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Wulandari LPL, Lubis DS, Kurniati DPY, Sumintang K, Ardrini DAM, Mariani P, Januraga PP, Camellia A, Laksmi NMDP, Mahmudah L, Ong JJ, Causer L, Liverani M, Guy R, Wiseman V. Challenges to integrating programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B into antenatal care: Experiences from Indonesia. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002977. [PMID: 38446812 PMCID: PMC10917262 DOI: 10.1371/journal.pgph.0002977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/25/2024] [Indexed: 03/08/2024]
Abstract
The WHO's Asia-Pacific framework for triple elimination recommends that countries evaluate their programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B (EMTCT), including identifying gaps to improve program planning and the implementation of elimination strategies in antenatal care (ANC) services. In 2022, the Indonesian Ministry of Health reported that only 39% of pregnant women were tested for HIV, 14% for syphilis, and 28% for hepatitis B, respectively. We conducted a qualitative study involving a focus group discussion (FGD) and in-depth interviews with 25 key stakeholders in Bali and West Nusa Tenggara Provinces to identify specific challenges to testing for HIV, syphilis, and hepatitis B in ANC settings. Thematic analysis was used to identify the themes generated from the data. Health system bottlenecks experienced by stakeholders included supply chain management issues involving stock forecasting and stock monitoring, stock-outs of rapid test reagents which were particularly most frequent and for longer durations for syphilis and hepatitis B, high staff turnover, lack of staff training on how to perform the test, the complexity and time needed to record the data on women's characteristics, risk behaviours, and testing in both paper format and into the computer-based surveillance systems, discrepancies in program coverage data from different divisions of the district health office involved in the reporting system, high levels of stigma that prevented women from being followed up, challenges in notifying partners, and inadequate reporting and referral of women from private providers to public ones for testing. Interventions addressing the above challenges are worthy of consideration to improve the health system function and integrate EMTCT into the ANC settings.
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Affiliation(s)
- Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Dinar Saurmauli Lubis
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Desak Putu Yuli Kurniati
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Karjono Sumintang
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Dewa Ayu Mirah Ardrini
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | | | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Indonesia
| | | | | | | | - Jason J. Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Louise Causer
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Bell L, van Gemert C, Allard N, Brink A, Chan PL, Cowie B, Hellard M, Homer CS, Howell J, O'Connor M, Hocking J. Progress towards triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis in Pacific Island Countries and Territories: a systematic review. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 35:100740. [PMID: 37424691 PMCID: PMC10326693 DOI: 10.1016/j.lanwpc.2023.100740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/05/2023] [Accepted: 02/26/2023] [Indexed: 04/08/2023]
Abstract
The diverse geographic, demographic, and societal factors in the Pacific Island Countries and Territories (PICTs) have contributed to unique epidemiological patterns of HIV, syphilis, and hepatitis B. Transmission can be during pregnancy, at the time of birth or via breastfeeding for HIV, and can have long-term adverse outcomes. Given the similarities in prevention of mother-to-child transmission of these infections, coordinated interventions for triple elimination are used. This systematic review has evaluated the peer-reviewed literature, grey literature, and global databases to assess the availability of data to report against elimination targets in the WHO Regional Framework for the Triple Elimination of Mother-to-Child Transmission of HIV, Hepatitis B and Syphilis in Asia and the Pacific 2018-2030. The secondary objective is to report on progress towards these targets. The findings show that none of the PICTs are on track to achieve triple elimination by 2030. Amongst the limited publicly available indicator data, there is suboptimal coverage for most indicators. It is important that there is an increase in availability of and access to antenatal care, testing, and treatment for pregnant women. Increased efforts are needed to collect data on key indicators and integrate reporting into existing systems to avoid extra burden. Funding Leila Bell was supported by an Australian Government Research Training Program (RTP) Scholarship, Australia. Funding sources had no role in paper design, data collection, data analysis, interpretation, or writing of the paper.
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Affiliation(s)
- Leila Bell
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Caroline van Gemert
- Burnet Institute, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Vanuatu Health Program, Port Vila, Vanuatu
| | - Nicole Allard
- Department of Infectious Diseases, University of Melbourne, Melbourne, Australia
- WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Australia
| | - Anne Brink
- HIV, Hepatitis and STI Unit, WHO Regional Office for the Western Pacific, Manila, Philippines
| | | | - Benjamin Cowie
- Department of Infectious Diseases, University of Melbourne, Melbourne, Australia
- WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
- Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Jess Howell
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Michelle O'Connor
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Grant-Beurmann S, Jumare J, Ndembi N, Matthew O, Shutt A, Omoigberale A, Martin OA, Fraser CM, Charurat M. Dynamics of the infant gut microbiota in the first 18 months of life: the impact of maternal HIV infection and breastfeeding. MICROBIOME 2022; 10:61. [PMID: 35414043 PMCID: PMC9004197 DOI: 10.1186/s40168-022-01230-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Access to antiretroviral therapy (ART) during pregnancy and breastfeeding for mothers with HIV has resulted in fewer children acquiring HIV peri- and postnatally, resulting in an increase in the number of children who are exposed to the virus but are not infected (HEU). HEU infants have an increased likelihood of childhood infections and adverse growth outcomes, as well as increased mortality compared to their HIV-unexposed (HUU) peers. We explored potential differences in the gut microbiota in a cohort of 272 Nigerian infants born to HIV-positive and negative mothers in this study during the first 18 months of life. RESULTS The taxonomic composition of the maternal vaginal and gut microbiota showed no significant differences based on HIV status, and the composition of the infant gut microbiota at birth was similar between HUU and HEU. Longitudinal taxonomic composition of the infant gut microbiota and weight-for-age z-scores (WAZ) differed depending on access to breast milk. HEU infants displayed overall lower WAZ than HUU infants at all time points. We observed a significantly lower relative abundance of Bifidobacterium in HEU infants at 6 months postpartum. Breast milk composition also differed by time point and HIV infection status. The antiretroviral therapy drugs, lamivudine and nevirapine, as well as kynurenine, were significantly more abundant in the breast milk of mothers with HIV. Levels of tiglyl carnitine (C5) were significantly lower in the breast milk of mothers without HIV. ART drugs in the breast milk of mothers with HIV were associated with a lower relative abundance of Bifidobacterium longum. CONCLUSIONS Maternal HIV infection was associated with adverse growth outcomes of HEU infants in this study, and these differences persist from birth through at least 18 months, which is a critical window for the development of the immune and central nervous systems. We observed that the relative abundance of Bifidobacterium spp. was significantly lower in the gut microbiota of all HEU infants over the first 6 months postpartum, even if HEU infants were receiving breast milk. Breastfeeding was of benefit in our HEU infant cohort in the first weeks postpartum; however, ART drug metabolites in breast milk were associated with a lower abundance of Bifidobacterium. Video abstract.
