1. Enhanced Perinatal Surveillance, Georgia 2005-2010

2. Background August 1994 the USPHS Task Force recommends use of ZDV to reduce perinatal transmission HIV testing recommendations revised 2006 to include routine opt-out HIV testing all pregnant women, repeat testing in third trimester and rapid testing during delivery Enhanced Perinatal Surveillance (EPS) begun in 7 states in 1995, increased to 24 jurisdictions in 1999 Name-based reporting begins in Georgia in 2004 Georgia funded for EPS 2005-2011 July 2008 USPHS Task Force recommendations update includes treatment options for HIV-infected pregnant women and for their infants

3. Overall goals for EPS project Assist in timely evaluation of perinatal prevention efforts Monitor the implementation of the USPHS recommendations for testing, use of antiretrovirals, and the effect of implementation of recommendations on perinatal HIV transmission Establish a surveillance system to collect data to allow states to respond to selected requirements of the Ryan White CARE Act

4. Methodology for EPS in Georgia Data collected on HIV-infected pregnant women who gave birth to a live infant 2005-2010 HIV-infected pregnancies identified through case report forms, birth registry match, and active case surveillance Eight page data collection form collects information from prenatal, intrapartum and neonatal periods EPS in Georgia transitioned from a population-based (2005-2006) to a facility-based surveillance system (2007-2010) to focus efforts on the seven tertiary care centers in Georgia

5. Facility-based sampling, Georgia EPS, 2007-2010 FacilityCity Health District Emory Crawford Long Hospital Atlanta 3-2 Grady Memorial Hospital Atlanta 3-2 Medical Center of Central Georgia Macon 5-2 Medical College of Georgia Augusta 6 Memorial Health University Savannah 9-1 Phoebe Putney Memorial Hospital Albany 8-2 The Medical CenterColumbus 7

6. EPS Georgia 2005-2010 Methodology changed – 2005-2006 EPS review attempted for every HIV-infected pregnancy proved overwhelming – 2007-2009 EPS review limited to seven tertiary care facilities in Georgia doing high risk obstetrics – 2010 close-out year with fewer case investigations Number of cases investigated decreased – 154 in 2005, 150 in 2006 – 109 (2007), 111 (2008), 118 (2009) – 69 (2010) – Cannot use the number of cases for trend analysis EPS data in this analysis represents a population based (2005-2006) and facility-based (2007-2010) sample of 695 HIV-infected pregnancies that resulted in 710 live births in Georgia during the years 2005-2010. Comparison of this Georgia sample is made with a national sample of 8,054 HIV-infected pregnancies from 15 jurisdictions 2005-2008

7. HIV infected pregnant women giving birth to a live infant, by age group, Georgia, 2005-2010 Georgia sample of 695 pregnancies during 2005-2010

8. Proportion of HIV infected pregnant women, by age group, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

9. Proportion of HIV-infected pregnant women, by race/ethnicity, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

10. Proportion of HIV-infected pregnant women, by transmission category, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008 Heterosexual contact = heterosexual contact with a person who is HIV infected or in a high risk transmission category (e.g., IDU or MSM)

11. Proportion of HIV infected pregnant women, by marital status, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

12. Proportion of HIV infected pregnant women, by mother’s country of origin, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

13. Proportion of HIV infected pregnant women receiving prenatal care, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008 Prenatal care = at least one prenatal care visit prior to delivery

14. Proportion of HIV infected pregnant women, by timing of HIV diagnosis, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

15. Proportion of HIV infected pregnant women receiving prenatal ART*, Georgia and US *ART = antiretroviral therapy Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

16. Proportion of HIV infected pregnant women receiving intrapartum ART*, Georgia and US *ART = antiretroviral therapy Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

17. Proportion of HIV exposed infants receiving ART* during neonatal period, Georgia and US *ART = antiretroviral therapy Georgia sample of 710 infants from 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

18. Proportion of HIV infected pregnancies by delivery type, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

19. Proportion of HIV infected women reporting illicit drug use during pregnancy, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

20. Proportion of HIV infected women reporting alcohol and/or tobacco use during pregnancy, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

21. Proportion of toxicology screen results among HIV infected women, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

22. Proportion of HIV infected pregnant women receiving Group B Strep (GBS) screen, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

23. Proportion of HIV infected pregnant women receiving Hepatitis B screen, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

24. Proportion of HIV infected pregnant women receiving Rubella screen, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

