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Pilecco FB, Ravalihasy A, Guillaume A, Desgrées du Loû A. HIV and induced abortion among migrants from sub-Saharan Africa living in Île-de-France: Results of the PARCOURS study. J Migr Health 2024; 10:100237. [PMID: 38989051 PMCID: PMC11233997 DOI: 10.1016/j.jmh.2024.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/04/2023] [Accepted: 06/05/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction HIV heavily affects sub-Saharan African women living in France and can impact reproductive decisions. It was investigated whether HIV was associated with induced abortion in pregnancies held after migration by women from sub-Saharan Africa living in Île-de-France. Methods We used data on ANRS Parcours, a retrospective life event survey conducted in health facilities in the metropolitan region of Paris, between February 2012 and May 2013, with migrants from sub-Saharan Africa. Data on the history of pregnancies were collected among women living with HIV (HIV group) and those attending primary care centers (reference group). We investigated 242 women in the reference group, who had 729 pregnancies, and the 277 women in the HIV group, who had 580 pregnancies. The association between abortion and HIV was evaluated using clustered logistic models, successively adjusted for women and pregnancy characteristics, for the whole sample, and stratified by pregnancy intendedness. Results In the reference group, 11.0 % of pregnancies were terminated in abortion, the same situation as 14.1 % in the HIV group (p = 0.124). HIV was not associated with abortion in the crude and adjusted models. However, after adjustments, HIV exhibited a non-significant trend towards reducing the likelihood of abortion, particularly when considering the intendedness of pregnancy variable. Conclusions Factors that shape the overall context of women's lives and pregnancies, which are shared with the reference group, may have a more significant impact on reproductive decision-making than HIV alone. Health services must pay attention to the intendedness of pregnancies, providing advice and support on the prevention of mother-to-child transmission to women living with HIV who intend to become pregnant, in addition to strengthening the provision of family planning and the prevention of unintended pregnancies.
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Affiliation(s)
- Flávia B. Pilecco
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais. Avenida Alfredo Balena, 190, sala 803. Zip Code: 30130-100. Belo Horizonte, MG, Brazil
- Programa de Pós-Graduação em Saúde Pública, Universidade Federal de Minas Gerais. Avenida Alfredo Balena, 190, sala 803. Zip Code: 30130-100. Belo Horizonte, MG, Brazil
| | - Andrainolo Ravalihasy
- Centre Population & Développement (UMR 196 - Université Paris Cité/IRD). 45 rue des Saints-Pères. Zip Code: 75006. Paris, France
| | - Agnès Guillaume
- Centre Population & Développement (UMR 196 - Université Paris Cité/IRD). 45 rue des Saints-Pères. Zip Code: 75006. Paris, France
| | - Annabel Desgrées du Loû
- Centre Population & Développement (UMR 196 - Université Paris Cité/IRD). 45 rue des Saints-Pères. Zip Code: 75006. Paris, France
| | - the Parcours Study Group
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais. Avenida Alfredo Balena, 190, sala 803. Zip Code: 30130-100. Belo Horizonte, MG, Brazil
- Programa de Pós-Graduação em Saúde Pública, Universidade Federal de Minas Gerais. Avenida Alfredo Balena, 190, sala 803. Zip Code: 30130-100. Belo Horizonte, MG, Brazil
- Centre Population & Développement (UMR 196 - Université Paris Cité/IRD). 45 rue des Saints-Pères. Zip Code: 75006. Paris, France
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Onono M, Odwar T, Wahome S, Helova A, Bukusi EA, Hampanda K, Turan J, Abuogi L. Behavioral Interventions can Mitigate Adverse Pregnancy Outcomes Among Women Conceiving on ART and Those Initiated on ART During Pregnancy: Findings From the MOTIVATE Trial in Southwestern Kenya. J Acquir Immune Defic Syndr 2021; 86:46-55. [PMID: 33306563 PMCID: PMC7851482 DOI: 10.1097/qai.0000000000002521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) is essential for the elimination of mother-to-child transmission and improved health outcomes for women living with HIV (WLWH). However, adverse pregnancy outcomes (APOs) among pregnant women on ART are a growing concern. METHODS We investigated the associations between timing of ART initiation and APOs among pregnant WLWH receiving behavioral interventions (community mentor mothers and text messaging) in the Mother-Infant Visit Adherence and Treatment Engagement (MOTIVATE) study in southwestern Kenya. Log binomial models were used for estimation of relative risks (RRs) (adjusted for the clustered nature of data) evaluating APOs with 3 exposure comparisons: (1) preconception ART initiation vs. postconception initiation; (2) among postconception ART initiating women, comparisons across gestational ages at cART initiation (first versus second and third trimester exposure), and (3) intervention allocation. RESULTS Of the 1275 women included in this analysis, 388 (30%) had an APO: 306 preterm births, 38 low birth weight infants, 33 stillbirths, and 11 miscarriages. In multivariable analysis, viral load ≥1000 copies/mL, moderate and severe anemia at baseline increased risk of APOs. Among women initiating ART before and after conception, no difference was observed in the composite APO. Women who received community mentor mother visits alone (aRR 0.74: 95% CI: 0.71 to 0.76) or text messages alone (aRR 0.79: 95% CI: 0.70 to 0.89) had lower risks of experiencing any APOs. CONCLUSIONS Receiving supportive behavioral interventions may mitigate the risk of experiencing an APO among WLWH on ART. Further studies are needed to investigate the underlying mechanisms and optimize the benefits of these interventions.