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Affiliation(s)
- Silvia Grant-Beurmann
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jibreel Jumare
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Ashley Shutt
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Olivia A Martin
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Claire M Fraser
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Incidence of Mortality among Under-Five-Year-Old Children Born to Women Living with HIV and Those Born to Women Not Living with HIV in Botswana: A 5-Year Retrospective Study. AIDS Res Treat 2022; 2022:9659871. [PMID: 35127177 PMCID: PMC8816585 DOI: 10.1155/2022/9659871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/12/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background Child mortality is a core indicator for child health and wellness. Botswana reported an under-five-year-old children (UFC) mortality rate of 48 deaths per 1000 live births in 2017 against 152 deaths per 1000 live births in 1971. This was a commendable accomplishment. However, given the current country situation whereby 23% of children are born to women living with HIV, the incidence of mortality among UFC born to women living with and not living with HIV and their survival are better health metrics to inform decision making. Nevertheless, such data are still very scarce in Botswana. The study's objective was to estimate the incidence of UFC mortality among children born to women living with and not living with HIV and to compare UFC survival between the two groups. Methods A retrospective cohort study of mortality among UFC was conducted in Botswana, including all UFC born between January 2014 and June 2018. Data were extracted from the National Under-Five Mortality Audit Committee (NUFMAC) database using a standardized data collection tool. The incidence rate of UFC death was estimated as a function of the duration from birth to death. Survival functions of UFC born to women living with and not living with HIV were plotted and compared using Kaplan–Meier survival analysis. Results The overall incidence of UFC death was 4.63/1000 child months (CM) (95% CI 4.36–4.90). The incidence of UFC death among children born to women living with HIV was 6.96/1000 CM (95% CI 6.47–7.45) and that of UFC born to women not living with HIV was 4.34/1000 CM (95% CI 4.03–4.65). The overall average and standard error (SE) time to event/death for UFC born to women living with and not living with HIV was 54.80 (0.18) months. The mean (SE) time to death for UFC born to women living with HIV was 52.79 (0.41) months and that of UFC born to women not living with HIV was 55.44 (0.19) months (log-rank X2 = 37.59, p < 0.001). Prematurity or low birth weight was the leading cause of UFC death in both groups; but, it was higher in UFC born to women not living with HIV subgroup than their counterparts. Four cases only or 0.5% of the 806 death cases reported by reporting physicians were attributable to HIV-related complications. Conclusion Despite the commendable efforts made in reducing UFC death, the incidence of UFC death among UFC born to women living with HIV in Botswana is still higher, and their survival is shorter compared to UFC born to women not living with HIV. Child survival interventions should prioritize UFC born to women living with HIV to improve their survival.
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Mukosha M, Kaonga P, Kapembwa KM, Musonda P, Vwalika B, Lubeya MK, Jacobs C. Modelling mortality within 28 days among preterm infants at a tertiary hospital in Lusaka, Zambia: a retrospective review of hospital-based records. Pan Afr Med J 2021; 39:69. [PMID: 34422192 PMCID: PMC8363965 DOI: 10.11604/pamj.2021.39.69.27138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/05/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction globally, almost half of all deaths in children under five years of age occur among neonates. We investigated the predictors of mortality within 28 days among preterm infants at a tertiary hospital in Lusaka, Zambia. Methods we reviewed admission records linked to birth, mortality, and hospital discharge from 1st January 2018 to 30th September 2019. Information was retrieved with a follow-up period of 28 days post-delivery to discharge/mortality. We used the Weibull hazards regression to establish the best predictor model for mortality among the neonates. Results a total of 3237 case records of women with a median age of 27 years (IQR, 22-33) were included in the study, of which 971 (30%) delivered term infants and 2267 (70%) preterm infants. The overall median survival time of the infants was 98 hours (IQR, 34-360). Preterm birth was not associated with increased hazards of mortality compared to term birth (p=0.078). Being in the Kangaroo Mother Care compared to Neonatal Intensive Care Unit (NICU), and a unit increase in birth weight were independently associated with reduced hazards of mortality. On the other hand, having hypoxic-ischemic encephalopathy, experiencing difficulty in feeding and vaginal delivery compared to caesarean section independently increased the hazards of mortality. Conclusion having hypoxic-ischemic encephalopathy, vaginal delivery, and experiencing difficulty in feeding increases the risk of mortality among neonates. Interventions to reduce neonatal mortality should be directed on these factors in this setting.
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Affiliation(s)
- Moses Mukosha
- Department of Pharmacy, University of Zambia, Lusaka, Zambia.,School of Public Health, University of Zambia, Lusaka, Zambia
| | - Patrick Kaonga
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Patrick Musonda
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Mwansa Ketty Lubeya
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia.,Young Emerging Scientists Zambia, Lusaka, Zambia
| | - Choolwe Jacobs
- School of Public Health, University of Zambia, Lusaka, Zambia
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Groene EA, Valeris-Chacin RJ, Stadelman AM, Safo SE, Cusick SE. Maternal HIV and child anthropometric outcomes over time: an analysis of Zimbabwe demographic health surveys. AIDS 2021; 35:477-484. [PMID: 33252491 PMCID: PMC7855570 DOI: 10.1097/qad.0000000000002772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To understand the association between children's anthropometric measures and maternal HIV status in Zimbabwe and to determine whether these relationships changed over time. DESIGN Data from Demographic Health Surveys in Zimbabwe rounds 2005, 2010, and 2015 were used to conduct cross-sectional analyses of child anthropometric measures (stunting, underweight, and wasting). METHODS Using separate logistic regression models for each of the anthropometric measures, we estimated the adjusted prevalence odds ratio (OR) of stunting, underweight, and wasting in children according to maternal HIV status. Moreover, we evaluated an interaction by survey year to evaluate change over time. RESULTS Children of mothers with HIV had 32% greater odds [OR = 1.32, 95% confidence interval (CI) 1.16-1.5] of stunting, 27% greater odds (OR = 1.27, 95% CI 1.1-1.48) of underweight status and 7% greater odds (OR = 1.07, 95% CI 0.81-1.42) of wasting status, than children of mothers without HIV. These associations between maternal HIV status and child undernutrition did not differ by year (P > 0.05 for all interaction terms). CONCLUSION In Zimbabwe, having a mother who tested positive for HIV at the time of the survey has been associated with greater child undernutrition over the last two decades with no significant change by survey round. This emphasizes the need for continued programming to address nutritional deficiencies, sanitation, and infectious disease prevention in this high-risk population. The greatest impact of maternal HIV status has been on child stunting and underweight, associated with poor long-term child development.
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Affiliation(s)
- Emily A Groene
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | | | - Anna M Stadelman
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Sandra E Safo
- Division of Biostatistics, University of Minnesota School of Public Health
| | - Sarah E Cusick
- University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
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Duri K, Gumbo FZ, Munjoma PT, Chandiwana P, Mhandire K, Ziruma A, Macpherson A, Rusakaniko S, Gomo E, Misselwitz B, Mazengera LR. The University of Zimbabwe College of Health Sciences (UZ-CHS) BIRTH COHORT study: rationale, design and methods. BMC Infect Dis 2020; 20:725. [PMID: 33008316 PMCID: PMC7532096 DOI: 10.1186/s12879-020-05432-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/21/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Commencing lifelong antiretroviral therapy (ART) immediately following HIV diagnosis (Option B+), has greatly improved maternal-infant health. Thus, large and increasing numbers of HIV-infected women are on ART during pregnancy, a situation concurrently increasing numbers of HIV-exposed-uninfected (HEU) infants. Compared to their HIV-unexposed-uninfected (HUU) counterparts, HEU infants show higher rates of adverse birth outcomes, mortality, infectious/non-communicable diseases including impaired growth and neurocognitive development. There is an urgent need to understand the impact of HIV and early life ART exposures, immune-metabolic dysregulation, comorbidities and environmental confounders on adverse paediatric outcomes. METHODS Six hundred (600) HIV-infected and 600 HIV-uninfected pregnant women ≥20 weeks of gestation will be enrolled from four primary health centres in high density residential areas of Harare. Participants will be followed up as mother-infant-pairs at delivery, week(s) 1, 6, 10, 14, 24, 36, 48, 72 and 96 after birth. Clinical, socio-economic, nutritional and environmental data will be assessed for adverse birth outcomes, impaired growth, immune/neurodevelopment, vertical transmission of HIV, hepatitis-B/C viruses, cytomegalovirus and syphilis. Maternal urine, stool, plasma, cord blood, amniotic fluid, placenta and milk including infant plasma, dried blood spot and stool will be collected at enrolment and follow-up visits. The composite primary endpoint is stillbirth and infant mortality within the first two years of life in HEU versus HUU infants. Maternal mortality in HIV-infected versus -uninfected women is another primary outcome. Secondary endpoints include a range of maternal and infant outcomes. Sub-studies will address maternal stress and malnutrition, maternal-infant latent tuberculosis, Helicobacter pylori infections, immune-metabolomic dysregulation including gut, breast milk and amniotic fluid dysbiosis. DISCUSSION The University of Zimbabwe-College of Health-Sciences-Birth-Cohort study will provide a comprehensive assessment of risk factors and biomarkers for HEU infants' adverse outcomes. This will ultimately help developing strategies to mitigate effects of maternal HIV, early-life ART exposures and comorbidities on infants' mortality and morbidity. TRIAL REGISTRATION ClinicalTrial.gov Identifier: NCT04087239 . Registered 12 September 2019.
