TY - JOUR
T1 - HIV infection and prevention of mother-tochild transmission in childbearing women
T2 - La romana, Dominican republic, 2002-2006
AU - Román-Poueriet, José
AU - Fernandez, Aracelis D.
AU - Beck-Sagué, Consuelo M.
AU - Szabó, René García
AU - Mercedes, Fermin
AU - Duke, William
AU - Martinez, Anny
AU - Nicholas, Stephen
PY - 2009/10
Y1 - 2009/10
N2 - Objectives. To strengthen prevention of mother-to-child HIV transmission (pMTCT) program implementation in La Romana (LR) province, by estimating HIV prevalence and identifying characteristics associated with HIV infection in parturients. Methods. Umbilical cord blood samples were collected at seven obstetrical sites where over 95% of LR's deliveries occur during four phases (pilot, expanded pilot, full study, and pMTCT program monitoring) from 2 August 2002 to 30 September 2006. Results were linked to data abstracted from delivery records. Results. HIV seroprevalence was 2.6% (263/10 040 overall; 114/4 452, full-study phase (95% confidence interval = 2.1%-3.1%)). Most HIV-infected parturients were Dominican (68.9%) and urban (64.0%). However, prevalence was higher among Haitians (3.7%) than Dominicans (2.3% (p < 0.001)), especially those aged 21-25 years (5.2% vs. 2.3% (p < 0.001)), and among rural, batey, and peri-urban (vs. urban) parturients (3.4% vs. 2.3%, (p = 0.003)). HIV prevalence was associated with commercial sex work (reported by only 0.4%), and prior pregnancy. In logistic regression analysis, commercial sex work, Haitian nationality, and prior pregnancy were independently associated with HIV infection. Caesarean deliveries were more frequent, and rose in the last years of the study, among HIV seropositives; however, most deliveries among seropositives (57.5%) were vaginal. Conclusions. HIV prevalence among LR parturients was higher than the estimated prevalence in the Dominican Republic (0.8%-1.0%) and, in contrast to past studies, predominantly affected urban Dominicans. HIV prevalence among LR Haitian parturients was higher than among Dominican counterparts and prenatal clinic attendees in Haiti (who had a rate of 3.1%). Consistently implemented, targeted pMTCT interventions are needed.
AB - Objectives. To strengthen prevention of mother-to-child HIV transmission (pMTCT) program implementation in La Romana (LR) province, by estimating HIV prevalence and identifying characteristics associated with HIV infection in parturients. Methods. Umbilical cord blood samples were collected at seven obstetrical sites where over 95% of LR's deliveries occur during four phases (pilot, expanded pilot, full study, and pMTCT program monitoring) from 2 August 2002 to 30 September 2006. Results were linked to data abstracted from delivery records. Results. HIV seroprevalence was 2.6% (263/10 040 overall; 114/4 452, full-study phase (95% confidence interval = 2.1%-3.1%)). Most HIV-infected parturients were Dominican (68.9%) and urban (64.0%). However, prevalence was higher among Haitians (3.7%) than Dominicans (2.3% (p < 0.001)), especially those aged 21-25 years (5.2% vs. 2.3% (p < 0.001)), and among rural, batey, and peri-urban (vs. urban) parturients (3.4% vs. 2.3%, (p = 0.003)). HIV prevalence was associated with commercial sex work (reported by only 0.4%), and prior pregnancy. In logistic regression analysis, commercial sex work, Haitian nationality, and prior pregnancy were independently associated with HIV infection. Caesarean deliveries were more frequent, and rose in the last years of the study, among HIV seropositives; however, most deliveries among seropositives (57.5%) were vaginal. Conclusions. HIV prevalence among LR parturients was higher than the estimated prevalence in the Dominican Republic (0.8%-1.0%) and, in contrast to past studies, predominantly affected urban Dominicans. HIV prevalence among LR Haitian parturients was higher than among Dominican counterparts and prenatal clinic attendees in Haiti (who had a rate of 3.1%). Consistently implemented, targeted pMTCT interventions are needed.
KW - Dominican Republic
KW - Hiv infections
KW - Infectious disease transmission, vertical
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U2 - 10.1590/S1020-49892009001000005
DO - 10.1590/S1020-49892009001000005
M3 - Article
C2 - 20107679
AN - SCOPUS:73649117858
SN - 1020-4989
VL - 26
SP - 315
EP - 323
JO - Revista Panamericana de Salud Publica/Pan American Journal of Public Health
JF - Revista Panamericana de Salud Publica/Pan American Journal of Public Health
IS - 4
ER -