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Affiliation(s)
- Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Tobias Odwar
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Samuel Wahome
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anna Helova
- Department of Health Care Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, United States
| | | | - Karen Hampanda
- Department of Community and Behavioral Health, School of Public Health, University of Colorado Denver, Aurora, United States
| | - Janet Turan
- Department of Health Care Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, United States
| | - Lisa Abuogi
- Department of Pediatrics, University of Colorado Denver, Aurora, United States
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Tukei VJ, Machekano R, Gill MM, Tiam A, Mokone M, Isavwa A, Nyabela M, Mots’oane T, Nchephe S, Letsie M, Kassaye SG, Guay L. 24-Month HIV-free survival among HIV-exposed Infants in Lesotho: the PEAWIL cohort study. J Int AIDS Soc 2020; 23:e25648. [PMID: 33314744 PMCID: PMC7733603 DOI: 10.1002/jia2.25648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/30/2020] [Accepted: 11/13/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Following the implementation of the provision of lifelong antiretroviral therapy to all HIV-positive pregnant or breastfeeding women for prevention of mother-to-child transmission (PMTCT) of HIV by the Kingdom of Lesotho in 2013, we assessed the effectiveness of this approach by evaluating 24-month HIV-free survival among HIV-exposed infants (HEIs). METHODS We conducted a prospective observational cohort study that enrolled HIV-positive and HIV-negative pregnant women, with follow-up of women and their infants for 24 months after delivery. Participant recruitment started in June 2014 and follow-up ended in September 2018. Trained nurses collected study information through patient interviews and chart abstraction at enrolment and every three to six months thereafter. Maternal HIV testing, infant mortality, HIV transmission and HIV-free survival rates were computed using Kaplan-Meier estimation. Cox regression hazard models were used to identify factors associated with infant HIV infection and death. RESULTS Between June 2014 and February 2016, we enrolled 653 HIV-positive and 941 HIV-negative pregnant women. Twenty-seven HIV-negative women acquired HIV during follow-up. Ultimately, 634 liveborn HEI (382 (52%) male, 303 (48%) female, 3 missing) and 839 who remained HIV-unexposed (HUIs) (409 (49.0%) male, 426 (51.0%) female, 4 missing) were followed; 550 HEIs and 701 HUIs completed the 24-month follow-up period. Of 607 (95.7%) HEIs who were tested for HIV at least once during follow-up, 17 were found to be HIV-positive. Two (9.5%) of 21 infants born to mothers who acquired HIV infection during follow-up were HIV-positive compared to 15 (2.4%) of 613 HEI born to women with known HIV infection. The risk of HIV transmission from HIV-positive mothers to their infants by 24 months of age was 2.9% (95% CI: 1.8 to 4.7). The estimated 24-month mortality rate among HEIs was 6.0% (95% CI: 4.4 to 8.2) compared to 3.8% (95% CI: 2.6 to 5.3) among HUIs (Log-rank p = 0.065). HIV-free survival at 24 months was 91.8% (95% CI: 89.2 to 93.7). Lower maternal age and birth weight were independently associated with increased HIV infection or death of infants. CONCLUSIONS The implementation of lifelong ART for PMTCT in the Lesotho public health system resulted in low HIV transmission, but survival of HEI remains lower than their HIV uninfected counterparts.