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Affiliation(s)
- Kerina Duri
- Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe.
| | - Felicity Z Gumbo
- Department of Paediatrics and Child Health, UZ-CHS, Harare, Zimbabwe
| | - Privilege T Munjoma
- Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe
| | | | | | - Asaph Ziruma
- Department of Obstetrics and Gynaecology, UZ-CHS, Harare, Zimbabwe
| | - Andrew Macpherson
- Clinic for Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | | | - Exnevia Gomo
- UZ-CHS Research Support Centre, UZ-CHS, Harare, Zimbabwe
- Department of Medical Laboratory Sciences, UZ-CHS, Harare, Zimbabwe
| | - Benjamin Misselwitz
- Clinic for Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Lovemore Ronald Mazengera
- Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe
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Wubneh CA, Endalamaw A, Tebeje NB. Predictors of mortality among HIV exposed infants at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Ital J Pediatr 2019; 45:137. [PMID: 31699137 PMCID: PMC6839236 DOI: 10.1186/s13052-019-0740-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/23/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the era of highly active antiretroviral therapy, vertical HIV transmission has been decreased. This may increase fertility desire of HIV infected women and an increasing number of HIV exposed infants as a result. A high probability of mortality among HIV exposed infants was reported across different countries. However, few studies are found on mortality of HIV exposed infants, in particular, no study was conducted before in the current study area. METHODS Institution based retrospective cohort study from July 2013 to December 2017 was conducted. A total of 408 HIV exposed children were selected through simple random sampling technique. Data were extracted from registration book by using data extraction tool, which is adapted from the Ethiopian Federal Ministry of Health HIV exposed infant follow-up form. Kaplan-Meier survival curve was used to show the probability of mortality rate. Bivariable and multivariable cox regression models were used to identify predictors of mortality. RESULTS Overall mortality rate was found to be 8.88 (95% CI: 6.36-12.36) per 100 child-year. Infant with death of at least one parent (AHR = 3.32; 95% CI: 1.503-7.32), non-exclusive breastfeeding (AHR = 0.10; 95% CI: 0.037-0.302), growth failure (AHR = 2.9; 95% CI: 1.09-8.09), presence of sign and symptom of HIV infection (AHR = 2.99; 95% CI: 1.33-6.74), and low birth weight (AHR = 2.6; 95% CI: 1.007-6.78) were found to be predictors of infant mortality. CONCLUSIONS Mortality of HIV exposed infants was high in Ethiopia. Prevention of the occurrence of HIV infection symptom, growth failure, and low birth weight is essential and further treat early whenever they occurred. Still, behavioral change interventions on mother who practice non-exclusive breastfeeding are indicated. Especial care for orphan infants is required due to their nature of vulnerability to varieties of health problem.
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Affiliation(s)
- Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Aklilu Endalamaw
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Nigusie Birhan Tebeje
- Unit of Community Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, P.O.BOX=196, Gondar, Ethiopia
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Cotransmission of Malaria and HIV to Infants of Mothers Coinfected With Malaria and HIV in the HAART Era in Benin City, Nigeria. J Acquir Immune Defic Syndr 2019; 79:255-260. [PMID: 30211777 DOI: 10.1097/qai.0000000000001786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Malaria and HIV are vertically transmitted to infants. In an era where specific interventions are available to reduce the burden of malaria in pregnancy and vertical transmission of HIV, we examined the transmission and cotransmission of HIV and malaria to infants of mothers coinfected with malaria and HIV. METHODS A cross-sectional analytic study performed on 101 HIV/malaria-coinfected mothers and their infants for whom DNA polymerase chain reaction results were available. Blood film for malaria parasites was performed on cord blood and peripheral blood on days 1, 3, and 7 in the newborns. Maternal peripheral blood film for malaria parasite was performed at delivery, and placental tissue was obtained for confirmation of placental malaria by histology. All infants received DNA polymerase chain reaction testing for HIV at 6-8 weeks of life. RESULTS Cotransmission of malaria and HIV occurred in 2 (1.98%) infants. Vertical transmission of HIV occurred in 7 (7%) babies, whereas congenital malaria was present in 32 (31.7%) babies. The transmission of HIV and presence of congenital malaria were not significantly associated with each other P = 1.000. Of the 88 babies of mothers who commenced highly active antiretroviral treatment (HAART) before pregnancy, 5 (5.7^) had HIV, which was significantly less than 2 (40%) of 5 babies of mothers who commenced HAART during pregnancy P = 0.04. CONCLUSIONS Among mothers coinfected with malaria and HIV, vertical transmission of malaria and HIV was not associated with each other. HAART reduces vertical transmission of HIV especially if started before pregnancy.
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Deichsel EL, Pavlinac PB, Richardson BA, Mbori-Ngacha D, Walson JL, McGrath CJ, Farquhar C, Bosire R, Maleche-Obimbo E, John-Stewart GC. Birth size and early pneumonia predict linear growth among HIV-exposed uninfected infants. MATERNAL AND CHILD NUTRITION 2019; 15:e12861. [PMID: 31222958 DOI: 10.1111/mcn.12861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 12/27/2022]
Abstract
Stunting remains a global health priority, particularly in sub-Saharan Africa. Identifying determinants of linear growth in HIV-exposed uninfected (HEU) infants can inform interventions to prevent stunting in this vulnerable population. HIV-infected mothers and their uninfected infants were followed monthly from pregnancy to 12-month post-partum in Nairobi, Kenya. Mixed-effects models estimated the change in length-for-age z-score (LAZ) from birth to 12 months by environmental, maternal, and infant characteristics. Multivariable models included factors univariately associated with LAZ. Among 372 HEU infants, mean LAZ decreased from -0.54 (95% confidence interval [CI] [-0.67, -0.41]) to -1.09 (95% CI [-1.23, -0.96]) between 0 and 12 months. Declines in LAZ were associated with crowding (≥2 persons per room; adjusted difference [AD] in 0-12 month change: -0.46; 95% CI [-0.87, -0.05]), use of a pit latrine versus a flush toilet (AD: -0.29; 95% CI [-0.57, -0.02]), and early infant pneumonia (AD: -1.14; 95% CI [-1.99, -0.29]). Infants with low birthweight (<2,500 g; AD: 1.08; 95% CI [0.40, 1.76]) and birth stunting (AD: 1.11; 95% CI [0.45, 1.78]) experienced improved linear growth. By 12 months of age, 46 infants were stunted, of whom 11 (24%) were stunted at birth. Of the 34 infants stunted at birth with an available 12-month LAZ, 68% were not stunted at 12 months. Some low birthweight and birth-stunted HEU infants had significant linear growth recovery. Early infant pneumonia and household environment predicted poor linear growth and may identify a subgroup of HEU infants for whom to provide growth-promoting interventions.
