       Document 0634
 DOCN  M9630634
 TI    Failure to identify human immunodeficiency virus-seropositive newborns:
       epidemiology and enrollment patterns in a predominantly white, nonurban
       setting.
 DT    9603
 AU    Coplan J; Dye TD; Contello KA; Cunningham CK; Kirkwood K; Weiner LB;
       Department of Pediatrics, State University of New York-Health; Science
       Center at Syracuse 13210, USA.
 SO    Pediatrics. 1995 Dec;96(6):1083-9. Unique Identifier : AIDSLINE
       MED/96095158
 AB    OBJECTIVE. To describe the epidemiology of newborn seroprevalence for
       human immunodeficiency virus (HIV) in a predominantly white, nonurban
       population, and to determine the factors associated with enrollment at a
       regional pediatric acquired immunodeficiency syndrome (AIDS) center
       serving that population. DESIGN. Retrospective case series of children
       enrolled at a regional pediatric AIDS center during a 6-year period and
       comparison with universal blind newborn screening data collected by the
       state of New York during the same time interval. SETTING. The Pediatric
       AIDS Center at State University of New York-Health Science Center at
       Syracuse, which serves as the only source of HIV-related pediatric care
       for children in a 16-country region of upstate New York totaling 1.8
       million population. RESULTS. One hundred thirty-nine HIV-seropositive
       infants were born in the region during the 6-year study period; complete
       blind screening data were available for 138. Sixty-five (47%) of these
       infants were white. Thirty-nine (28%) of 138 had been enrolled at the
       Pediatric AIDS Center within the first 90 days of life. An additional 22
       (16%) were enrolled at older than 90 days of life. The remaining 77
       (56%) have never been seen at the center and are presumed to be
       unidentified. County enrollment rates varied from 0% to 100% and
       correlated with percent nonwhite births (r = .58; 95% confidence
       interval, 0.04-0.86). Children in outlying counties were at greater risk
       for nonenrollment than children from Onondaga County (site of the
       Pediatric AIDS Center) (adjusted relative risk, 1.38; 95% confidence
       interval, 1.05-1.85). White infants residing outside of Onondaga County
       were at the greatest risk of nonenrollment; of 50 seropositive white
       infants residing outside of Onondaga County, only 7 (14%) were enrolled
       at the center within the first 90 days of life. CONCLUSIONS. Local
       demographic factors can skew the racial distribution of HIV-seropositive
       infants dramatically compared with the national experience. White race
       and residence in counties away from the medical center each constituted
       risk factors for nonenrollment at the Pediatric AIDS Center. The
       epidemiology of HIV in this predominantly white, rural population,
       coupled with physician practices, probably contributed to low
       identification and enrollment rates. As the AIDS epidemic spreads into
       similar populations elsewhere, HIV infection in pregnant women or
       newborn infants is likely to become progressively harder to detect,
       unless universal screening is adopted.
 DE    Blacks/STATISTICS & NUMER DATA  Chi-Square Distribution  Comparative
       Study  Data Collection/METHODS  Female  Hispanic Americans/STATISTICS &
       NUMER DATA  Human  HIV Seropositivity/*EPIDEMIOLOGY  *HIV Seroprevalence
       HIV-1/*IMMUNOLOGY  Infant, Newborn  Male  New York/EPIDEMIOLOGY
       Retrospective Studies  Risk Factors  Rural Population/*STATISTICS &
       NUMER DATA  Whites/*STATISTICS & NUMER DATA  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

