AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #90 - The impact of ethnicity on presentation to antenatal care among pregnant women living with HIV in the UK and Ireland
Authors: Presenting Author: Dr Shema Tariq - City University London
Additional Authors: Prof. Jonathan Elford, Dr. Mario Cortina-Borja, Dr. Pat A Tookey,
Aim: In the UK and Ireland, over 1400 women living with HIV are currently reported as pregnant every year; the majority are from sub–Saharan Africa. UK guidelines advise that all pregnant women should have their first antenatal care appointment by 13 weeks of pregnancy (referred to here as "antenatal booking"). In general, late antenatal booking is associated with factors such as young age, low socioeconomic status and being a migrant. However, few studies have explored this in women living with HIV. We explored the association between maternal ethnicity and late antenatal booking in HIV positive women.
Method / Issue: We analysed data from the National Study of HIV in Pregnancy and Childhood (NSHPC), the UK and Ireland's comprehensive surveillance programme for obstetric and paediatric HIV. We included all pregnancies in women who were diagnosed with HIV before delivery and had an estimated delivery date between 1 January 2008 and 31 December 2009, when antenatal booking dates were routinely collected. Late booking was defined as antenatal booking at 13 weeks or later. 'African' ethnicity was defined as being of black or mixed ethnicity and having been born in sub-Saharan Africa. The baseline reference group for all analyses comprised women of 'White' ethnicity. Logistic regression models were fitted to estimate adjusted odds ratios (AOR).
Results / Comments: There were 2787 eligible reported pregnancies; 62% (1731) had data available on antenatal care booking date. The median week of booking was 13.0 weeks (interquartile range 10.7-17.0 weeks). In just over 50% of pregnancies (877/1731) the antenatal booking date was late i.e. made at 13 weeks of pregnancy or later, including 5% (90/1731) during the third trimester (at 28 weeks or later). Women diagnosed with HIV during the current pregnancy were more likely to present for antenatal care at 13 or more weeks than those previously diagnosed (58.4 vs. 47.2%, p<0.001). In women diagnosed with HIV during pregnancy, the risk of late booking was higher for women of African ethnicity (AOR 2.85: 95% confidence interval (CI) 1.49, 5.45; p=0.001). Where the mother knew her HIV status prior to becoming pregnant, the risk of late booking was also raised for women of African ethnicity (AOR 1.61; 95% CI 1.03, 2.54; p=0.038).
Discussion: Over half the women booked for antenatal care later than advised by UK guidelines. Women of African ethnicity were more likely to book late compared with White women. This was seen for women diagnosed with HIV before pregnancy as well as for women diagnosed during pregnancy. Women initiating antenatal care beyond 13 weeks miss the opportunity of early screening for HIV (if they have not yet been diagnosed) and other conditions, and have less time to engage with HIV services. This may have an adverse effect on obstetric and maternal health outcomes. Work is needed to increase awareness of the importance of early antenatal booking and to elucidate potential barriers in this group.
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