The proportion of HIV-positive diagnosed women passing (transmitting) their infection to their babies in the UK is now at its lowest ever level, having dropped four-fold in 10 years. In 2000-2001 the percentage of women diagnosed with HIV who transferred the disease to their child stood at 2.1 per cent and by 2010-2011 it was down to 0.46 per cent.
The results, published recently in the journal AIDS, highlight the enormous success NHS Screening Programmes have had in helping to reduce the numbers of babies born with HIV. The chances of a child in the UK being born with HIV are now incredibly small and the UCL Institute of Child Health have said that, as far as they are aware, these are the lowest levels reported in the world.
At the heart of this success story sits a world-leading screening programme.
The NHS Infectious Diseases in Pregnancy Screening (IDPS) Programme is responsible for ensuring that all pregnant women are routinely offered screening for HIV, hepatitis B, syphilis and susceptibility to rubella infection. More information on the IDPS programme can be found here.
The aims of the programme are to ensure that women with HIV, hepatitis B, and syphilis are identified early in pregnancy and that strategies are put in place to prevent mother to child transmission of these conditions; and to identify women who are susceptible to rubella, for whom postnatal MMR vaccination could protect future pregnancies.
Screening is vital to identify those pregnant women who do not know they are infected with HIV. Almost 685,000 pregnant women were screened in the UK in 2012, with just over 1,300 testing HIV positive.
If a woman isn’t aware of her HIV infection, her baby has about a 1 in 4 chance of being infected. Knowing they are HIV positive means women can receive the appropriate treatment. In fact, transmission of HIV from mother to child is almost entirely preventable through careful management during pregnancy including appropriate antiretroviral therapy (ART), management of how the baby is delivered and avoidance of breastfeeding.
The reduction in transmission means that, each year, over 1,000 pregnant women living with HIV are able to give birth to babies who are free of HIV.
As with all NHS screening programmes, the whole treatment pathway is managed and quality assured, from the test through to diagnosis and treatment. It is this holistic approach to screening that ensures the right overall outcomes (like a 0.46 per cent transmission rate) and marks out NHS screening programmes in the UK.
In the UK, unlike in many other countries, screening is not just testing. The UK National Screening Committee (UK NSC) decides on what is screened for and what isn’t and will only recommend a condition be screened for if there is appropriate treatment available. The programme then manages patients through the whole treatment pathway.
The UK NSC uses scientific evidence and consultation to make screening recommendations. These decisions are sometimes difficult but the Committee always aims to only recommend a screening programme where there is evidence that the whole programme will benefit people in the UK. More detail on these considerations can be found in a recent post I wrote for this blog.
News like this on HIV demonstrates how the right programmes run to the highest standards can be hugely effective, save lives and ensure the UK continue to lead the way in delivering gold-standard screening services.