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Affiliation(s)
- Emily L Deichsel
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | - Patricia B Pavlinac
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | - Barbra A Richardson
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | | | - Judd L Walson
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington.,Child Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Christine J McGrath
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | - Carey Farquhar
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Grace C John-Stewart
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
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11
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The Burden of Acute Diarrheal Disease in Young Hospitalized Urban South African Children Five Years After Rotavirus Vaccine Introduction: A Retrospective Descriptive Study. Pediatr Infect Dis J 2019; 38:752-756. [PMID: 30985514 DOI: 10.1097/inf.0000000000002304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diarrheal disease is a leading cause of childhood morbidity and mortality worldwide. Multiple interventions, including rotavirus vaccination to infants since 2009, have reduced the incidence of diarrheal disease in South African children. Our study aimed to determine the burden of diarrheal disease 5 years after rotavirus vaccine introduction at a tertiary-level hospital. METHODS A retrospective review of a discharge summary database of children less than 5 years of age hospitalized with acute diarrheal illness from 2015 to 2016 at the Chris Hani Baragwanath Academic Hospital. RESULTS Diarrheal disease accounted for 14.8% of hospital admissions. The incidence (per 100,000 population) was 675.8 (95% CI: 638.8-714.3) in 2015 and 612.2 (95% CI: 577.0-648.9) in 2016. The case fatality ratio was 2.9% over the study period. The median age at diagnosis was 12 months (interquartile range: 6.2-21.4) and 50.4% of cases occurred during infancy. One third of cases were underweight and/or stunted. In a multivariable analysis using logistic regression, the adjusted odds ratio (aOR) for death was higher in children with an associated acute lower respiratory tract infection (aOR: 3.7, 95% CI: 1.2-11.5; P = 0.021), HIV infection (aOR: 9.1, 95% CI: 2.6-31.6; P = 0.001), and an age of less than 6 months (aOR: 6.9, 95% CI: 2.1-22.9; P = 0.002). CONCLUSIONS Sustained reductions in diarrheal disease incidence were observed 5 years post rotavirus vaccine implementation. In children hospitalized with an acute diarrheal illness, an increased risk of mortality occurs in young infants, children that are HIV infected, and those with an associated acute lower respiratory tract infection.
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12
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Abraha A, Myléus A, Byass P, Kahsay A, Kinsman J. The effects of maternal and child HIV infection on health equity in Tigray Region, Ethiopia, and the implications for the health system: a case-control study. AIDS Care 2019; 31:1271-1281. [PMID: 30957540 DOI: 10.1080/09540121.2019.1601670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Services that aim to prevent mother-to-child HIV transmission (PMTCT) can simultaneously reduce the overall impact of HIV infection in a population while also improving maternal and child health outcomes. By taking a health equity perspective, this retrospective case control study aimed to compare the health status of under-5 children born to HIV-positive and HIV-negative mothers in Tigray Region, Ethiopia. Two hundred and thirteen HIV-positive women (cases), and 214 HIV-negative women (controls) participated through interviews regarding their oldest children. Of the children born to HIV-positive mothers, 24% had not been tested, and 17% of those who had been tested were HIV-positive themselves. Only 29% of the HIV-positive children were linked to an ART programme. Unexpectedly, exposed HIV-negative children had fewer reports of perceived poor health as compared to unexposed children. Over 90% of all the children, regardless of maternal HIV status, were breastfed and up-to-date with the recommended immunizations. The high rate of HIV infection among the babies of HIV-positive women along with their low rates of antiretroviral treatment raises serious concerns about the quality of outreach to pregnant women in Tigray Region, and of the follow-up for children who have been exposed to HIV via their mothers.
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Affiliation(s)
- Atakelti Abraha
- a Tigray Health Bureau , Tigray , Ethiopia.,b Ethiopian Health Insurance Agency , Addis Ababa , Ethiopia
| | - Anna Myléus
- c Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Peter Byass
- c Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden.,d Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen , Aberdeen , UK.,e MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa
| | | | - John Kinsman
- c Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden.,g Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet , Stockholm , Sweden
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13
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Yeganeh N, Watts DH, Xu J, Kerin T, Joao EC, Pilotto JH, Theron G, Gray G, Santos B, Fonseca R, Kreitchmann R, Pinto J, Mussi-Pinhata MM, Veloso V, Camarca M, Mofenson L, Moye J, Nielsen-Saines K. Infectious Morbidity, Mortality and Nutrition in HIV-exposed, Uninfected, Formula-fed Infants: Results From the HPTN 040/PACTG 1043 Trial. Pediatr Infect Dis J 2018; 37:1271-1278. [PMID: 29750766 PMCID: PMC6226320 DOI: 10.1097/inf.0000000000002082] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV-exposed uninfected (HEU) infants are a growing population with potentially poor health outcomes. We evaluated morbidity and mortality in HEU formula-fed infants enrolled in the NICHD HPTN 040/PACTG 1043 trial. METHODS Infectious morbidity, mortality and undernutrition were evaluated within a cohort of 1000 HEU infants enrolled between April 2004 and April 2010 in Brazil (n = 766) and South Africa (n = 234) as part of the NICHD/HPTN 040 trial of 3 different antiretroviral regimens to decrease intrapartum HIV vertical transmission. RESULTS Twenty-three percent of infants had at least 1 infectious serious adverse effect. Infants born to mothers with <12 years of education [adjusted odds ratio (AOR), 2.6; 95% confidence interval [CI], 1.2-5.9), with maternal viral load of >1,000,000 copies/mL at delivery (AOR, 9.9; 95% CI, 1.6-63.1) were more likely to have infectious serious adverse effects. At 6 months, the infant mortality rate per 1000 live births overall was 22 ± 2.6, 9.1 ± 1.8 in Brazil and 64.1 ± 3 in South Africa. Undernutrition and stunting peaked at 1 month of age with 18% having a weight-for-age Z score ≤-2, and 22% with height for Z score ≤-2. The likelihood of infant mortality was greater among infants born in South Africa compared with Brazil (AOR, 6.2; 95% CI, 2.5-15.8), high maternal viral load (AOR, 1.7; 95% CI, 1.01-2.9) and birth weight-for-age Z score ≤-2 (AOR, 5.2; 95% CI, 1.8-14.8). CONCLUSIONS There were high rates of undernutrition, stunting and infectious serious adverse effect in this study's formula-fed HEU population. Suppressing maternal HIV viral load during the peripartum period may be a modifiable risk factor to decrease infant mortality.
