Prevention of Perinatal Transmission

Maternal-Pediatric HIV Prevention and Care Program

Background/Regulations

The Maternal-Pediatric HIV Prevention and Care Program (MPHPCP) is designed to eliminate perinatal HIV in New York State (NYS). This is achieved through policy, key collaborations, education, clinical guidance, technical assistance/capacity building, monitoring, and when indicated, regulatory action.  

The major components of the MPHPCP are set forth in State law and New York State Department of Health (NYSDOH) regulations which govern HIV testing and care for pregnant and postpartum women and their newborns. Implemented in 1996, these regulations require all women receiving prenatal care in regulated facilities receive HIV counseling with testing recommended. Effective February 1997, State law requires routine HIV screening of all infants as part of the NYSDOH Newborn Screening Program. The standard of care in NYS for all providers is routine opt-out HIV testing as early in pregnancy as possible with repeat HIV testing in the third trimester to identify maternal seroconversion.  

Medical and scientific evidence in the prevention of perinatal HIV transmission prompted additional regulatory changes (August 1999) which required expedited HIV testing in the obstetrical setting (labor and delivery and newborn nursery) for women whose HIV status is unknown or undocumented at presentation for delivery. Expedited testing in the obstetrical setting is a “safety net” to facilitate late identification of maternal HIV infection to implement measures to reduce the risk of mother-to-child transmission (MTCT) of HIV including intrapartum (labor and delivery) antiretroviral (ARV) prophylaxis. When a woman has not had prenatal ARV, initiating ARVs during the intrapartum and newborn periods can reduce the risk of perinatal HIV transmission. In 2003, the NYSDOH issued emergency regulations reducing the turnaround time for expedited HIV test results to a maximum of 12 hours. NYS standard of care and best practice is expedited test results within 60 minutes. Expedited testing in the obstetrical setting is done with consent for maternal testing and without consent for newborn testing.

To eliminate MTCT of HIV, all pregnant women must have access to early prenatal care, HIV testing, and for those who test positive, prompt initiation of antiretroviral therapy (ART) for their own health and to prevent HIV transmission to their newborn. Receiving ART during pregnancy is necessary to suppress a woman’s viral load, which significantly reduces the risk of MTCT. All HIV-exposed newborns are recommended to receive ARV prophylaxis within the first hours of life up to six weeks.

Activities Performed by the MPHPCP

  • Conduct regulatory oversight of over 100 birth facilities in NYS, monitoring compliance with MPHPCP regulations;
  • Provide education, capacity building and technical assistance to prenatal and pediatric providers and birth facilities;
  • Perform comprehensive reviews of all perinatal HIV-related sentinel events including MTCTs, maternal seroconversions, HIV-exposed births, and “missed opportunities” (i.e., those cases in which HIV exposure is first identified through routine newborn HIV screening and an undetected/untreated exposure of a newborn to HIV has occurred); 
  • Collaborate with staff in other NYSDOH programs, such as the Wadsworth Center Newborn Screening Program and Pediatric HIV Diagnostic Testing Service, the Bureau of HIV/AIDS Epidemiology, and the Bureau of HIV/STD Field Services to ensure that HIV-exposed infants are in care
  • Assist providers in linkage and retention in care of HIV-positive pregnant and postpartum women and their exposed/positive children; and
  • Respond to inquiries from stakeholders, including health care providers, supportive services organizations, community members and consumers, and other state and federal agencies.

Key MPHPCP Outcomes

  • The percent of women who are aware of their HIV status prior to delivery is ≥95% each year. The annual statewide prenatal HIV testing rate has remained at ≥95% for nearly two decades. Previously, in 1997 when routine newborn HIV screening began, the statewide prenatal HIV testing rate was 64%, and when expedited testing in the obstetrical setting was implemented in 1999, the statewide rate increased to 77%. 
  • The annual percent of HIV-exposed infants who receive ARV prophylaxis is 99%.
  • The annual percent of pregnant women who are prescribed ART is ≥95%.
  • The number of cases of MTCT of HIV have dramatically declined from 99 cases in 1997 to two in 2019.
  • In 2011, the federal Centers for Disease Control and Prevention (CDC) developed two annual goals for elimination of perinatal HIV transmission, defining “elimination” as (1) less than one baby born with HIV per 100,000 live births, and (2) less than 1% transmission rate among HIV-exposed births.  NYS achieved and has maintained elimination of MTCT of HIV, meeting the CDC goals in 2013 and consecutively from 2015 – 2019. Elimination of MTCT is not a single event, but the result of ongoing multifaceted annual prevention efforts, sustained resources and vigilance.

Contact:

Suzanne Kaufman, MPH, BSN, RN, AACRN
Director, Perinatal HIV Prevention Program
Division of HIV and Hepatitis Health Care
(518) 486-6048
suzanne.kaufman@health.ny.gov

Lisa Haskin, R.N., B.S.
Program Coordinator, Perinatal HIV Prevention Program
Division of HIV and Hepatitis Health Care
(518) 486-6048
lisa.haskin@health.ny.gov