Women in the UK who have HIV (previously diagnosed or not) are more than twice as likely to present late for antenatal care than HIV-negative women, a survey has found, and just over 50% present after the first trimester (three months) of pregnancy. UK guidelines advise that all pregnant women should have their first antenatal care appointment by 13 weeks of pregnancy. National surveys report that, overall, only 22% of women present at 13 weeks or later.
The study found that 25% of women presented after 17 weeks and 5% after 28 weeks.
The study, presented at the Tenth AIDS Impact conference on behavioural science and HIV by Dr Shema Tariq of City University in London, found that this was largely accounted for by the fact that women of sub-Saharan African ethnicity who were diagnosed with HIV during pregnancy were 2.85 (185%) times more likely to present late than white UK women with HIV. National surveys show that women from ethnic minorities tend to present late for antenatal care.
Even in women aware they had HIV before pregnancy, African women were 60% more likely to present late for antenatal care than white HIV-positive UK women.
The late-presentation rate in women not previously diagnosed was 58%, compared with 47% in women already diagnosed.
The study data was collected from the National Study of HIV in Pregnancy and Childhood (NSHPC), the UK and Ireland's comprehensive surveillance programme for obstetric and paediatric HIV and covered the two-year period from January 2008 to December 2009.
During this time 2787 pregnant women were reported as having HIV (newly or previously diagnosed) of whom 1731 had data available on antenatal booking dates.
“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," Dr Tariq commented. “This may have an adverse effect on obstetric and maternal health outcomes.”
She urged "More work is needed to increase awareness of the importance of early antenatal booking and to elucidate potential barriers in this group”.
Tariq S et al. The impact of ethnicity on presentation to antenatal care among pregnant women living with HIV in the UK and Ireland. Tenth AIDS Impact Conference, Santa Fe, New Mexico, abstract 90, 2011.