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Affiliation(s)
- Nava Yeganeh
- David Geffen UCLA School of Medicine, Los Angeles, CA
| | - D. Heather Watts
- Office of the Global AIDS Coordinator and Health Diplomacy, U.S. Dept. of State, Washington D.C
| | | | - Tara Kerin
- David Geffen UCLA School of Medicine, Los Angeles, CA
| | - Esau C. Joao
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Jose Henrique Pilotto
- Hospital Geral de Nova Iguaçu, Nova Iguaçu and Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, (Fiocruz), Rio de Janeiro, Brazil, Perinatal HIV Research Unit
| | - Gerhard Theron
- Stellenbosch University/Tygerberg Hospital, Cape Town, South Africa
| | - Glenda Gray
- University of Witwatersrand/Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | | | | | | | - Jorge Pinto
- Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Valdilea Veloso
- Laboratório de Pesquisa Clínica em DST e AIDS - Instituto de Pesquisa Clínica Evandro Chagas - Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | | | - Lynne Mofenson
- Elisabeth Glaser Pediatric AIDS Foundation, Washington DC
| | - Jack Moye
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Ajibola G, Leidner J, Mayondi GK, van Widenfelt E, Madidimalo T, Petlo C, Moyo S, Mmalane M, Williams PL, Cassidy AR, Shapiro R, Kammerer B, Lockman S. HIV Exposure and Formula Feeding Predict Under-2 Mortality in HIV-Uninfected Children, Botswana. J Pediatr 2018; 203:68-75.e2. [PMID: 30318370 PMCID: PMC6252117 DOI: 10.1016/j.jpeds.2018.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/14/2018] [Accepted: 08/08/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To prospectively assess rates and detailed predictors of morbidity and mortality among HIV-exposed uninfected children and HIV-unexposed children in Botswana in a more recent era. STUDY DESIGN We enrolled HIV-infected and HIV-uninfected mothers and their children in the prospective observational Tshipidi study at 2 sites (1 city and 1 village) in Botswana from May 2010-July 2012. Live-born children and their mothers were followed for 24 months postpartum. Detailed sociodemographic data, health, and psychosocial characteristics were collected at baseline and prospectively, and health outcomes ascertained. Mothers chose infant feeding method with counselling. RESULTS A total of 893 live-born HIV-uninfected children (436 HIV-exposed uninfected, 457 HIV-unexposed) were followed. HIV-infected mothers had a median CD4 count of 410 cells/mm3, 32% took 3-drug antiretroviral treatment during pregnancy, 67% took only zidovudine, and 1% took <2 weeks of any antiretrovirals antepartum. Twenty four-month vital status was available for 888 (99.4%) children. HIV-exposed uninfected children had a significantly higher risk of death compared with children of HIV-uninfected mothers (5.0% vs 1.8%) (adjusted hazard ratio 3.27, 95% CI 1.44-7.40). High collinearity between maternal HIV status and child feeding method precluded analysis of these factors as independent predictors of mortality. Preterm birth, low birth weight, and congenital anomaly were also associated with mortality (in separate analyses), but maternal socioeconomic factors, depression, substance use, and social support were not significant predictors. CONCLUSIONS The strongest predictors of 24-month mortality among children in Botswana were HIV exposure and formula feeding, although the relative contribution of these factors to child health could not be separated.
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Affiliation(s)
- Gbolahan Ajibola
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
| | | | | | | | | | - Chipo Petlo
- HIV Prevention Unit, Ministry of Health, Botswana
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Paige L Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Adam R Cassidy
- Harvard Medical School, Boston, MA; Department of Psychiatry, Boston Children's Hospital, Boston, MA
| | - Roger Shapiro
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Betsy Kammerer
- Harvard Medical School, Boston, MA; Department of Psychiatry, Boston Children's Hospital, Boston, MA
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA; Harvard Medical School, Boston, MA; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
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15
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Smith BL, Zizzo S, Amzel A, Wiant S, Pezzulo MC, Konopka S, Golin R, Vrazo AC. Integration of Neonatal and Child Health Interventions with Pediatric HIV Interventions in Global Health. Int J MCH AIDS 2018; 7:192-206. [PMID: 30631638 PMCID: PMC6322631 DOI: 10.21106/ijma.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND/OBJECTIVES In the last decade, many strategies have called for integration of HIV and child survival platforms to reduce missed opportunities and improve child health outcomes. Countries with generalized HIV epidemics have been encouraged to optimize each clinical encounter to bend the HIV epidemic curve. This systematic review looks at integrated child health services and summarizes evidence on their health outcomes, service uptake, acceptability, and identified enablers and barriers. METHODS Databases were systematically searched for peer-reviewed studies. Interventions of interest were HIV services integrated with: neonatal/child services for children <5 years, hospital care of children <5 years, immunizations, and nutrition services. Outcomes of interest were: health outcomes of children <5 years, integrated services uptake, acceptability, and enablers and barriers. PROSPERO ID: CRD42017082444. RESULTS Twenty-eight articles were reviewed: 25 (89%) evaluated the integration of HIV services into child health platforms, while three articles (11%) investigated the integration of child health services into HIV platforms. Studies measured health outcomes of children (n=9); service uptake (n=18); acceptability of integrated services (n=8), and enablers and barriers to service integration (n=14). Service integration had positive effects on child health outcomes, HIV testing, and postnatal service uptake. Integrated services were generally acceptable, although confidentiality and stigma were concerns. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Each clinical "touch point" with infants and children is an opportunity to provide comprehensive health services. In the current era of flat funding levels, integration of HIV and child health services is an effective, acceptable way to achieve positive child health outcomes.
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Affiliation(s)
- Brianna L Smith
- Office of Sustainable Development, Africa Bureau, United States Agency for International Development, 1300 Pennsylvania Ave NW, Washington, District of Columbia, 20004, USA
| | - Sara Zizzo
- Office of Sustainable Development, Africa Bureau, United States Agency for International Development, 1300 Pennsylvania Ave NW, Washington, District of Columbia, 20004, USA
| | - Anouk Amzel
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, 20004, USA
| | - Sarah Wiant
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, 20004, USA
| | - Molly C Pezzulo
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, 20004, USA
| | - Sarah Konopka
- Management Sciences for Health, Arlington, VA, 22203, USA
| | - Rachel Golin
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, 20004, USA
| | - Alexandra C Vrazo
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, 20004, USA
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16
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Drake AL, Unger JA, Ronen K, Matemo D, Perrier T, DeRenzi B, Richardson BA, Kinuthia J, John-Stewart G. Evaluation of mHealth strategies to optimize adherence and efficacy of Option B+ prevention of mother-to-child HIV transmission: Rationale, design and methods of a 3-armed randomized controlled trial. Contemp Clin Trials 2017; 57:44-50. [PMID: 28315480 DOI: 10.1016/j.cct.2017.03.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/01/2017] [Accepted: 03/13/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Lifelong antiretroviral therapy (ART) (Option B+) is recommended for all HIV-infected pregnant/postpartum women, but high adherence is required to maximize HIV prevention potential and maintain maternal health. Mobile health (mHealth) interventions may provide treatment adherence support for women during, and beyond, the pregnancy and postpartum periods. METHODS AND DESIGN We are conducting an unblinded, triple-arm randomized clinical trial (Mobile WACh X) of one-way short message service (SMS) vs. two-way SMS vs. control (no SMS) to improve maternal ART adherence and retention in care by 2years postpartum. We will enroll 825 women from Nairobi and Western Kenya. Women in the intervention arms receive weekly, semi-automated motivational and educational SMS and visit reminders via an interactive, human-computer hybrid communication system. Participants in the two-way SMS arm are also asked to respond to a question related to the message. SMS are based in behavioral theory, are tailored to participant characteristics through SMS tracks, and are timed along the pregnancy/postpartum continuum. After enrollment, follow-up visits are scheduled at 6weeks; 6, 12, 18, and 24months postpartum. The primary outcomes, virological failure (HIV viral load ≥1000copies/mL), maternal retention in care, and infant HIV infection or death, will be compared in an intent to treat analysis. We will also measure ART adherence and drug resistance. DISCUSSION Personalized and tailored SMS to support HIV-infected women during and after pregnancy may be an effective strategy to motivate women to adhere to ART and remain in care and improve maternal and infant outcomes.
