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P208 Audit of the management of HIV positive pregnant women in a low prevalence setting
  1. Kasey Redler,
  2. Rebecca Hallgren,
  3. Rebecca Swingler
  1. Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK

Abstract

Background/introduction HIV Maternal to child transmission (MTCT) has reduced from 25% in 1993 to 0.57% in 2007 due to increased intervention in pregnancy. Compliance with BHIVA guidelines requires multidisciplinary care, which could be a challenge in areas with low HIV prevalence.

Aim(s)/objectives To audit the management of HIV positive pregnant women in a large district general hospital (DGH) against BHIVA guidelines.

Methods Retrospective audit of all HIV positive women giving birth at this DGH between September 2010 and October 2015.

Results 21 women identified. Diagnosis: 100% screened for STI, hepatitis C, VZV and HIV. Treatment: 81% on HAART at start of pregnancy, 100% of the four women not on HAART were started on treatment during pregnancy. At start of pregnancy 61% (n = 13) had a viral load <50RNA copies/ml, by the end of pregnancy this increased to 86% (n = 18). 100% (n = 21) had MDT management. Delivery: 43%: vaginal delivery. 38%: elective Caesarean section. 19% emergency Caesarean section. Post-partum care: 100% babies had post exposure prophylaxis started within 4 hours. No babies contracted HIV. 100% babies exclusively bottle-fed. 57% mothers given carbegoline.

Discussion/conclusion There was good compliance with guidelines. All women received HAART and the MTCT rate was 0%. 43% of women had a vaginal birth. Inclusion of the importance of carbergoline in departmental training may improve compliance in this area. In a low prevalence centre a specialist HIV antenatal clinic cannot be justified. The centre has introduced bimonthly MDT meetings to discuss these cases and these results suggest that communication and standards of care are high.

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