Prevention of Perinatal Transmission
The Maternal-Pediatric HIV Prevention and Care Program (MPHPCP) is designed to reduce perinatal HIV transmission through education, technical assistance, monitoring and regulatory action, when indicated. The goal of the program is to reduce mother-to-child transmission (MTCT) of HIV to the lowest level possible by ensuring that all pregnant women have access to HIV counseling and testing and that those who test positive have access to antiretroviral (ARV) medications for their own health and to prevent HIV transmission to their newborn. A three-part regimen of ARV, administered to the mother during pregnancy, labor, and delivery, and to the newborn immediately after birth, is optimal. However, studies conducted by the New York State Department of Health (NYSDOH) have suggested that partial regimens of ARV prophylaxis, initiated during the intrapartum and newborn periods, can significantly reduce the risk of perinatal transmission.
The major components of this program are set forth in NYSDOH regulations. The MPHPCP regulations, first issued in 1996, require all women in prenatal care in regulated facilities receive HIV counseling with testing presented as a clinical recommendation. Routine prenatal HIV counseling with recommended testing has become a standard of care for all New York State prenatal care providers. The MPHPCP regulations were amended in 1997 to implement routine HIV screening of all infants as part of the NYSDOH Newborn Screening Program. In August 1999, as a result of medical and scientific advances in the prevention of perinatal HIV transmission, the regulations for the MPHPCP were again amended to require that expedited HIV testing be done in the obstetrical setting in instances where the mother’s HIV status is unknown at presentation for delivery. Expedited testing in the obstetrical setting is a “safety net” to facilitate late identification of maternal HIV infection so that ARV prophylaxis may be given to prevent MTCT. In these circumstances, ARV prophylaxis should be administered during labor and delivery and to the newborn during the first hours of life to be most effective. Expedited testing in the obstetrical setting is done with consent for maternal testing, and without consent for newborn testing.
Activities conducted by MPHPCP program staff include:
- Providing regulatory oversight of the approximately 138 birth facilities in New York State by monitoring compliance with the MPHPCP regulations;
- Providing education and technical assistance to prenatal providers and birth facilities onsite, by telephone or in writing;
- Working with staff in other NYSDOH programs, such as the Newborn Screening Program, Pediatric HIV Diagnostic Testing Service and the Bureau of HIV/AIDS Epidemiology, to ensure that HIV-exposed infants are in care;
- Investigating "missed opportunities", that is, those cases in which HIV exposure is first identified through Newborn Screening and an undetected/untreated exposure of a newborn to HIV has occurred; and
- Responding to inquiries from and providing information to providers, consumers and other state and federal agencies.
The New York State Strategic Plan for Elimination of Mother-to-Child Transmission of HIV and a companion User Guide were released in 2012. These documents may be found at www.health.ny.gov/diseases/aids/emtct. The Strategic Plan, developed form recommendations of the New York State Advisory Panel on the Prevention of Perinatal HIV Transmission, provides a flexible framework for diverse stake holders to align their efforts in support of elimination of perinatal transmission.
By providing program oversight, and with the collective efforts of facilities across the state, the NYSDOH has noted significant improvement in prenatal HIV testing rates and a marked decrease in mother-to-child HIV transmission rates:
- In 1997, when routine newborn screening began, the statewide prenatal HIV testing rate was 64%. In 1999, when expedited testing in the obstetrical setting was implemented, the statewide prenatal testing rate had risen to 77%. By 2003, the rate had risen to 95%. The statewide prenatal HIV testing rate has remained at 95 - 96% through 2010.
- Since routine HIV newborn screening began in New York in1997, the number of cases of mother-to-child HIV transmission in the state has declined from 97 cases to just three in 2010, which is a rate of 0.7 percent. The federal Centers for Disease Control and Prevention (CDC) has two goals for elimination of mother-to-child transmission. The first goal is a rate of less than 1 percent, which New York surpassed in 2010. The second goal is less than one baby born with HIV per 100,000 births, which New York came very close to meeting, with 1.3 cases per 100,000 births.
Bureau of HIV Ambulatory Care Services