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Affiliation(s)
- Alison L Drake
- Department of Global Health, University of Washington, Box 359909, Seattle, WA 98195-7236, USA.
| | - Jennifer A Unger
- Departments of Global Health and Obstetrics and Gynecology, University of Washington, Box 359909, Seattle, WA 98195-7236, USA.
| | - Keshet Ronen
- Departments of Global Health and Epidemiology, University of Washington, Box 359909, Seattle, WA 98195-7236, USA.
| | - Daniel Matemo
- Department of Research and Programs, Kenyatta National Hospital, PO Box 20723-00202, Nairobi, Kenya.
| | - Trevor Perrier
- Department of Computer Science and Engineering, University of Washington, Box 352350, Seattle, WA 98195-7236, USA.
| | - Brian DeRenzi
- Department of Computer Science, University of Cape Town, Room 306, Computer Science Building, Cape Town, South Africa.
| | - Barbra A Richardson
- Department of Biostatistics, University of Washington, Box 359909, Seattle, WA 98195-7236, USA.
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, PO Box 20723-00202, Nairobi, Kenya.
| | - Grace John-Stewart
- Departments of Global Health, Medicine, Epidemiology, and Pediatrics, University of Washington, Box 359909, Seattle, WA 98195-7236, USA.
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Tiam M, Velaphi S. Maternal human immunodeficiency virus status and morbidity and mortality in very low birthweight infants. Paediatr Int Child Health 2017; 37:14-20. [PMID: 26403835 DOI: 10.1179/2046905515y.0000000060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) remains a common cause of infection in pregnant women. The effect of HIV exposure on growth, morbidity and mortality in very low-birthweight infants (VLBWI) is under-reported. AIM To determine anthropometry at birth, morbidity during hospital stay and mortality at hospital discharge of VLBWI stratified according to HIV-exposure in a tertiary public government hospital in Johannesburg, South Africa. METHODS Retrospective descriptive study. Records of VLBWI were reviewed for maternal HIV status, infant characteristics, diagnosis and outcome to hospital discharge. Anthropometry, morbidity and mortality were compared according to HIV-exposure. RESULTS Of 302 VLBWI,103 (34.1%)were HIV-exposed. Among the 103mothers, 38 (36.9%)were on combined anti-retroviral therapy (cART), 41 (39.8%) were on zidovudine (AZT) and 24 (23%) were not on either. More HIV-exposed VLBWI weighed v1000 g (41.2 vs 23.1%, Pv0.01). There were no differences in incidence or number of episodes of sepsis between HIV-exposed and -unexposed. More HIV-exposed VLBWI had severe intraventricular haemorrhage (IVH) (57.1 vs 11.4%, Pv0.01). The overall mortality rate was 27%, with HIV-exposed VLBWI having a mortality rate of 38.6% compared with 21% of the HIV-unexposed (Pv0.01). On multivariate analysis, the predictor of mortality was birthweight (Pv0.01). CONCLUSION HIV-exposed VLBWI are more likely to have extremely low birthweights. Morbidity in VLBWI is not affected by HIV-exposure, except for severe IVH. Birthweight is a predictor of mortality in VLBWI, irrespective of maternal HIV status.
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Affiliation(s)
- Mayowa Tiam
- a Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Sithembiso Velaphi
- a Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
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18
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Ásbjörnsdóttir KH, Slyker JA, Maleche-Obimbo E, Wamalwa D, Otieno P, Gichuhi CM, John-Stewart G. Breastfeeding Is Associated with Decreased Risk of Hospitalization among HIV-Exposed, Uninfected Kenyan Infants. J Hum Lact 2016; 32:NP61-6. [PMID: 26423513 PMCID: PMC4814344 DOI: 10.1177/0890334415607854] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 08/26/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-exposed uninfected (HEU) infants are a growing population in sub-Saharan Africa, with higher morbidity and mortality than HIV-unexposed infants. HEU infants may experience increased morbidity due to breastfeeding avoidance. OBJECTIVES We sought to describe the burden and identify predictors of hospitalization among HEU infants in the first year of life. METHODS Using a retrospective cohort of HIV-infected mothers and their HEU infants in Nairobi, Kenya, we identified infants who were HIV-uninfected at birth and were followed monthly until their last negative HIV test, death, loss to follow-up, or study exit at 1 year of age. Incidence, timing, and reason for hospitalization was assessed overall as well as stratified by feeding method. Predictors of first infectious disease hospitalization were identified using competing risk regression, with HIV acquisition and death as competing risks. RESULTS Among 388 infants, 113 hospitalizations were reported (35/100 infant-years [the combined years of observation contributed by all infants in the study]; 95% confidence interval [CI], 29-42). Ninety hospitalizations were due to 1 or more infectious diseases (26/100 infant-years; 95% CI, 21-32)-primarily pneumonia (n = 40), gastroenteritis (n = 17), and sepsis (n = 14). Breastfeeding was associated with decreased risk of infectious disease hospitalization (subhazard ratio = 0.39; 95% CI, 0.24-0.64), as was time-updated nutrition status (subhazard ratio = 0.73; 95% CI, 0.61-0.89). Incidence of infectious disease hospitalization among formula-fed infants was 51/100 infant-years (95% CI, 37-70) compared to 19/100 infant-years (95% CI, 14-25) among breastfed infants. CONCLUSION Among HEU infants, breastfeeding and nutrition status were associated with reduced hospitalization during the first year of life.
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Affiliation(s)
| | - Jennifer A Slyker
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Dalton Wamalwa
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | | | - Christine M Gichuhi
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA Department of Medicine, University of Washington, Seattle, WA, USA Department of Pediatrics, University of Washington, Seattle, WA, USA
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19
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Arunda MO, Choudhry V, Ekman B, Asamoah BO. Under-five mortality and maternal HIV status in Tanzania: analysis of trends between 2003 and 2012 using AIDS Indicator Survey data. Glob Health Action 2016; 9:31676. [PMID: 27329937 PMCID: PMC4916291 DOI: 10.3402/gha.v9.31676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/04/2016] [Accepted: 05/24/2016] [Indexed: 12/25/2022] Open
Abstract
Background Mortality among children under five remains a significant health challenge across sub-Saharan Africa. HIV/AIDS is one of the leading contributors to the relatively slow decline in under-five mortality in this region. In Tanzania, HIV prevalence among under-five children is high and 90% of all infections are due to mother-to-child transmission. Objectives The study aimed to examine the association between maternal HIV-positive status and under-five mortality in Tanzania. It also aimed to estimate the proportions and trends of under-five mortality attributable to maternal HIV/AIDS in Tanzania between 2003 and 2012. Design Binomial logistic regression was used to analyze cross-sectional survey data from the Tanzania AIDS Indicator Surveys to examine the association between maternal HIV positivity and under-five mortality between 2003 and 2012. Results After controlling for confounders, the adjusted odds ratios were 1.5 (95% CI 1.1–1.9) in 2003–2004, 4.6 (95% CI 2.7–7.8) in 2007–2008, and 2.4 (95% CI 1.2–4.6) in 2011–2012. The maternal HIV-attributable mortality risk percent of under-five children was 3.7 percent in 2003–2004, 11.3 percent in 2007–2008 and 5.6% in 2011–2012. Conclusion Maternal HIV positivity is associated with under-five mortality in Tanzania, making maternal HIV serostatus a relevant determinant of whether a child will survive up to five years of age or not. The impact of maternal HIV/AIDS attributable mortality risk has a significant contribution to the overall under-five mortality in Tanzania. The continued monitoring of HIV and mortality trends is important for policy development and design of interventions.