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Affiliation(s)
| | | | | | - Appolinaire Tiam
- Elizabeth Glaser Pediatric AIDS FoundationWashingtonDCUSA
- Centre for International HealthUniversity of BergenNorway
| | | | | | | | | | | | | | - Seble G Kassaye
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Laura Guay
- Elizabeth Glaser Pediatric AIDS FoundationWashingtonDCUSA
- Department of EpidemiologyGeorge Washington University Milken Institute School of Public HealthWashingtonDCUSA
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Larsen A, Magasana V, Dinh TH, Ngandu N, Lombard C, Cheyip M, Ayalew K, Chirinda W, Kindra G, Jackson D, Goga A. Longitudinal adherence to maternal antiretroviral therapy and infant Nevirapine prophylaxis from 6 weeks to 18 months postpartum amongst a cohort of mothers and infants in South Africa. BMC Infect Dis 2019; 19:789. [PMID: 31526366 PMCID: PMC6745776 DOI: 10.1186/s12879-019-4341-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite improved policies to prevent mother-to-child HIV transmission (MTCT), adherence to maternal antiretroviral therapy (ART) and infant Nevirapine prophylaxis (NVP) is low in South Africa. We describe ART adherence amongst a cohort of HIV-positive mothers and HIV-exposed but uninfected infants from 6 weeks until 18 months post-delivery and identify risk factors for nonadherence. METHODS Data were collected in 2012-2014 through a nationally representative survey of PMTCT effectiveness. Mother-infant pairs were enrolled during the infant's first immunization visit at 6 weeks. Mothers and HIV-exposed infants (2811 pairs) were followed to 18 months at 3-month intervals. Mothers who self-reported being on ART at 6 weeks postpartum (N = 1572 (55.9%)) and infants on NVP at 6 weeks (N = 2370 (84.3%)) were eligible for this analysis and information about their adherence was captured at each interview they attended thereafter. We defined nonadherence within each 3-month interval as self-report of missing > 5% of daily ART/NVP doses, estimated adherence using a Cox survival curve with Andersen & Gill setup for recurring events, and identified risk factors for nonadherence with an extended Cox regression model (separately for mothers and infants) in Stata 13. Results are not nationally representative as this is a subgroup analysis of the follow-up cohort. RESULTS Amongst mothers on ART at 6 weeks postpartum, cumulative adherence to maternal ART until 18 months was 63.4%. Among infants on NPV at 6 weeks postpartum, adherence to NVP was 74.5%.. Risk factors for nonadherence to maternal ART, controlling for other factors, included mother's age (16-24 years vs. ≥34 years, adjusted Hazard Ratio (aHR): 1.9, 95% CI: 1.4-2.5), nondisclosure of HIV status to anyone (nondisclosure vs. disclosure: aHR: 1.7, 95% CI: 1.3-2.1), and timing of ART initiation (initiated ART after delivery vs. initiated ART before delivery: aHR: 1.6, 95% CI: 1.3-2.0). Provincial variation was seen in nonadherence to infant NVP, controlling for other factors. CONCLUSION Maintaining ART adherence until 18 months postpartum remains a crucial challenge, with maternal ART adherence among the six week maternal ART cohort below 65% and infant NVP adherence among breastfeeding infants in this cohort below 75%.This is gravely concerning, given the global policy shift to lifelong ART amongst pregnant and lactating women, and the need for extended infant prophylaxis amongst mothers who are not virally suppressed. Our findings suggest that young mothers and mothers who do not disclose their status should be targeted with messages to improve adherence, and that late maternal ART initiation (after delivery) increases the risk of maternal nonadherence.
