Antenatal detection of HIV: national surveillance and unlinked anonymous survey
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7309.376 (Published 18 August 2001) Cite this as: BMJ 2001;323:376
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re. Antenatal Detection of HIV.
EDITOR - We read with interest the recent paper by Cliffe et al1 on
the value of antenatal screening for HIV and the role it plays in
reducing perinatal transmission of HIV. The National Blood Service offers
antenatal HIV screening linked to its traditional antenatal red cell
serology service, and consequently it can provide useful data in a timely
fashion on the prevalence of this infection in the antenatal population of
England. We have analysed such data for women whose antenatal blood
samples were received in the first eight months of 2001 by the five
participating transfusion centres ( Birmingham, Oxford, Cambridge, Leeds,
and Trent). In total, blood samples were received from 94,723 pregnant
women. Of these 52,198 (55%) consented to have an HIV test, out of which
27(0.05%) were positive for HIV (Table 1).
Further data on those infected was only available from the first
three centres. Of the 15 HIV positive women detected by those laboratories
only one was known to be HIV positive before her pregnancy. The major
risk (9/15)associated with positivity was that the woman had moved to
England from Africa (6 from Zimbabwe). Of 3 HIV positive Caucasian
women, one had a partner from Zimbabwe, one a UK born Afro-Caribbean
partner and the other had a bisexual partner. Three women were UK born
Afro-Caribbean one of whom had a partner who had recently come from the
Caribbean, the status of the other 2 partners is not known.
The number of women detected within the first eight months of this
year(27) greatly exceeds the 6 reported for 1999 in the paper by Cliffe at
al1
and the increased uptake of HIV screening since Health Service Circular
HSC 1999/183 2 should make a significant impact on reducing mother to baby
transmission of HIV.
Elizabeth Boxall and John Kurtz
on behalf of the antenatal screening laboratories of the National Blood
Service
1. Cliffe S, Tookey PA, Nicoll A. Antenatal detection of HIV:
national surveillance and unlinked anonymous survey. BMJ 2001; 323:376-7.
2. Health Service Circular. Reducing mother to baby transmission of HIV.
London DOH 1999; HSC 1999/183
NBA antenatal HIV screening
Transfusion
Centre Total antenatal Number screened Number positive
samples for HIV(%) for HIV (%)
Birmingham 33,292 18,996 (57) 6 (0.03)
Oxford 9,280 5,420 (58) 8 (0.15)
East Anglia 8,376 6,993 (83.5) 1 (0.01)
Leeds 10,891 4,089 (37.5) 4 (0.09)
Trent 32,884 16,700 (50.8) 8 (0.05)
Total 94,723 52,198 (55) 27 (0.05)
Competing interests: NBA antenatal HIV screeningTransfusionCentre Total antenatal Number screened Number positive samples for HIV(%) for HIV (%)Birmingham 33,292 18,996 (57) 6 (0.03)Oxford 9,280 5,420 (58) 8 (0.15)East Anglia 8,376 6,993 (83.5) 1 (0.01)Leeds 10,891 4,089 (37.5) 4 (0.09)Trent 32,884 16,700 (50.8) 8 (0.05)Total 94,723 52,198 (55) 27 (0.05)
EDITOR – Cliffe et al1 point out that if the national targets of an
80% reduction in vertical transmission are to be reached by December 2002
then rates of antenatal HIV diagnosis must improve outside London.
Results from the unlinked anonymous salivary dried blood spot survey
suggest that Brighton and Hove is a low prevalence area with an estimated
two HIV infected women giving birth each year. Since introducing routine
antenatal testing 98% of women have agreed to HIV testing and in the last
14 months three HIV infected women have been diagnosed. All have accepted
recommended interventions to reduce vertical transmission. We feel there
are several factors contributing to the sustained high uptake:
· Prior to antenatal testing commencing a co-ordinator was appointed
who was responsible for the planning and delivery of training to community
midwives
· Close links have been maintained with the midwives since this initial
period and the service has had on-going monitoring and evaluating
· The provision of bespoke training for new and returning midwives.
· Training itself focused on attitudes and skills, reflecting the plethora
of research demonstrating the belief of the midwife in HIV testing as key
in a pregnant woman’s decision to test.
We have shown that the Department of Health’s target of a 90% uptake
of antenatal HIV testing2 is clearly achievable in low prevalence areas
outside London. It is hoped that this example will inform practice in
other areas, especially given that (as Cliffe et al point out) over one
quarter of pregnant women infected with HIV live outside of London.
Gillian Dean HIV/GUM
Consultant
gillian.dean@brighton-healthcare.nhs.uk
Claude Nicol Centre/Lawson Unit,
Royal Sussex County Hospital, Brighton Healthcare Trust. Brighton. BN2 5BE
Martin Fisher
HIV/GUM Consultant
Claude Nicol Centre/Lawson Unit,
Royal Sussex County Hospital, Brighton Healthcare Trust. Brighton. BN2 5BE
Melanie Ottewill
Health Advisor/Antenatal coordinator
Claude Nicol Centre/Lawson Unit
Royal Sussex County Hospital, Brighton Healthcare Trust. Brighton. BN2 5BE
1Cliffe S, Tookay PA, Nicoll A. Antenatal detection of HIV: national
surveillance and unlinked anonymous survey. BMJ, 2001; 323:376-7 (18 Aug).
2UK Health Departments. Targets aimed at reducing the number of children
born with HIV: report from an expert group. London: Stationery Office,
1999.
Competing interests: No competing interests
Re: Antenatal Detection of HIV
Interesting similarities are noted between antenatal HIV detection in
Canada and the UK. One notes in the communication by Boxall and Kurtz
(BMJ 17 Oct 2001) a variable uptake in the number of women tested
depending on area with an overall rate of testing being 55% (i.e 45%
refusal ). Gillian Dean and colleagues (BMJ 19 Sept 2001) on the other
hand report that in Brigton and Hove following the introduction of routine
testing 98% of women agreed to HIV screening (i.e a 2% refusal ?).
The diagnosis of 8 new cases of infant HIV infection at HSC Toronto
was a cause of concern back in August (Medical Post Aug 7 2001). In
Ontario the uptake of HIV was 52% with only 49% of pregnant women being
tested. This compared with the situation in the province of Alberta
where routine HIV serology for all pregnancies was performed (unless
specifically refused) with 98% of women in agreement with testing.
In Brigton as in Alberta it would seem there may be light at the end
of the tunnel. The application of universal 'routine' screening for
infectious disease is not discriminatory and is in everyone's best
interests particularly those of infants and children.
James E Parker
Competing interests: No competing interests