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Geographic origin trends among HIV+ mothers and children in Canada and impact on vertical HIV transmission rates
Abstract Content:
Background: Migration contributes significantly to new HIV
cases in Canada. This study describes geographic origin trends among HIV+
mothers and perinatally infected children and the impact of geographic origin on vertical HIV
transmission (VT) rates among HIV+ mother-infant pairs (MIP) in Canada from
1990-2013.
Methods: The Canadian Perinatal HIV Surveillance Program collects data at 22 centres. The primary focus is on MIP with an infant born in Canada and identified prior to/within 3 months of birth; MIP with Canadian-born infants identified after 3 months and HIV+ children born abroad are also tracked. Data reviewed for this study included: maternal country of origin, clinical characteristics, antiretroviral usage and infant outcome. Logistic regression determined VT rate differences for foreign-born (FBM) versus Canadian-born mothers (CBM).
Results: Among 3877 MIP, 2089 (53.9%) mothers were FBM. Of 1481 (70.9%) African mothers, 30.7%, 20.1%, 17.7%, and 16.7% came from East, Central, Horn, and West Africa, respectively. CBM accounted for 66.7% (971/1456) in Western/Central Canada, whereas FBM predominated in Ontario (945/1357, 69.6%; greatest proportion East African, 25.0%) and Quebec (713/1020, 69.9%; greatest proportion Caribbean, 36.2%). The largest numbers of FBM originated from Haiti (12.5%), Ethiopia (8.7%), Congo (7.0%), Zimbabwe (5.4%), and Nigeria (4.6%). In the pre-cART era (1990-1996), Haiti contributed 29.9% (90/301) of FBM, decreasing to 13.0% (119/918) in 1997-2007, and 6.6% (52/782) in 2008-2013. Since 2008, Ethiopia (80/782, 10.2%), Congo (64/782, 8.2%), and Nigeria (62/782, 7.9%) predominated.
VT rate among Canadian-born children from 1990-2013 was 3.8% (3.0% among FBM) and 1.2% from 2008-2013 (0.7% among FBM). African mothers had lower risk of VT (1990-2013: OR = 0.45, 95%CI 0.29-0.71; 2008-2013: OR 0.35, 95%CI 0.12-1.08) compared to CBM; no differences were seen for other regions.
Of 353 HIV+ children (born in Canada or abroad) with FBM, the greatest numbers came from Haiti (48, 13.6%), Ethiopia (33, 9.3%), Burundi (30, 8.5%), and Congo (15, 4.2%).
Conclusions: Geographic origins of HIV+ FBM in Canada have changed over time, shifting from predominantly Haitian in the pre-cART era to predominantly African more recently. African mothers have lower VT rates than CBM. Understanding country-specific cultural and obstetrical/pediatric health issues is imperative to providing optimal care.
Methods: The Canadian Perinatal HIV Surveillance Program collects data at 22 centres. The primary focus is on MIP with an infant born in Canada and identified prior to/within 3 months of birth; MIP with Canadian-born infants identified after 3 months and HIV+ children born abroad are also tracked. Data reviewed for this study included: maternal country of origin, clinical characteristics, antiretroviral usage and infant outcome. Logistic regression determined VT rate differences for foreign-born (FBM) versus Canadian-born mothers (CBM).
Results: Among 3877 MIP, 2089 (53.9%) mothers were FBM. Of 1481 (70.9%) African mothers, 30.7%, 20.1%, 17.7%, and 16.7% came from East, Central, Horn, and West Africa, respectively. CBM accounted for 66.7% (971/1456) in Western/Central Canada, whereas FBM predominated in Ontario (945/1357, 69.6%; greatest proportion East African, 25.0%) and Quebec (713/1020, 69.9%; greatest proportion Caribbean, 36.2%). The largest numbers of FBM originated from Haiti (12.5%), Ethiopia (8.7%), Congo (7.0%), Zimbabwe (5.4%), and Nigeria (4.6%). In the pre-cART era (1990-1996), Haiti contributed 29.9% (90/301) of FBM, decreasing to 13.0% (119/918) in 1997-2007, and 6.6% (52/782) in 2008-2013. Since 2008, Ethiopia (80/782, 10.2%), Congo (64/782, 8.2%), and Nigeria (62/782, 7.9%) predominated.
VT rate among Canadian-born children from 1990-2013 was 3.8% (3.0% among FBM) and 1.2% from 2008-2013 (0.7% among FBM). African mothers had lower risk of VT (1990-2013: OR = 0.45, 95%CI 0.29-0.71; 2008-2013: OR 0.35, 95%CI 0.12-1.08) compared to CBM; no differences were seen for other regions.
Of 353 HIV+ children (born in Canada or abroad) with FBM, the greatest numbers came from Haiti (48, 13.6%), Ethiopia (33, 9.3%), Burundi (30, 8.5%), and Congo (15, 4.2%).
Conclusions: Geographic origins of HIV+ FBM in Canada have changed over time, shifting from predominantly Haitian in the pre-cART era to predominantly African more recently. African mothers have lower VT rates than CBM. Understanding country-specific cultural and obstetrical/pediatric health issues is imperative to providing optimal care.