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Affiliation(s)
- Anna Larsen
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Vuyolwethu Magasana
- Health Systems Research Unit, South African Medical Research Council (HSRU, SAMRC), Pretoria, South Africa
| | - Thu-Ha Dinh
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
| | - Nobubelo Ngandu
- Health Systems Research Unit, South African Medical Research Council (HSRU, SAMRC), Pretoria, South Africa
| | - Carl Lombard
- Health Systems Research Unit, South African Medical Research Council (HSRU, SAMRC), Pretoria, South Africa
| | - Mireille Cheyip
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Kassahun Ayalew
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Witness Chirinda
- Health Systems Research Unit, South African Medical Research Council (HSRU, SAMRC), Pretoria, South Africa
| | - Gurpreet Kindra
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Debra Jackson
- United Nations Children’s Fund (UNICEF), New York, NY USA
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Ameena Goga
- Health Systems Research Unit, South African Medical Research Council (HSRU, SAMRC), Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
- HIV Prevention Research Unit, South African Medical Research Council, 123 Jan Hofmeyr Road, Westville, Durban, KwaZulu-Natal 3630 South Africa
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Wang X, Guo G, Zheng J, Lu L. Cost-effectiveness of option B+ in prevention of mother-to-child transmission of HIV in Yunnan Province, China. BMC Infect Dis 2019; 19:517. [PMID: 31185927 PMCID: PMC6560771 DOI: 10.1186/s12879-019-3976-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/11/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Although Option B+ may be more costly than Options B, it may provide additional health benefits that are currently unclear in Yunnan province. We created deterministic models to estimate the cost-effectiveness of Option B+. METHODS Data were used in two deterministic models simulating a cohort of 2000 HIV+ pregnant women. A decision tree model simulated the number of averted infants infections and QALY acquired for infants in the PMTCT period for Options B and B+. The minimum cost was calculated. A Markov decision model simulated the number of maternal life year gained and serodiscordant partner infections averted in the ten years after PMTCT for Option B or B+. ICER per life year gained was calculated. Deterministic sensitivity analyses were conducted. RESULTS If fully implemented, Option B and Option B+ averted 1016.85 infections and acquired 588,01.02 QALYs.The cost of Option B was US$1,229,338.47, the cost of Option B+ was 1,176,128.63. However, when Options B and B+ were compared over ten years, Option B+ not only improved mothers'ten-year survival from 69.7 to 89.2%, saving more than 3890 life-years, but also averted 3068 HIV infections between serodiscordant partners. Option B+ yielded a favourable ICER of $32.99per QALY acquired in infants and $5149per life year gained in mothers. A 1% MTCT rate, a 90% coverage rate and a 20-year horizon could decrease the ICER per QALY acquired in children and LY gained in mothers. CONCLUSIONS Option B+ is a cost-effective treatment for comprehensive HIV prevention for infants and serodiscordant partners and life-long treatment for mothers in Yunnan province, China. Option B+ could be implemented in Yunnan province, especially as the goals of elimination mother-to-child transmission of HIV and "90-90-90" achieved, Option B+ would be more attractive.
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Affiliation(s)
- Xiaowen Wang
- Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, Yunnan Province China
- Kunming Medical University, No. 1168, west Chunrong Street, Chenggong district, Kunming, Yunnan Province China
| | - Guangping Guo
- Yunnan Maternal and Child Health Care Hospital, No. 200, Gulou Street, Wuhua District, Kunming, Yunnan Province China
| | - Jiarui Zheng
- Yunnan Maternal and Child Health Care Hospital, No. 200, Gulou Street, Wuhua District, Kunming, Yunnan Province China
| | - Lin Lu
- Kunming Medical University, No. 1168, west Chunrong Street, Chenggong district, Kunming, Yunnan Province China
- Health Commission of Yunnan Province, No. 309, Guomao Street, Kunming, Yunnan Province China
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Van Hout MC, Mhlanga-Gunda R. 'Mankind owes to the child the best that it has to give': prison conditions and the health situation and rights of children incarcerated with their mothers in sub-Saharan African prisons. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2019; 19:13. [PMID: 30836967 PMCID: PMC6402132 DOI: 10.1186/s12914-019-0194-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 02/08/2019] [Indexed: 12/18/2022]
Abstract
Background In recent times, sub-Saharan African (SSA) prisons have seen a substantial increase in women prisoners, including those incarcerated with children. Methods A scoping review mapped what is currently known about the health situation and unique rights violations of children incarcerated with their mothers in SSA prisons. A systematic search collected and reviewed all available and relevant published and grey literature (2000–2018). Following application of exclusion measures, 64 records remained, which represented 27 of the 49 SSA countries. These records were charted and thematically analysed. Results Four main themes were generated as follows: 1) the prison physical environment; 2) food availability, adequacy and quality; 3) provision of basic necessities and 4) availability and accessibility of health services for incarcerated children. Conclusions The review highlights the grave situation of children incarcerated with their mothers in SSA prisons, underpinned by the lack of basic necessities, inadequate hygiene, sanitation and safe drinking water, exposure to diseases in overcrowded cells, inadequate nutrition, lack of provision of clothing and bedding, and difficulties accessing paediatric care. Reported paediatric morbidity and mortality associated with such prison conditions is deeply concerning and contrary to international mandates for the rights of the child, right to health and standards of care. Electronic supplementary material The online version of this article (10.1186/s12914-019-0194-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie-Claire Van Hout
- Public Health Institute, Liverpool John Moore's University, Liverpool, L32ET, UK. .,Public Health Institute, Exchange Station, Liverpool John Moore's University, Liverpool, L32ET, UK.