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Affiliation(s)
- Malachi Ochieng Arunda
- International Master Programme in Public Health, Faculty of Medicine, Lund University, CRC, Jan Waldenströms gata 35, 205 02 Malmö, Sweden;
| | - Vikas Choudhry
- Social Medicine and Global Health, Department of Clinical Sciences, Malmo, Lund University, Sweden
| | - Björn Ekman
- Social Medicine and Global Health, Department of Clinical Sciences, Malmo, Lund University, Sweden
| | - Benedict Oppong Asamoah
- Social Medicine and Global Health, Department of Clinical Sciences, Malmo, Lund University, Sweden
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Clinical outcomes of a comprehensive integrated program for HIV-exposed infants: a 3-year experience promoting HIV-free survival in rural Rwanda. J Acquir Immune Defic Syndr 2013. [PMID: 23202811 DOI: 10.1097/qai.0b013e31827d5118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prevention of mother-to-child transmission of HIV services are often inadequate in promoting HIV-free child survival in rural areas with limited resources. An integrated comprehensive child survival program in rural Rwanda with special emphasis on HIV-exposed infants was established in 2005 and scaled-up. The objective of this study was to report program outcomes and identify predictors of program retention. METHODS We conducted a retrospective study of infants born to HIV-infected women enrolled in the program at or before birth from March 1, 2007, to February 28, 2010, in Eastern Rwanda. Key program elements included improved access to health care, antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV, clean water sources and replacement feeding, home visits by community health workers, prevention and treatment of childhood illness, nutritional support, family planning, and socioeconomic support for the extremely vulnerable. RESULTS Overall,1038 infants enrolled in the program in the study period during which time there was a 4-fold increase in the number of current participants. Uptake of contraception and treatment for diarrheal disease were high. The 18-month survival probability and retention probability were 0.93 (95% confidence interval: 0.91 to 0.94) and 0.88 (95% confidence interval: 0.86 to 0.90), respectively. Twenty-seven (2.6%) children tested positive for HIV, of which 1 died and none were lost-to-follow-up at 18 months. No statistically significant predictors of retention were identified. CONCLUSIONS Our findings demonstrate that a comprehensive integrated program to promote HIV-free survival can achieve high rates of retention and survival in a highly vulnerable population, even during a period of rapid growth.
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Nutman S, McKee D, Khoshnood K. Externalities of prevention of mother-to-child transmission programs: a systematic review. AIDS Behav 2013; 17:445-60. [PMID: 22711224 DOI: 10.1007/s10461-012-0228-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There has been considerable debate about the effects of targeted global health assistance in low- and middle-income countries on health systems, specifically HIV/AIDS funding. Recently, a handful of studies have emerged that describe the implementation of PMTCT programs, which have many theoretical links to maternal and child health. Through a systematic review of research published between January 2000 and March 2011, this paper synthesizes evidence evaluating the impact of these programs. We assessed 5,855 papers, reviewed 154, and included 21 articles. They offer evidence of beneficial synergies between PMTCT programs and both STI prevention and early childhood immunization. Other data, including information about antenatal and delivery care, family planning, and nutrition supplementation varied considerably across studies demonstrating both positive and negative effects of PMTCT. More research is needed to allow countries and funders to make informed decisions regarding allocation of limited funds to targeted versus broad categories of health care.
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Affiliation(s)
- Sarah Nutman
- College of Arts and Sciences, Yale University, New Haven, CT, USA
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22
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Madhi SA, Izu A, Violari A, Cotton MF, Panchia R, Dobbels E, Sewraj P, van Niekerk N, Jean-Philippe P, Adrian PV. Immunogenicity following the first and second doses of 7-valent pneumococcal conjugate vaccine in HIV-infected and -uninfected infants. Vaccine 2012; 31:777-83. [PMID: 23228814 DOI: 10.1016/j.vaccine.2012.11.076] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/14/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The immunogenicity of pneumococcal conjugate vaccine (PCV) has not been evaluated in HIV-infected infants following the first and second PCV-doses. We studied antibody kinetics of serotypes included in 7-valent PCV in HIV-infected and HIV-uninfected infants prior to and following each of three PCV-doses. METHODS HIV-uninfected infants born to HIV-uninfected (HUU) and HIV-infected mothers (HEU); and perinatal HIV-infected children with CD(4+)<25% randomized to initiate antiretroviral treatment (ART) when clinically and/or immunologically indicated (ART-) or immediately (ART+) were enrolled. Vaccination occurred at approximately 7.4, 11.5 and 15.5 weeks of age. Serotype-specific antibody was measured by ELISA following each PCV-dose and opsonophagocytic activity (OPA) to three serotypes following the second and third doses. RESULTS Pre-vaccination, antibody geometric mean concentrations (GMCs) were higher in HUU compared to HIV-exposed groups for most serotypes. GMCs and proportion of infants with antibody ≥0.35 μg/ml were similar in HUU compared to other groups following the second PCV-dose. In all groups, GMCs were greater following the third compared to post-second dose; and a higher proportion within each group had antibody ≥0.35 μg/ml to 6B and 23F. OPA GMTs increased after the third compared to post-second dose for studied-serotypes; as did the proportion with OPA ≥8 to 23F. CONCLUSION A two-dose primary-series of PCV probably confers similar protection against invasive pneumococcal disease in HIV-infected compared to HUU children. The inferior response to serotypes 6B and 23F, and lower GMCs and OPA GMTs, following two compared to after three PCV-doses may have implications in the prevention of pneumococcal disease in high-burden countries.
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Affiliation(s)
- Shabir A Madhi
- National Institute for Communicable Diseases - Division of National Health Laboratory Service, Centre for Vaccines and Immunology, Sandringham, South Africa.
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23
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Landes M, van Lettow M, Chan AK, Mayuni I, Schouten EJ, Bedell RA. Mortality and health outcomes of HIV-exposed and unexposed children in a PMTCT cohort in Malawi. PLoS One 2012; 7:e47337. [PMID: 23082157 PMCID: PMC3474798 DOI: 10.1371/journal.pone.0047337] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/10/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mortality and morbidity among HIV-exposed children are thought to be high in Malawi. We sought to determine mortality and health outcomes of HIV-exposed and unexposed infants within a PMTCT program. METHOD Data were collected as part of a retrospective cohort study in Zomba District, Malawi. HIV-infected mothers were identified via antenatal, delivery and postpartum records with a delivery date 18-20 months prior; the next registered HIV-uninfected mother was identified as a control. By interview and health record review, data on socio-demographic characteristics, service uptake, and health outcomes were collected. HIV-testing was offered to all exposed children. RESULTS 173 HIV-infected and 214 uninfected mothers were included. 4 stillbirths (1.0%) occurred; among the 383 livebirths, 41 (10.7%) children died by 20 months (32 (18.7%) HIV-exposed and 9 unexposed children (4.3%; p<0.0001)). Risk factors for child death included: HIV-exposure [adjOR2.9(95%CI 1.1-7.2)], low birthweight [adjOR2.5(1.0-6.3)], previous child death (adjOR25.1(6.5-97.5)] and maternal death [adjOR5.3(11.4-20.5)]. At 20 months, HIV-infected children had significantly poorer health outcomes than HIV-unexposed children and HIV-exposed but uninfected children (HIV-EU), including: hospital admissions, delayed development, undernutrition and restrictions in function (Lansky scale); no significant differences were seen between HIV-EU and HIV-unexposed children. Overall, no difference was seen at 20 months among HIV-infected, HIV-EU and HIV-unexposed groups in Z-scores (%<-2.0) for weight, height and BMI. Risk factors for poor functional health status at 20 months included: HIV-infection [adjOR8.9(2.4-32.6)], maternal illness [adjOR2.8(1.5-5.0)] and low birthweight [adjOR2.0(1.0-4.1)]. CONCLUSION Child mortality remains high within this context and could be reduced through more effective PMTCT including prioritizing the treatment of maternal HIV infection to address the effect of maternal health and survival on infant health and survival. HIV-infected children demonstrated developmental delays, functional health and nutritional deficits that underscore the need for increased uptake of early infant diagnosis and institution of ART for all infected infants.
