Equitable Timing of HIV Diagnosis Prior to Pregnancy: A Canadian Perspective

Esther S Shoemaker; Kate Volpini; Stephanie Smith; Mona Loutfy; Claire Kendall

doi:10.7759/cureus.16691

Equitable Timing of HIV Diagnosis Prior to Pregnancy: A Canadian Perspective

Cureus. 2021 Jul 28;13(7):e16691. doi: 10.7759/cureus.16691. eCollection 2021 Jul.

Authors

Esther S Shoemaker^{1

2

3}, Kate Volpini^{1

4}, Stephanie Smith⁵, Mona Loutfy^{6

2

7}, Claire Kendall^{8

9

10

11

12}

Affiliations

¹ Internal Medicine, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, CAN.
² Internal Medicine, Institute for Clinical Evaluative Sciences (ICES), Toronto, CAN.
³ Internal Medicine, Ottawa Hospital Research Institute, Ottawa, CAN.
⁴ Internal Medicine, University of Ottawa, Ottawa, CAN.
⁵ Medicine, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, CAN.
⁶ Infectious Disease, Women's College Research Institute, Women's College Hospital, Toronto, CAN.
⁷ Internal Medicine, University of Toronto, Toronto, CAN.
⁸ Family Medicine, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, CAN.
⁹ Family Medicine, Institute for Clinical Evaluative Sciences (ICES), Toronto, CAN.
¹⁰ Family Medicine, Ottawa Hospital Research Institute, Ottawa, CAN.
¹¹ Family Medicine, University of Ottawa, Ottawa, CAN.
¹² Family Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, CAN.

Abstract

Initiating antiretrovirals prior to conception leads to a negligible risk of perinatal transmission. This study aimed to determine the timing of HIV diagnosis among pregnant women with HIV in Ontario. A retrospective population-level cohort study using linked health administrative databases was conducted to establish maternal HIV status and timing of HIV diagnosis of all women living with HIV who gave birth in 2006-2018. The majority of the 1012 women living with HIV who gave birth in Ontario were diagnosed prior to pregnancy (87.9%); however, many were not (12.1%). Among those diagnosed during pregnancy, only 23% were diagnosed in the first trimester. While HIV screening tests are being well directed towards young women, several women still enter pregnancy undiagnosed and are not diagnosed early. This calls for a continuous effort to promote universal pre-conception screening and to use HIV point-of-care testing for at-risk pregnant women and those presenting late to prenatal care.

Keywords: family planning; hiv; infectious disease; obstetrics; preconception care; screening.

Grants and funding

The study was funded by the Canadian Institutes of Health Research (CIHR) PCS-161876. CIHR had no role in the design of the study, the collection, analysis, and interpretation of the data, and the reporting of the findings. The study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of the analysis were based on data compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed in the manuscript are those of the authors, and not necessarily those of CIHI.