| | - Rosemary Mhlanga-Gunda
- College of Health Sciences, Centre for Evaluation of Public Health Interventions, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
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Offering pre-exposure prophylaxis for HIV prevention to pregnant and postpartum women: a clinical approach. J Int AIDS Soc 2017; 20:21295. [PMID: 28361503 PMCID: PMC5577744 DOI: 10.7448/ias.20.2.21295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction: HIV prevention during pregnancy and lactation is critical for both maternal and child health. Pregnancy provides a critical opportunity for clinicians to elicit women’s vulnerabilities to HIV and offer HIV testing, treatment and referral and/or comprehensive HIV prevention options for the current pregnancy, the postpartum period and safer conception options for future pregnancies. In this commentary, we review the safety of oral pre-exposure prophylaxis with tenofovir/emtricitabine in pregnant and lactating women and suggest opportunities to identify pregnant and postpartum women at substantial risk of HIV. We then describe a clinical approach to caring for women who both choose and decline pre-exposure prophylaxis during pregnancy and postpartum, highlighting areas for future research. Discussion: Evidence suggests that pre-exposure prophylaxis with tenofovir/emtricitabine is safe in pregnancy and lactation. Identifying women vulnerable to HIV and eligible for pre-exposure prophylaxis is challenging in light of the myriad of individual, community, and structural forces impacting HIV acquisition. Validated risk calculators exist for specific populations but have not been used to screen and offer HIV prevention methods. Partner testing and engagement of men living with HIV are additional means of reaching at-risk women. However, women’s vulnerabilities to HIV change over time. Combining screening for HIV vulnerability with HIV and/or STI testing at standard intervals during pregnancy is a practical way to prompt providers to incorporate HIV screening and prevention counselling. We suggest using shared decision-making to offer women pre-exposure prophylaxis as one of multiple HIV prevention strategies during pregnancy and postpartum, facilitating open conversations about HIV vulnerabilities, preferences about HIV prevention strategies, and choosing a method that best meets the needs of each woman. Conclusion: Growing evidence suggests that pre-exposure prophylaxis with tenofovir/emtricitabine during pregnancy and lactation is safe and effective. Shared decision-making provides one approach to identify at-risk women and offers pre-exposure prophylaxis but requires implementation research in diverse clinical settings. Including pregnant and breastfeeding women in future HIV prevention research is critical for the creation of evidence-driven public health policies and clinical guidelines.
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Kajubi R, Huang L, Jagannathan P, Chamankhah N, Were M, Ruel T, Koss CA, Kakuru A, Mwebaza N, Kamya M, Havlir D, Dorsey G, Rosenthal PJ, Aweeka FT. Antiretroviral Therapy With Efavirenz Accentuates Pregnancy-Associated Reduction of Dihydroartemisinin-Piperaquine Exposure During Malaria Chemoprevention. Clin Pharmacol Ther 2017; 102:520-528. [PMID: 28187497 PMCID: PMC5546920 DOI: 10.1002/cpt.664] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 11/08/2022]
Abstract
Dihydroartemisinin (DHA)-piperaquine is promising for malaria chemoprevention in pregnancy. We assessed the impacts of pregnancy and efavirenz-based antiretroviral therapy on exposure to DHA and piperaquine in pregnant Ugandan women. Intensive sampling was performed at 28 weeks gestation in 31 HIV-uninfected pregnant women, in 27 HIV-infected pregnant women receiving efavirenz, and in 30 HIV-uninfected nonpregnant women. DHA peak concentration and area under the concentration time curve (AUC0-8hr ) were 50% and 47% lower, respectively, and piperaquine AUC0-21d was 40% lower in pregnant women compared to nonpregnant women. DHA AUC0-8hr and piperaquine AUC0-21d were 27% and 38% lower, respectively, in pregnant women receiving efavirenz compared to HIV-uninfected pregnant women. Exposure to DHA and piperaquine were lower among pregnant women and particularly in women on efavirenz, suggesting a need for dose modifications. The study of modified dosing strategies for these populations is urgently needed.