25. Proportion of HIV-infected pregnant women receiving Syphilis screen, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

26. Proportion of HIV infected pregnant women with an STD*, Georgia and US *Includes presumptive or definitive diagnosis during pregnancy of Chlamydia, genital herpes, Gonorrhea, hepatitis B, syphilis and/or Trichomonas Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

27. Proportion of HIV infected pregnant women receiving prenatal care, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

28. Proportion of HIV infected Black, non- Hispanic women receiving prenatal care, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

29. Proportion of HIV infected Hispanic/Latino women receiving prenatal care, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

30. Proportion of HIV infected white, non- Hispanic women receiving prenatal care, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

31. Proportion of HIV infected Black, non- Hispanic pregnant women, by timing of HIV diagnosis, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

32. Proportion of HIV infected Hispanic/Latino pregnant women, by timing of HIV diagnosis, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

33. Proportion of HIV infected white, non- Hispanic pregnant women, by timing of HIV diagnosis, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

34. Proportion of HIV infected Black, non- Hispanic women receiving perinatal ART, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

35. Proportion of HIV infected Black, non- Hispanic women receiving intrapartum ART, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

36. Proportion of HIV exposed Black, non- Hispanic infants given neonatal ART, Georgia and US Georgia sample of 710 infants from 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

37. Proportion of HIV infected Hispanic/Latino women receiving prenatal ART, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

38. Proportion of HIV infected Hispanic/Latino women receiving intrapartum ART, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

39. Proportion of HIV exposed Hispanic/Latino infants given neonatal ART, Georgia and US Georgia sample of 710 infants from 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

40. Proportion of HIV infected white, non- Hispanic women receiving prenatal ART, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

41. Proportion of HIV infected white, non-Hispanic women receiving intrapartum ART, Georgia and US Georgia sample of 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

42. Proportion of HIV exposed white, non-Hispanic infants given neonatal ART, Georgia and US Georgia sample of 710 infants from 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

43. Proportion of HIV-exposed infants receiving Pneumocystis prophylaxis during first year of life, Georgia and US Georgia sample of 710 infants from 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

44. Proportion of infants infected with HIV through mother-to-child transmission, Georgia and US *Indeterminate includes cases missing infant’s HIV status Georgia sample of 710 infants from 695 pregnancies during 2005-2010 US sample of 8,054 pregnancies from 15 jurisdictions 2005-2008

45. Highlights Higher proportions of HIV infected women in Georgia EPS were Black, non-Hispanic (85%) vs. national sample (65%) Majority (58%) of HIV infected pregnant women in Georgia had an unknown transmission category vs. nationally (37%) Almost all (90%) had at least one prenatal care visit in both the Georgia and national sample The proportion receiving prenatal care in Georgia was comparable across races with at least one prenatal visit documented for 90% Black, 93% Hispanic/Latino and 89% white women

46. Highlights (continued) Almost all (97%) HIV infected pregnant women in Georgia were diagnosed with HIV before (63%) or during (34%) pregnancy, comparable to the national rates Most HIV infected Georgia women received prenatal ART (79%) and/or intrapartum ART (82%) Comparisons with national data are limited by missing data (15% and 12% for prenatal and intrapartum ART use in Georgia) Most (85%) HIV exposed infants in Georgia received neonatal ART, with 12% missing data Most (58%) HIV infected pregnant women in Georgia delivered by elective C-section compared to 40% nationally

47. Highlights (continued) Based on this sample of 710 HIV infected pregnancies in Georgia, 2.5% (18/710) resulted in mother-to-child (MTC) HIV transmission, comparable to the national sample rate of 2%

48. Limitations Facility-based sample may not accurately reflect HIV perinatal care for all Georgia Large proportion of unknown values for some variables limits comparisons within category and to the national sample Large proportion of indeterminate HIV status for HIV exposed infants limits calculation of MTC transmission in Georgia Definition of heterosexual contact as sexual contact with a man known to be HIV infected or in a high risk transmission category (MSM or IDU) contributes to the high proportion of unknown transmission category

49. For more information on Perinatal Surveillance visit http://dph.georgia.gov/enhanced-perinatal-hivaids-surveillance-eps For information on HIV prevention visit http://dph.georgia.gov/hiv-prevention-program For more information on HIV surveillance in Georgia, visit http://dph.georgia.gov/georgias-hivaids-epidemiology-surveillance-section