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Affiliation(s)
- Megan Landes
- Dignitas International, Zomba, Malawi
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Monique van Lettow
- Dignitas International, Zomba, Malawi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- * E-mail:
| | - Adrienne K. Chan
- Dignitas International, Zomba, Malawi
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Erik J. Schouten
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Management Sciences for Health, Lilongwe, Malawi
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Cutland CL, Schrag SJ, Zell ER, Kuwanda L, Buchmann E, Velaphi SC, Groome MJ, Adrian PV, Madhi SA. Maternal HIV infection and vertical transmission of pathogenic bacteria. Pediatrics 2012; 130:e581-90. [PMID: 22869824 DOI: 10.1542/peds.2011-1548] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND HIV-exposed newborns may be at higher risk of sepsis because of immune system aberrations, impaired maternal antibody transfer and altered exposure to pathogenic bacteria. METHODS We performed a secondary analysis of a study (clinicaltrials.gov, number NCT00136370) conducted between April 2004 and October 2007 in South Africa. We used propensity score matching to evaluate the association between maternal HIV infection and (1) vaginal colonization with bacterial pathogens; (2) vertical transmission of pathogens to the newborn; and (3) sepsis within 3 days of birth (EOS) or between 4-28 days of life (LOS). RESULTS Colonization with group B Streptococcus (17% vs 23%, P = .0002), Escherichia coli (47% vs 45%, P = .374), and Klebsiella pneumoniae (7% vs 10%, P = .008) differed modestly between HIV-infected and uninfected women, as did vertical transmission rates. Maternal HIV infection was not associated with increased risk of neonatal EOS or LOS, although culture-confirmed EOS was >3 times higher among HIV-exposed infants (P = .05). When compared with HIV-unexposed, neonates, HIV-exposed, uninfected neonates (HEU) had a lower risk of EOS (20.6 vs 33.7 per 1000 births; P = .046) and similar rate of LOS (5.8 vs 4.1; P = .563). HIV-infected newborns had a higher risk than HEU of EOS (134 vs 21.5; P < .0001) and LOS (26.8 vs 5.6; P = .042). CONCLUSIONS Maternal HIV infection was not associated with increased risk of maternal bacterial colonization, vertical transmission, EOS, or LOS. HIV-infected neonates, however, were at increased risk of EOS and LOS.
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Affiliation(s)
- Clare L Cutland
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases & Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Soweto, South Africa
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25
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Kurewa EN, Kandawasvika GQ, Mhlanga F, Munjoma M, Mapingure MP, Chandiwana P, Chirenje MZ, Rusakaniko S, Stray-Pedersen B. Realities and Challenges of a Five Year Follow Up of Mother and Child Pairs on a PMTCT Program in Zimbabwe. Open AIDS J 2011; 5:51-8. [PMID: 21760874 PMCID: PMC3134989 DOI: 10.2174/1874613601105010051] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 12/07/2010] [Accepted: 02/18/2011] [Indexed: 11/26/2022] Open
Abstract
Background: Complete follow up is an essential component of observational cohorts irrespective of the type of disease. Objectives: To describe five years follow up of mother and child pairs on a PMTCT program, highlighting loss to follow up (LTFU) and mortality (attrition). Study Design: A cohort of pregnant women was enrolled from the national PMTCT program at 36 weeks gestational age attending three peri urban clinics around Harare offering maternal and child health services. Mother-infant pairs were followed up from birth and twice yearly for five years. Results: A total of 479 HIV infected and 571 HIV negative pregnant women were enrolled, 445(92.9%) and 495(86.6%) were followed up whereas 14(3.0%) and 3(0.5%) died in the 1st year respectively; RR (95%CI) 5.3(1.5-18.7). At five years 227(56.7%) HIV infected and 239(41.0%) HIV negative mothers turned up, whereas mortality rates were 34 and 7 per 100 person years respectively. Birth information was recorded for 401(83.7%) HIV exposed and 441(77.2%) unexposed infants, 247(51.6%) and 232(40.6) turned up in the first year whilst mortality was 58(12.9%) and 22(4.4%) respectively, RR (95%CI) 3.2(2.0-5.4). At five years 210(57.5%) HIV exposed and 239(44.3%) unexposed infants were seen, whilst mortality rates were 53 per 1000 and 15 per 1 000 person years respectively. Mortality rate for HIV infected children was 112 compared to 21 per 1 000 person years for the exposed but uninfected. Conclusion: HIV infected mothers and their children succumbed to mortality whereas the HIV negatives were LTFU. Mortality rates and LTFU are high within PMTCT program.
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Affiliation(s)
- E N Kurewa
- Letten Foundation Research Center, No.3 Everrett Close, Harare Zimbabwe
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Munjoma MW, Mhlanga FG, Mapingure MP, Kurewa EN, Mashavave GV, Chirenje MZ, Rusakaniko S, Stray-Pedersen B. The incidence of HIV among women recruited during late pregnancy and followed up for six years after childbirth in Zimbabwe. BMC Public Health 2010; 10:668. [PMID: 21047407 PMCID: PMC2989962 DOI: 10.1186/1471-2458-10-668] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 11/03/2010] [Indexed: 11/10/2022] Open
Abstract
Background HIV incidence is a useful tool for improving the targeting of populations for interventions and assessing the effectiveness of prevention strategies. A study in Harare, Zimbabwe reported cumulative incidences of 3.4% (3.0-3.8) and 6.5% (5.7-7.4) among post-partum women followed for 12 and 24 months respectively between 1997 and 2001. According to a Government report on HIV the prevalence of HIV fell from about 30% in 1999 to 14% in 2008. The purpose of this study was to determine the incidence of HIV-1 among women enrolled during late pregnancy and followed for six years after childbirth and to identify risk factors associated with acquisition of HIV. Methods HIV-uninfected pregnant women around 36 weeks gestation were enrolled from primary health care clinics in peri-urban settlements around Harare and followed-up for up to six years after childbirth. At every visit a questionnaire was interview-administered to obtain socio-demographic data and sexual history since the previous visit. A genital examination was performed followed by the collection of biological samples. Results Of the 552 HIV-uninfected women 444 (80.4%) were seen at least twice during the six years follow-up and 39 acquired HIV, resulting in an incidence (95% CI) of 2.3/100 woman-years-at-risk (wyar) (1.1-4.1). The incidence over the first nine months post-partum was 5.7/100 wyar (3.3-8.1). A greater proportion of teenagers (15.3%) contributed to a high incidence rate of 2.9/100 (0.6-8.7) wyar. In multivariate analysis lower education of participant, RR 2.1 (1.1-4.3) remained significantly associated with HIV acquisition. Other risk factors associated with acquisition of HIV-1 in univariate analysis were young age at sexual debut, RR 2.3, (1.0-5.6) and having children with different fathers, RR 2.7(1.3-5.8). Women that knew that their partners had other sexual partners were about four times more likely to acquire HIV, RR 3.8 (1.3-11.2). Conclusion The incidence of HIV was high during the first nine months after childbirth. Time of seroconversion, age and educational level of seroconverter are important factors that must be considered when designing HIV intervention strategies.
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Affiliation(s)
- Marshall W Munjoma
- University of Zimbabwe, College of Health Sciences, Department of Obstetrics and Gynaecology, Harare, Zimbabwe.
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