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Affiliation(s)
- Richard Kajubi
- Infectious Disease Research Collaboration, Makerere University
College of Health Sciences- all in Kampala, Uganda
- Department of Pharmacology and Therapeutics, Makerere University
College of Health Sciences- all in Kampala, Uganda
| | - Liusheng Huang
- Department of Clinical Pharmacy, University of California, San
Francisco, San Francisco General Hospital, San Francisco, CA, USA
| | - Prasanna Jagannathan
- Department of Medicine, University of California, San Francisco, San
Francisco General Hospital, San Francisco, CA, USA
| | - Nona Chamankhah
- Department of Clinical Pharmacy, University of California, San
Francisco, San Francisco General Hospital, San Francisco, CA, USA
| | - Moses Were
- Infectious Disease Research Collaboration, Makerere University
College of Health Sciences- all in Kampala, Uganda
| | - Theodore. Ruel
- Department of Pediatrics, University of California, San Francisco,
San Francisco General Hospital, San Francisco, CA, USA
| | - Catherine A. Koss
- Department of Medicine, University of California, San Francisco, San
Francisco General Hospital, San Francisco, CA, USA
| | - Abel Kakuru
- Infectious Disease Research Collaboration, Makerere University
College of Health Sciences- all in Kampala, Uganda
| | - Norah Mwebaza
- Infectious Disease Research Collaboration, Makerere University
College of Health Sciences- all in Kampala, Uganda
- Department of Pharmacology and Therapeutics, Makerere University
College of Health Sciences- all in Kampala, Uganda
| | - Moses Kamya
- Infectious Disease Research Collaboration, Makerere University
College of Health Sciences- all in Kampala, Uganda
| | - Diane Havlir
- Department of Medicine, University of California, San Francisco, San
Francisco General Hospital, San Francisco, CA, USA
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, San
Francisco General Hospital, San Francisco, CA, USA
| | - Philip J. Rosenthal
- Department of Medicine, University of California, San Francisco, San
Francisco General Hospital, San Francisco, CA, USA
| | - Francesca T. Aweeka
- Department of Clinical Pharmacy, University of California, San
Francisco, San Francisco General Hospital, San Francisco, CA, USA
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Unmet needs persist in pediatric HIV programs: lessons from selected case studies in Uganda. AIDS 2017; 31:1196-1199. [PMID: 28441178 DOI: 10.1097/qad.0000000000001436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rollout of efavirenz-based regimens in option B+ in the prevention of mother-to-child transmission programs: challenges and lessons learned from a postexposure prophylaxis experience. AIDS 2016; 30:N29-31. [PMID: 27603165 DOI: 10.1097/qad.0000000000001212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Egbe TO, Tazinya RMA, Halle-Ekane GE, Egbe EN, Achidi EA. Estimating HIV Incidence during Pregnancy and Knowledge of Prevention of Mother-to-Child Transmission with an Ad Hoc Analysis of Potential Cofactors. J Pregnancy 2016; 2016:7397695. [PMID: 27127653 PMCID: PMC4830744 DOI: 10.1155/2016/7397695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/07/2016] [Accepted: 02/11/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We determined the incidence of HIV seroconversion during the second and third trimesters of pregnancy and ad hoc potential cofactors associated with HIV seroconversion after having an HIV-negative result antenatally. We also studied knowledge of PMTCT among pregnant women in seven health facilities in Fako Division, South West Region, Cameroon. METHOD During the period between September 12 and December 4, 2011, we recruited a cohort of 477 HIV-negative pregnant women by cluster sampling. Data collection was with a pretested interviewer-administered questionnaire. Sociodemographic information, knowledge of PMTCT, and methods of HIV prevention were obtained from the study population and we did Voluntary Counselling and Testing (VCT) for HIV. RESULTS The incidence rate of HIV seroconversion during pregnancy was 6.8/100 woman-years. Ninety percent of the participants did not use condoms throughout pregnancy but had a good knowledge of PMTCT of HIV. Only 31.9% of participants knew their HIV status before the booking visit and 33% did not know the HIV status of their partners. CONCLUSION The incidence rate of HIV seroconversion in the Fako Division, Cameroon, was 6.8/100 woman-years. No risk factors associated with HIV seroconversion were identified among the study participants because of lack of power to do so.
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Affiliation(s)
- Thomas Obinchemti Egbe
- Department of Obstetrics and Gynecology, Douala General Hospital, Douala, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - Gregory Edie Halle-Ekane
- Department of Obstetrics and Gynecology, Douala General Hospital, Douala, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
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12
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Affiliation(s)
- Katherine Luzuriaga
- From the Program in Molecular Medicine, University of Massachusetts Medical School, Worcester (K.L.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Lynne M Mofenson
- From the Program in Molecular Medicine, University of Massachusetts Medical School, Worcester (K.L.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
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