Maternal-Pediatric HIV Prevention and Care Program
The Maternal-Pediatric HIV Prevention and Care Program (MPHPCP) is designed to reduce perinatal HIV transmission through education, technical assistance, monitoring and, when indicated, regulatory action. The goal of the program is elimination of mother-to-child transmission (MTCT) of HIV. To achieve this, all pregnant women must have access to HIV counseling and testing and, for those who test positive, 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/delivery and 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 still significantly reduce the risk of perinatal transmission.
The major components of this program are set forth in state law and NYSDOH regulations. The MPHPCP regulations, first issued in 1996, require all women in prenatal care in regulated facilities receive HIV counseling with testing recommended. Since then, routine prenatal HIV counseling with recommended testing has become a standard of care for all New York State prenatal care providers. Effective February 1, 1997, State law required 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 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, to be most effective, ARV prophylaxis should be administered intrapartum and to the newborn during the first hours of life. Expedited testing in the obstetrical setting is done with consent for maternal testing and without consent for newborn testing.
Activities conducted by MPHPCP staff include:
- Providing regulatory oversight of the approximately 130 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 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 from 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 the collective efforts of providers across the state, the NYSDOH has noted significant improvements in prenatal HIV testing rates and provision of perinatal ARV prophylaxis, and a marked decrease in mother-to-child HIV transmission:
- 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 2013.
- In 1997, for mother/baby dyads with complete perinatal ARV prophylaxis data available, only 64% received ARV prophylaxis in one or more periods (prenatal, intrapartum, neonatal) and only 57% had received it in all three periods. In 2011, these rates had significantly increased to 99.7% having received ARV prophylaxis in at least one period and 90.6% having received it in all three periods.
- Since routine HIV newborn screening began in New York in 1997, the number of cases of mother-to-child HIV transmission in the state has declined from 97 cases to just two in 2013. 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, 2012 and 2013. The second goal is less than one baby born with HIV per 100,000 births, which New York achieved in 2013.
- From 1998-2013, it is estimated that these efforts saved approximately 900 infants from lifetimes of living with HIV. In addition, these efforts also saved roughly $321 million in HIV-related medical expenses that would have been required for the care of these infants. It is estimated, that for every $1 invested in prevention, New York saved nearly $4 in pediatric HIV treatment costs.
Barbara Warren, B.S.N., M.P.H., P.N.P.
Director, Perinatal HIV Prevention Program and Special Projects
Division of HIV and Hepatitis Health Care