Annual Summary Report 2000 Edition Introduction

This report provides summary information on the New York State Department of Health Maternal-Pediatric HIV Prevention and Care Program for calendar year 2000.

The Maternal-Pediatric HIV Prevention and Care Program is a comprehensive program that seeks to address many of the steps in the chain of events leading to an HIV-infected child, as identified by the Institute of Medicine in their 1998 report, "Reducing the Odds." The goal of the perinatal HIV prevention program in New York is to reduce perinatal HIV transmission to the lowest possible level and to ensure that HIV-positive mothers and their infants have access to the care they need. This includes:

  • ensuring access to prenatal care for all pregnant women;
  • establishing HIV counseling and recommended testing as a standard of prenatal care;
  • ensuring that all HIV-positive pregnant women are offered antiretroviral (ARV) therapy for their own health and to reduce the risk of perinatal HIV transmission to their infants;
  • ensuring that HIV test information is transferred in a timely way from the prenatal care site to the anticipated birth facility; and
  • conducting expedited testing in the delivery setting for all women/newborns for whom prenatal HIV test results are not available.

Methods and Summary of Results

This report is divided into three sections. The first section provides information on maternal HIV seroprevalence and maternal HIV testing history for the period of January 1, 2000 through December 31, 2000. The second section provides information related to expedited HIV testing. Section three of this report provides information on how the Department monitors compliance with all aspects of the Maternal-Pediatric HIV Prevention and Care Program. A summary of consumer questions, concerns or complaints about prenatal HIV counseling and testing and/or expedited HIV testing, as well as any action taken by the Department in response to these calls is also presented in section three. Providers are strongly encouraged to review this important section of the annual summary.

Report Structure and Table Interpretation

A. Section I

Maternal Seroprevalence and Maternal HIV Status

To determine the HIV prevalence among childbearing women, data from the Comprehensive Newborn HIV Testing Program is obtained on all single births and the first infants of multiple births for whom a suitable specimen was provided. The information collected included maternal age, maternal county of residence at delivery, maternal HIV testing history and the race/ethnicity of the infant. The maternal HIV testing history is assessed at delivery and recorded on the Maternal HIV Test History and Assessment Form (DOH 4068); the information is then transferred to the Newborn Blood Collection Form (DOH 1514). There are four categories of response. A fifth category, "Data Missing," exists if Maternal HIV Testing History is not recorded.

In the report, these categories represent maternal HIV test history:

  • "During" - Documented as tested During this pregnancy
  • "Prior" - Documented as tested Prior to this pregnancy
  • "Not Previous" - The maternal HIV testing history category labeled Not Previous consists of those women who had not previously been tested for HIV.
  • All women whose HIV status was unknown or not documented by medical record review at the time of delivery are categorized as having an Unknown HIV test history.

Data are available from newborn heel-stick specimens tested by the Department of Health's Wadsworth Laboratory for 251,546 women giving birth from January 1, 2000 to December 31, 2000. Of these, 830 women (0.33 percent) tested positive for HIV antibodies via their newborns' tests. The presence of antibodies in a newborn's specimen indicates that the mother is HIV-infected and her HIV-exposed infant may or may not be infected with HIV. In 1998, approximately 18 percent of infants in New York State who were born to HIV-infected mothers who received no antiretroviral prophylaxis were found to be HIV infected.

HIV seroprevalence in childbearing women varied by geographic area, age and racial/ethnic group The highest prevalence was detected among childbearing women in New York City, with 0.57 percent or one in 175 women giving birth having an abnormal HIV antibody test result. Women giving birth elsewhere in the state had a prevalence of 0.12 percent with approximately one in 833 women giving birth having a positive HIV test result.

Statewide, HIV seroprevalence increased with increasing maternal age. Seroprevalence ranged from 0.13 percent for those 10 to 19 years of age to 0.29 percent for those 20 to 24 years of age, 0.35 percent for those 25 to 29 and 30 to 34 years of age, and 0.40 percent for those 35 years of age or older.

HIV seroprevalence also differed by race or ethnicity. While representing only 37 percent of all newborns, Black and Hispanic infants accounted for 85 percent of those testing positive for maternal HIV antibodies. The HIV prevalence by race or ethnicity was 1.13 percent (1 in 88) for Blacks, 0.42 percent (1 in 238) for Hispanics, and 0.05 percent (1 in 2,000) for Whites. This represented a decrease from 1999 in HIV prevalence for Blacks (1.26 percent), Hispanics (0.49 percent), and Whites (0.07 percent).

