摘要：Objectives. We evaluated the effectiveness of a program that includes routine opt-out prenatal HIV screening, combination antiretroviral therapy (ART), and a multidisciplinary team in preventing perinatal HIV transmission. Methods. A retrospective analysis was performed on HIV-infected pregnant women in northern Alberta, Canada, who delivered between January 1, 1999, and February 28, 2006. Results. Ninety-eight women had 113 deliveries. Forty-three percent were diagnosed with HIV infection through prenatal screening. Approximately 60% of HIV-infected pregnant women were Aboriginal, with 45% reporting alcohol use and 42% illicit drug use during pregnancy. The use of combination ART during pregnancy increased throughout the study period; 89% or more received combination ART from 2004 through 2006. Only 1 of the 111 infants (0.9%) was confirmed to be HIV infected, and that infant was born to a woman with no prenatal care. Conclusions. High rates of HIV testing using an opt-out approach, combined with efforts by a multidisciplinary team, resulted in a low rate of perinatal HIV transmission in our cohort. The added value of retesting high-risk women late in pregnancy or with rapid HIV tests at the time of delivery should be explored. Combination antiretroviral therapy (ART), consisting of at least 3 antiretroviral drugs, is recommended during pregnancy to reduce perinatal transmission of HIV and to improve maternal health. 1 Prevention strategies that include the use of combination ART during pregnancy have been associated with perinatal HIV transmission rates of 1% or less. 2 , 3 However, lack of prenatal care, the absence of routine prenatal testing, and the sociodemographic characteristics of many HIV-infected pregnant women, including homelessness and addictions, contribute to higher rates of perinatal transmission in many parts of Canada and the United States. Alberta is a Canadian province with a population of approximately 3 million people. HIV care is delivered by 2 separate programs in the northern and southern half of the province. From 1999 to 2006, between 800 and 1100 HIV-infected individuals were followed by the Northern Alberta HIV Program. The most common reported risk factors for HIV infection in this population included injection drug use (35%), heterosexual transmission (32%), and homosexual transmission (28%). Approximately one third of patients were female. Prevention of perinatal HIV transmission is an important focus of the Northern Alberta HIV Program. For pregnant women, HIV care is delivered by a multidisciplinary team, including infectious disease physicians (adult and pediatric), obstetricians, virologists, social workers, pharmacists, nurses (clinical and public health), clinical psychologists and psychiatrists, and a dietician. Features of the perinatal program include a comprehensive perinatal protocol derived from published guidelines, 1 interdisciplinary communication through monthly team meetings, close individualized social support for pregnant women with chaotic lifestyles, coordination of services for women giving birth in rural parts of Alberta, infant-feeding counseling and free infant formula for 1 year, and infant follow-up care. In addition, a perinatal public health designate nurse compiles patient information (e.g., estimated date of confinement, planned site of delivery, use of ART, and virological response) and communicates with other members of the team. 4 Because prevention strategies depend on all pregnant women with HIV being identified, routine opt-out HIV screening for pregnant women has been recommended by the US Centers for Disease Control and Prevention (CDC) since 2003. 5 Routine opt-out screening refers to HIV testing as part of the routine panel of tests for all pregnant women, with the provision that women are notified that the test is being carried out and have the opportunity to decline (opt out). In Alberta, routine prenatal opt-out HIV screening has been in place since September 1998. More than 95% of all pregnant women accessing antenatal care undergo HIV testing each year in Alberta, including the northern half of the province. 6 We aimed to evaluate the effectiveness of the Northern Alberta HIV Program's perinatal HIV transmission program, which includes routine opt-out HIV screening, combination ART, and care delivered by a multidisciplinary team.
