Abstract
BackgroundElimination of mother-to-child transmission (MTCT) of HIV by 2020 is a goal of the World Health Organization (WHO) action plan for the European Region. However, data to monitor progress towards MTCT elimination are not readily available in Germany.AimWe aimed to estimate the number of pregnant women with HIV and MTCT rates in Germany.MethodsWe triangulated retrospectively obtained data from: (i) healthcare reimbursement for HIV screening tests, (ii) a statutory health insurance subsample of prevalent and incident HIV diagnoses among pregnant women, (iii) a mathematical model of the German HIV epidemic with number, region of origin and risk factors for women of childbearing age, and (iv) the statutory anonymous HIV registry on children infected through HIV MTCT.ResultsThe number of women aged 15–49 years with HIV increased from ca 6,000 in 1993 to ca 11,000 in 2016. Risk of injecting drug use (IDU) declined from 65% in 1993 to 16% in 2016. The annual proportion of women living with HIV giving live birth increased from a mean of 1.9% during 1993 to 1998 to 4.9% in 2011 to 2015. HIV screening rates during pregnancy increased from ca 50% in 2001 to ca 90% in 2016. The HIV MTCT rate dropped from 6.8% in 2001 to 1.1% in 2016.ConclusionsThe population of women living with HIV in Germany shifted from predominantly IDU-associated infections to predominantly sexually acquired infections, while fertility rates more than doubled. MTCT rates dropped, mainly because of improved detection and management of HIV in pregnancy.
Highlights
In 2016, the World Health Organization Regional Office for Europe (WHO/Europe) published an ‘Action plan for the health sector response to HIV in the WHO European Region’ [1]
The elimination targets specific to the prevention of mother-to-child transmission (MTCT) were to: (i) reduce MTCT to < 2% in non-breastfeeding populations and (ii) reduce the rate of HIV and congenital syphilis in infants. This should be achieved by setting national targets, expanding coverage with antenatal care and testing, providing lifelong antiretroviral treatment (ART) for women during pregnancy and after delivery, and ensuring early diagnosis of infants and immediate treatment for all infants diagnosed with HIV
It has been shown that Caesarean section has no additional benefit if maternal viral load is undetectable at delivery, and it is debated whether postpartum post-exposure prophylaxis (PEP) for the newborn is still required if maternal viral load was undetectable during the last weeks of pregnancy [7]
Summary
In 2016, the World Health Organization Regional Office for Europe (WHO/Europe) published an ‘Action plan for the health sector response to HIV in the WHO European Region’ [1]. The elimination targets specific to the prevention of MTCT were to: (i) reduce MTCT to < 2% in non-breastfeeding populations and (ii) reduce the rate of HIV and congenital syphilis in infants. Effective measures to prevent or reduce MTCT have been established: (i) Caesarean section to reduce exposure to maternal blood during delivery [2], (ii) antiretroviral treatment during pregnancy with the goal to have an undetectable viral load at delivery [3,4]; (iii) postpartum post-exposure prophylaxis (PEP) for the newborn with antiretroviral drugs [5], and (iv) formula feeding instead of breastfeeding to avoid HIV transmission via breastmilk [6]. Elimination of mother-to-child transmission (MTCT) of HIV by 2020 is a goal of the World Health Organization (WHO) action plan for the European Region. MTCT rates dropped, mainly because of improved detection and management of HIV in pregnancy
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