B. Section I

Maternal HIV Testing History

During the period of January 1, 2000 through December 31, 2000, 251,546 women gave birth in New York State. This report demonstrates that Maternal HIV Testing History varied by geographic area, age and racial or ethnic group. The percent of women tested for HIV during pregnancy in this reporting period was lower for women residing in New York City (86 percent) than for those residing elsewhere in the state (93 percent).

The percent of women who were tested for HIV during pregnancy did not vary by age. The testing rate during pregnancy was 88 percent for women 10 to 19 years of age, 88 percent for women 20 to 24 years of age, 90 percent for women 25 to 29 years of age, 90 percent for women 30 to 34 years of age, and 88 percent for women 35 years of age or older.

In those for whom race/ethnicity data are available, HIV testing during pregnancy is as follows: 88 percent in Hispanics, 84 percent in Blacks, and 91 percent in Whites.

C. Section II

Expedited HIV Testing

Expedited HIV testing information is also obtained from data reported through the Comprehensive Newborn HIV Testing Program. In this report, expedited HIV testing history is summarized as follows:

  • Mother Tested - mother consented and received expedited HIV testing
  • Infant Tested - expedited testing performed on the newborn (consent not required)
  • Not Necessary - expedited testing was not done; mother tested HIV-negative during this pregnancy or is known to be HIV-positive
  • Data Missing - signifies that no information was recorded.

In 2000, 25,118 mothers consented to expedited testing for themselves, and at least 6,726 infants received expedited testing.

Expedited Testing is described in the following categories:

  • Box "E": Mother consented and Tested
  • Box "F": Infant Tested
  • Box "G": Expedited Testing Not Necessary due to the mother having tested as HIV-negative during this pregnancy or is known to be HIV-positive
  • Data Missing

D. Caution (page v)

  • Data are reported by geographic area based on mother's county of residence except for the tables "Hospitals by Location," where the birth facilities are reported in the county in which they are located.
  • Since the Expedited HIV testing regulation became effective on August 1, 1999, birth facilities are required to review the prenatal care record for written documentation to determine if the woman's HIV status is known. A woman's report of her HIV test history is not sufficient for the purposes of the assessment.
  • Data on Maternal HIV Testing History do not necessarily reflect the prenatal HIV counseling and testing success of the birth facility as women often receive prenatal care at other sites.
  • Immediately after the implementation of the Expedited HIV Testing regulation, information about the Expedited HIV Testing history was not always recorded on the Newborn Screening Blood Collection Form (DOH 1514). This unrecorded information appears in this report as "Data Missing." It should be noted that accurate documentation of Expedited HIV testing history has steadily improved since the regulation was implemented.
  • In certain instances the number of individuals with specific characteristics may be too small to maintain the confidentiality of those tested if it were to be reported here. In these instances, groups or categories may be combined into other categories, often termed "other/unknown", or the category may not be listed. An example of this is that at least 20 individuals must have provided suitable specimens in order for a facility to be listed in this report. Also, please note that not all women giving birth are in the data. Sometimes a suitable specimen was not initially available; the data presented here does not include the repeat specimens that may have been received at a later time.

Monitoring Strategies and Interventions

Section III

This section presents the Department's oversight and intervention strategies for monitoring compliance with the prenatal HIV counseling requirement, as well as the HIV testing regulations affecting care in the labor, delivery and newborn care settings (the Expedited HIV Testing and Newborn HIV Screening requirements). Consumer and provider concerns received by the Department throughout the year are also summarized.

Contact Information

For information regarding:

Program, Policy or Monitoring

Sheila Hackel or Ellen Kowalski
AIDS Institute
New York State Department of Health
P.O. Box 2094
Empire State Plaza Station
Albany, NY 12220-0094
Phone: 518-473-8427
Email: MPRU@health.state.ny.us

Data and Data Tables

Wendy Pulver
Bureau of HIV/AIDS Epidemiology
New York State Department of Health
Empire State Plaza
Corning Tower
Albany, NY 12237
Phone: 518-474-4284
Email: MPRU@health.state.ny.us

Section III: Monitoring Strategies and Interventions

A. Managing Provider and Consumer Questions and Concerns

Since the Expedited HIV Testing program was first proposed in December 1998, the Department continues to receive a few calls from consumers and providers who seek clarification of the prenatal HIV counseling and expedited HIV testing requirements. Most of these callers inquire about whether prenatal HIV testing is mandatory in New York State. Some callers want details about the prenatal HIV counseling requirement. AIDS Institute staff address these inquiries. The Department routinely provides copies of DOHM AI 99-01 and other materials related to the Maternal-Pediatric HIV Prevention and Care Program. In a few instances, based upon information provided by consumers, the Department has contacted prenatal providers to discuss their policies and practices, answer questions about the Expedited HIV Testing requirement, and offer technical assistance.

