The missing link: documentation of recognized maternal human immunodeficiency virus infection in exposed infant birth records, 24 United States jurisdictions, 1999-2003.

Despite substantial improvements, perinatal human immunodeficiency virus (HIV) transmission has not been eliminated in the United States. We examined the extent and contribution of missed communication opportunities between obstetric and pediatric providers who cared for HIV-infected women and their infants. This was a retrospective review of HIV-exposed infants whose data were reported to the Centers for Disease Control and Prevention Enhanced Perinatal Surveillance System from 1999-2003 (n = 8115). For approximately 4% of the HIV-exposed infants whose data were reported to the Enhanced Perinatal Surveillance System between 1999 and 2003, recognized maternal HIV infection was not documented in the exposed infants' birth records. Such infants were at higher risk of not receiving appropriate neonatal antiretroviral prophylaxis (adjusted odds ratio, 37.3; 95% CI, 24.6-56.4) and had increased odds of HIV infection (adjusted odds ratio, 1.7; 95% CI, 1.1-2.6). Enhanced communication between pediatric and obstetric and gynecologic providers to eliminate this missed opportunity for prevention would improve HIV infection outcomes for HIV-exposed infants and improve care for their mothers.

A framework for elimination of perinatal transmission of HIV in the United States.

The availability of effective interventions to prevent mother-to-child HIV transmission and the significant reduction in the number of HIV-infected infants in the United States have led to the concept that elimination of mother-to-child HIV transmission (EMCT) is possible. Goals for elimination are presented. We also present a framework by which elimination efforts can be coordinated, beginning with comprehensive reproductive health care (including HIV testing) and real-time case-finding of pregnancies in HIV-infected women, and conducted through the following: facilitation of comprehensive clinical care and social services for women and infants; case review and community action; allowing continuous quality research in prevention and long-term follow-up of HIV-exposed infants; and thorough data reporting for HIV surveillance and EMCT evaluation. It is emphasized that EMCT will not be a one-time accomplishment but, rather, will require sustained effort as long as there are new HIV infections in women of childbearing age.