Progress towards elimination of HIV mother-to-child transmission in the Dominican Republic from 1999 to 2011.

In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999-2008 and 12/302 (4.0%) in 2009-2011 (P < .001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003-2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed.

HIV infection and prevention of mother-to-child transmission in childbearing women: La Romana, Dominican Republic, 2002-2006.

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.

HIV infection and prevention of mother-to-child transmission in childbearing women: La Romana, Dominican Republic, 2002-2006 / Infección por el VIH en parturientas y prevención de la transmisión madre-hijo en La Romana, República Dominicana, 2002-2006

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 percent 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 percent (263/10 040 overall; 114/4 452, full-study phase (95 percent confidence interval = 2.1 percent-3.1 percent)). Most HIV-infected parturients were Dominican (68.9 percent) and urban (64.0 percent). However, prevalence was higher among Haitians (3.7 percent) than Dominicans (2.3 percent (p < 0.001)), especially those aged 21-25 years (5.2 percent vs. 2.3 percent (p < 0.001)), and among rural, batey, and peri-urban (vs. urban) parturients (3.4 percent vs. 2.3 percent, (p = 0.003)). HIV prevalence was associated with commercial sex work (reported by only 0.4 percent), 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 percent) were vaginal. CONCLUSIONS: HIV prevalence among LR parturients was higher than the estimated prevalence in the Dominican Republic (0.8 percent-1.0 percent) 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 percent). Consistently implemented, targeted pMTCT interventions are needed.

OBJETIVOS: Fortalecer el programa de prevención de la transmisión de la infección por el VIH madre-hijo (PPTIMH) en la provincia de La Romana (LR), mediante la estimación de la prevalencia y la identificación de las características asociadas con esta infección en las mujeres parturientas. MÉTODOS: Se tomaron muestras de sangre del cordón umbilical en siete puntos de atención obstétrica, que concentran más de 95 por ciento de los partos de LR, durante las cuatro fases de estudio (piloto, piloto extendido, estudio completo y monitoreo del PPTIMH) entre el 2 de agosto de 2002 y el 30 de septiembre de 2006. Los resultados se enlazaron con los datos extraídos de los registros de parto. RESULTADOS: La seroprevalencia al VIH fue de 2,6 por ciento (263/10 040 general; 114/4 452 en la fase de estudio completo; intervalo de confianza de 95 por ciento: 2,1 por ciento a 3,1 por ciento). La mayoría de las parturientas infectadas eran dominicanas (68,9 por ciento) y de zonas urbanas (64,0 por ciento). No obstante, la prevalencia fue mayor en las haitianas (3,7 por ciento) que en las dominicanas (2,3 por ciento; P < 0,001) - especialmente en las de 21 a 25 años (5,2 por ciento frente a 2,3 por ciento; P < 0,001)- y de bateyes y zonas rurales y periurbanas con respecto a las de zonas urbanas (3,4 por ciento frente a 2,3 por ciento; P = 0,003). La prevalencia de VIH se asoció con actividad sexual profesional (aunque solamente 0,4 por ciento manifestó realizarlo) y embarazos previos. Según el análisis de regresión logística, ser profesional del sexo, haitiana y haber tenido algún embarazo previo se asociaron independientemente con la infección por el VIH. Los partos por cesárea fueron más frecuentes en las seropositivas al VIH, y aumentaron en el último año del estudio; no obstante, la mayoría de los partos de las mujeres seropositivas fueron vaginales (57,5 por ciento). CONCLUSIONES: La prevalencia de la infección por el VIH en las parturientas de LR ...