The effect of the COVID-19 pandemic on access to HIV Treatment and vertical transmission: results from the Canadian Perinatal HIV Surveillance Program


BACKGROUND: We describe demographics, antiretroviral treatment during pregnancy, and vertical transmission rates in the Canadian perinatal HIV surveillance cohort of births to women living with HIV (WLWH) and assess the effect of the COVID-19 pandemic on access to optimal therapy and perinatal transmission.
METHODS: 22 Canadian pediatric and HIV centres update data including demographics, antiretroviral treatment during pregnancy, and perinatal transmission, on births in WLWH yearly each January. The results reported in this abstract reflect births up to the end of 2020 but will be updated to include 2021 results.
RESULTS: The number of HIV exposed infants per year has increased over time in Canada, with 250 infants born in 2020; 32% came from Ontario, 24% from Quebec, 17% from Alberta, 14% from Saskatchewan, 7% from British Columbia and 4% from Manitoba; 60% were Black, 21% were Indigenous, and 13% were white. Overall, 63% of this population acquired HIV heterosexually, 13% through injection drug use and 4.4% perinatally. The proportion and number of pregnant women sub-optimally treated in May-December 2020 was 7.7% (12/155) compared to 6.6% (86/1297) in the period from 2015-2019.The corresponding transmission rates were 3.2% (5/155) versus 1.3% (17/1297), respectively. Among those who had acquired HIV through IDU, the sub-optimal treatment rate was 26.1% during the COVID-19 pandemic, versus 13.6% in the pre-COVID-19 period.
CONCLUSIONS: The perinatal transmission rate increased from 1.3% (2015-2019) to 3.2% during the pandemic, the highest reported rate in over 5 years.Pregnant women who acquired HIV through IDU may have been at highest risk of vertical transmission because of sub-optimal treatment.These data signal disturbing problems in accessing care for addictions, prenatal care and HIV-specific care in the first waves of the pandemic.Additional attention to at-risk populations is needed as the pandemic continues to affect Canada.