In July 1999, the Department published a statewide hotline number to manage consumer questions, concerns or complaints about HIV counseling and testing in the perinatal period (1-877-249-5115). The Department has published this number extensively in patient educational materials. Fewer than 10 calls are received on this line monthly. To date, no call has resulted in the filing of a complaint or the initiation of an investigation of the care rendered by a provider.

B. Program Monitoring and Intervention Strategies

Download a Printable version of Program Monitoring & Intervention Strategies (PDF, 118 KB, 2pgs)

Regulatory Requirement Monitoring Intervention
Prenatal HIV Counseling Annual IPRO Review IPRO Review Results
Regulated parties must provide prenatal HIV counseling with a clinical recommendation for HIV testing. Select prenatal providers are annually reviewed by IPRO for the indicator "HIV Counseling and Testing: Pregnant Women with Unknown HIV Status". The result of this review, along with Department's observations about the provider's performance, and plans for intervention, if any, are reported to representatives of the facility's administrative and medical staff.
Note: In 2000, IPRO reviews conducted at 67 prenatal care sites around the state, revealed an average pre-test counseling rate of 96 percent.		 When a facility fails to demonstrate compliance with the Prenatal HIV Counseling requirement, Department intervention includes:
  • requesting, reviewing and providing feedback on "rapid quality improvement plan" submitted by facility;
  • if requested, reviewing relevant policies, procedures, quality plans and practices;
  • conducting on-site technical assistance site visits;
  • requesting a written plan of correction, and then, if the facility fails to achieve compliance,
  • issuing a Statement of Deficiency (SOD). Please note: a SOD is only issued when attempts at technical assistance have failed to bring about compliance and a site visit by the AIDS Institute confirms non-compliance.
Expedited HIV Testing Newborn Specimen Data Data Review
Since August 1999, birth facilities must screen all women admitted for delivery for documented negative HIV test results from prenatal care, or for documentation that the woman is known to be HIV-positive. Women who do not have an HIV test result from the current pregnancy at the time of admission for delivery are to be counseled and offered an expedited HIV test. If the mother declines, or if there is no time to perform testing on the mother, the infant is tested immediately after birth, without consent. Preliminary HIV test results must be returned as soon as possible, but no later than 48 hours after the specimen is collected.

All preliminary positive HIV test results must be reported to the Department using form DOH-4159.

 Maternal-Newborn test history data are submitted by all birth facilities to the Wadsworth Center on the Newborn Screening Blood Collection Form (DOH-1514). The Wadsworth Center forwards this information to the AIDS Institute weekly for review. On a regular basis, the AIDS Institute receives, reviews and reports aggregate data to all birth facilities. Of special concern in reviewing data are:
  • failures to identify maternal HIV infection, resulting in a missed opportunity to provide therapy to reduce the risk of HIV transmission to the infant;
  • instances when expedited testing was indicated but not done;
  • birth facilities that perform a disproportionate number of expedited tests on infants as compared to mothers.
 Data are collected from the Newborn Blood Collection Form (DOH 1514) which is submitted by the birth facility or birth attendant. Weekly reviews are conducted by the AIDS Institute and periodic reports are forwarded to birth facilities. When non-compliance or other problems in implementing the expedited testing requirement are identified, Department interventions may include:
  • providing technical assistance by telephone;
  • requesting, reviewing, and offering feedback on rapid quality improvement plans submitted by facility.
  • if requested, reviewing and providing feedback on policies and procedures;
  • scheduling an on site technical assistance visit.

Continued non-compliance, or failure to identify an HIV positive birth may result in:

  • requesting a written plan of correction, and/or
  • issuing a Statement of Deficiency (SOD).

Please note: a SOD is only issued when multiple attempts at technical assistance have failed to bring about compliance and a site visit by the AIDS Institute confirms non-compliance.