, Georgia and US
Infected Not infected Indeterminate*0
1020304050607080
2 1/2
45 53
2
71
27
GA 2005-2010 15 areas US 2005-2008
Perc
ent
of to
tal
*Indeterminate includes cases missing infant’s HIV statusGeorgia sample of 710 infants from 695 pregnancies during 2005-2010US 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 visithttp://dph.georgia.gov/enhanced-perinatal-hivaids-surveillance-eps
For information on HIV prevention visithttp://dph.georgia.gov/hiv-prevention-program
For more information on HIV surveillance in Georgia, visithttp://dph.georgia.gov/georgias-hivaids-epidemiology-surveillance-section