Missed Opportunities to Prevent Perinatal Human Immunodeficiency Virus Transmission in 15 Jurisdictions in the United States During 2005–2008

Abstract

The objective of this study was to identify factors related to failure to receive recommended interventions for the prevention of mother-to-child HIV transmission among HIV-infected pregnant women in the United States. Using Enhanced Perinatal Surveillance data from 2005 through 2008, we identified characteristics of HIV-infected women (n = 5,391) that increased their odds of missing an opportunity to prevent perinatal HIV transmission. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were calculated by using backward step-wise logistic regression analyses to determine the relationship between demographic variables and missed opportunities. Of 4,220 HIV-infected pregnant women with complete data, 2,545 (60%) did not receive all of the recommended interventions. Missed opportunities for prevention occurred more often among HIV-infected women aged 25–34 years (aOR = 1.9, 95% CI = 1.4–2.5), and greater than 34 years (aOR = 2.0, 95% CI = 1.5–2.7) compared to those 13–19 years and among injection drug users (aOR = 1.3, CI = 1.0–1.5) compared to women infected with HIV through heterosexual contact. Clinicians can decrease missed opportunities by routinely providing recommended interventions, especially among HIV-infected women who are injection drug users or aged 25 years or older.