Variable uptake of recommended interventions to reduce mother-to-child transmission of HIV in Australia, 1982–2005

Michelle L Giles, Ann M McDonald, Elizabeth J Elliott, John B Ziegler, Margaret E Hellard, Sharon R Lewin and John M Kaldor
Med J Aust 2008; 189 (3): 151-154.


Objective: To analyse the uptake of interventions known to reduce the risk of perinatal HIV transmission among Australian women with HIV infection (who knew their HIV status before delivery), and identify predictors of uptake.

Design: Retrospective analysis of perinatal HIV surveillance data in Australia.

Patients: Women reported as having HIV infection and having given birth to a child (1982–2005) were identified through three mechanisms: an informal network of clinicians (1982–1993); an active surveillance program through paediatricians (since 1993); and state health department reports of children born to women newly diagnosed with HIV (since 1995).

Main outcome measures: Uptake of interventions — avoidance of breastfeeding (after 1985), use of zidovudine during pregnancy (after 1994), and elective caesarean section (after 1999). Factors associated with uptake of these interventions were identified by univariate and multivariate analyses.

Results: 367 live births were reported in 291 women with HIV infection. Among the subgroup diagnosed with HIV infection before delivery, 4/255 (1.6%) elected to breastfeed (post 1985), 44/185 (24%) did not receive zidovudine (after 1994), and 41/118 (35%) did not have an elective caesarean section (after 1999). In multivariate analysis, there were significant differences in uptake of zidovudine and elective caesarean section according to year of birth and state in which the birth took place.

Conclusion: In Australia between 1982 and 2005, uptake of interventions to reduce mother-to-child transmission of HIV was high. There were significant differences associated with use of zidovudine and mode of delivery according to location of delivery and year of birth.

  • Michelle L Giles1,2,0,3
  • Ann M McDonald4
  • Elizabeth J Elliott5,6,7
  • John B Ziegler8,9
  • Margaret E Hellard2,3
  • Sharon R Lewin1,3
  • John M Kaldor4

  • 1 Department of Medicine, Monash University, Melbourne, VIC.
  • 2 Centre for Epidemiology and Population Health Research, Burnet Institute, Melbourne, VIC.
  • 3 Infectious Disease Unit, Alfred Hospital, Melbourne, VIC.
  • 4 National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW.
  • 5 Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW.
  • 6 Children’s Hospital at Westmead, Sydney, NSW.
  • 7 Australian Paediatric Surveillance Unit, Sydney, NSW.
  • 8 Department of Immunology, Sydney Children’s Hospital, Sydney, NSW.
  • 9 School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW.


The activities of the APSU are supported by the Australian Government Department of Health and Ageing (National Health and Medical Research Council [NHMRC] Enabling Grant No. 402784 and NHMRC Practitioner Fellowship No. 457084 [Elizabeth Elliott]); Discipline of Paediatrics and Child Health, University of Sydney; and the Royal Australasian College of Physicians.

Competing interests:

Sharon Lewin has received funding to attend meetings by Gilead, Pfizer, Roche and Boehringer. She received educational grants from Roche and has sat on advisory boards for Roche and Pfizer.

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