Date of Award

Spring 2025

Language

English

Embargo Period

4-10-2026

Document Type

Dissertation

Degree Name

Doctor of Public Health (DrPH)

College/School/Department

Department of Epidemiology and Biostatistics

Program

Public Health

First Advisor

Dr. Rachel Hart-Malloy

Committee Members

Dr. Elizabeth Vásquez, Dr. Carol-Ann Swain, Dr. Christine Bozlak, Dr. Rachel Hart-Malloy

Keywords

HIV, MCH, Disparities, Pregnancy, HIV treatment, ART

Abstract

ABSTRACT

Objective: The Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission advises patient counseling to facilitate informed decision-making when evaluating changes in antiretroviral therapy (ART) during pregnancy and for patients to stay on suppressive regimens regardless of drug class. The purpose of this study was to investigate racial and ethnic disparities in the prescription of ‘preferred’ HIV drug regimens for pregnant people living with diagnosed HIV in New York State (NYS). This research also assessed whether prescribing practices for pregnant people on ART were consistent with Department of Health and Human Services (DHHS) guidelines.

Methods: A retrospective cohort study using NYS HIV Surveillance data from 2010 through 2019 was conducted to evaluate racial and ethnic disparities in prescribing practices of ART among pregnant people diagnosed with HIV. Data sources included 1) Maternal-Pediatric HIV Prevention and Care (MPPC) data, which contains abstracted prenatal, delivery, and newborn medical records, 2) Enhanced HIV/AIDS Reporting System (eHARS), and 3) New York Electronic HIV Management System (NYEHMS). A descriptive analysis was conducted to assess the distribution, variability, and missingness in the data among pregnant people diagnosed with HIV who were prescribed ART. A bivariate analysis utilizing chi-square tests was performed to examine the association between the prescription of ‘preferred’ ART and independent variables of interest, including race and ethnicity. A backward stepwise Poisson regression method with generalized estimating equations (GEE) was applied to model the relationship between race and ethnicity and the prescription of ‘preferred’ ART drugs.

Results: Between January 2010 and December 2019, there were 4,183 live birth pregnancy events among people living with HIV. The final study population included 3,243 live birth pregnancy events from 2,520 pregnant people living with HIV. Over half of the pregnancy events (64.9%) included pregnant people prescribed ‘preferred’ ART regimens, while 35.1% included pregnant people prescribed ‘other’ ART regimens. In the bivariate analysis, Non-Hispanic Black [Risk Ratio (RR) 0.90; 95% Confidence Interval (CI) 0.81-1.00], and Hispanic (RR 0.94; 95% CI 0.84-1.04) individuals were less likely than their Non-Hispanic White counterparts to be prescribed ‘preferred’ ART, but the difference was not statistically significant. In the multivariable analysis, receiving a ‘preferred’ ART regimen was associated with the year of delivery (adjusted Risk Ratio (adjRR) 0.97; 95% CI 0.96-0.98), prenatal care received in New York City (NYC) (adjRR 0.88; 95% CI 0.84-0.93), pregnancy events among pregnant individuals aged 40 years and older (adjRR 1.11; 95% CI 1.02-1.21), those on private insurance (adjRR 1.11; CI 1.01-1.24) or other forms of insurance (adjRR 1.22; 95% CI 1.08-1.37), those unsuppressed at their first viral load laboratory visit after conception (adjRR 1.22; 95% CI 1.16-1.29), and those diagnosed with HCB or HCV during pregnancy (adjRR 1.14; 95% CI 1.02-1.27). All these associations were statistically significant at an alpha level < 0.05.

Conclusion: Approximately two-thirds (65%) of the study population were prescribed ‘preferred’ ART, indicating a high compliance with DHHS guidelines. In addition, no significant associations were identified between race and/or ethnicity and the prescription of a ‘preferred’ ART regimen. The APR is a primary source of information on current antiretroviral therapies for maternal use employed by the Panel on Antiretroviral Guidelines for Adults and Adolescents that monitors prenatal exposures to all marketed antiretroviral drugs for potential birth defect risks (Gliklich et al., 2014). Greater opportunities to advance treatment of pregnant people living with HIV can be achieved with improved prenatal conception care and greater awareness and use of the Antiretroviral Pregnancy Registry.

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This work is licensed under the University at Albany Standard Author Agreement.

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Available for download on Friday, April 10, 2026

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