UPTAKE OF INTERVENTIONS TO REDUCE MOTHER-TO-CHILD TRANSMISSION OF HIVIN THE UNITED-KINGDOM AND IRELAND

Objectives: To describe the uptake of interventions to reduce mother-t o-child transmission of HIV infection. Design: Voluntary confidential reporting of HIV infection in pregnancy and childhood; telephone inter view with key professionals in all London maternity units. Subjects an d setting: HIV-infected pregnant women and children in the United King dom and Ireland. Main outcome measures: Trends in breastfeeding, use o f zidovudine, mode of delivery and terminations of pregnancy. Results: Between 1990 and 1995, 14 (4%) out of 314 women diagnosed with HIV in fection before delivery breastfed compared with 109 (77%) out of 142 d iagnosed after delivery. Since 1994, zidovudine use has increased in e ach 6-month period (14, 39, 67, and 75%; chi(2) = 17.5, P < 0.001), al though in 1995 it was the policy of only 48% of London maternity units to offer zidovudine to HIV-infected women. During 1995, 44% of HIV-in fected women were delivered by elective Cesarean section. Since 1990, 20% of women first diagnosed in pregnancy were reported to have their pregnancy terminated. Conclusions: Although detection of previously un diagnosed HIV infection in pregnancy remains low in the United Kingdom , and particularly in London, HIV-infected pregnant women who are awar e of their status are increasingly active in taking up interventions t o reduce transmission to their infants. if all HIV-infected women atte nding for antenatal care in London consented to testing and took up in terventions and termination of pregnancy at the rates observed in this study, the number of vertically infected babies born in London each y ear could be reduced from an estimated 41 to 13.