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Perception of coercion during contraceptive counseling among individuals with HIV. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100791. [DOI: 10.1016/j.srhc.2022.100791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 09/02/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
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Latham AH, Nissim OA, Spitznagel MC, Kirk SE, Tarleton JL, Lazenby GB. Impact of Integrase Strand Transfer Inhibitor Use During Pregnancy on Viral Suppression at Delivery and Infant Outcomes: A Statewide Retrospective Cohort Study. J Acquir Immune Defic Syndr 2022; 89:448-453. [PMID: 35202051 DOI: 10.1097/qai.0000000000002882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND We sought to determine whether pregnant women with HIV prescribed integrase strand transfer inhibitor (INSTI) were more likely to have viral suppression at delivery and any increased risk of adverse infant outcomes. METHODS This was a retrospective, statewide cohort study of women with HIV and their HIV-exposed infants who delivered in South Carolina from 2008 to 2019. Women's antenatal AVRs were classified as INSTI or non-INSTI. We compared the percentage of women with undetectable HIV RNA viral load (<40 copies/mL) at delivery between groups. We compared the percentage of HIV-exposed singleton infants who were born preterm delivery, low birth weight, and small for gestational age and had confirmed perinatal HIV infection. Categorical outcomes were compared using the χ2 test or Fischer exact test. RESULTS A total of 832 infants, including 11 sets of twins, were exposed to maternal HIV. Detailed antiretroviral regimens were available for analysis in a third of mother-infant pairs (n = 315). Half of the infants were exposed to INSTI (159) and half to non-INSTI antiretrovirals (156). Most women had an undetectable viral load at delivery (80% INSTI and 73% non-INSTI, P= 0.11). The percentage of singleton infants with adverse outcomes was similar between INSTI and non-INSTI groups: preterm delivery (21% and 16%, P = 0.3), low birth weight (19% and 21%, P = 0.7), small for gestational age (11% vs 9%, P = 0.5), and perinatal HIV infection (2.5% and 1.3%, P = 0.7). CONCLUSIONS We observed that viral suppression before delivery was similar between pregnant women prescribed INSTI and non-INSTI antiretroviral therapy. The percentage of infants with adverse outcomes was similar when exposed to INSTI and non-INSTI antiretroviral therapy.
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Affiliation(s)
- A Hayden Latham
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC; and
| | - Oriel A Nissim
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC; and
| | | | - Stephanie E Kirk
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Jessica L Tarleton
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC; and
| | - Gweneth B Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC; and
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Cohn E, Korte JE, Lazenby GB. Timing is everything: assessing the impact of maternal HIV infection diagnosis timing on infant outcomes in a ten-year retrospective cohort study in South Carolina. AIDS Care 2019; 33:299-305. [PMID: 31870184 DOI: 10.1080/09540121.2019.1707470] [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: 10/25/2022]
Abstract
The aims were to evaluate the impact of maternal HIV infection diagnosis timing on infant outcomes. The outcomes of interest included preterm delivery (PTD) and confirmed infant HIV infection. Data for all HIV-exposed infants from 2004-14 were obtained. Maternal HIV infection diagnosis timing was categorized as: perinatal (PHIV), adult infection before conception, and after conception. Infant outcomes were compared according to timing of maternal HIV diagnosis. Bivariate outcomes were compared using χ 2 tests. Continuous variables were compared using Kruskal-Wallis tests. Logistic regression was used to determine predictors of PTD and infant HIV infection. Most women were diagnosed with HIV before conception: PHIV (21, 3%), before conception (431, 69%), and post-conception (176, 28%). Women diagnosed with HIV as an adult before conception were more likely to deliver preterm (P = 0.007). Prenatal care was associated with lower risk of PTD (aOR 0.1, 95% CI 0.04-0.5). Six infants contracted HIV. Infant HIV infection was more likely in women who did not take antiretroviral therapy (aOR 13.5, 95% CI 2.5-72.1) or delivered preterm (aOR 5.3, 95% 1.1-25.1). Women with PHIV were more likely to deliver at term, and there were no HIV infections among PHIV-exposed infants. These findings are reassuring to PHIV women who desire pregnancy.
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Affiliation(s)
- Ellery Cohn
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey E Korte
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Gweneth B Lazenby
- Departments of Obstetrics and Gynecology and Medicine, Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
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Lazenby G, Francis E, Brzozowski N, Rucker L, Dempsey A. Postpartum LARC discontinuation and short interval pregnancies among women with HIV: a retrospective 9-year cohort study in South Carolina. Contraception 2019; 100:279-282. [PMID: 31226321 DOI: 10.1016/j.contraception.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate rates of discontinuation and short interval pregnancy among women with HIV who received a postpartum IUD or implant. METHODS We conducted a retrospective cohort study of women who had an IUD or implant placed within 3 months postpartum during a 9-year period (1/1/09 to 2/14/18). We assessed the prevalence of discontinuation within 12 months and rates of subsequent delivery within 18 months. We examined differences in these outcomes between women with and without HIV. RESULTS Of the 794 women who received a long-acting reversible contraception (LARC) within 3 months postpartum, most chose an IUD (85%). Twenty-one percent (165) elected for immediate postpartum placement: 119 IUDs and 46 implants. Women with HIV were more likely to receive an implant (48% vs 13%, p<.0001) and were more likely to have immediate postpartum placement (76% vs 17%, p<.0001). Women with HIV (n=50) were not more likely to remove LARC devices within 12 months of placement (38% vs 36%, p=.9), and they did not experience any short interval pregnancies. CONCLUSIONS Women with HIV in South Carolina were more likely than HIV-negative women to receive immediate postpartum LARC and to receive an implant. They were not more likely to discontinue LARC within 12 months nor experience short interval pregnancies. IMPLICATIONS Further study is needed to evaluate preferences for implants and immediate postpartum insertion among women with HIV.
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Affiliation(s)
- Gweneth Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425.
| | - Elizabeth Francis
- Department of College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
| | - Nicole Brzozowski
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
| | - Lindsay Rucker
- Department of College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
| | - Angela Dempsey
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
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Hackett S, Badell ML, Meade CM, Davis JM, Blue J, Curtin L, Camacho-Gonzalez A, Chahroudi A, Chakraborty R, Nguyen MLT, Palmore MP, Sheth AN. Improved Perinatal and Postpartum Human Immunodeficiency Virus Outcomes After Use of a Perinatal Care Coordination Team. Open Forum Infect Dis 2019; 6:ofz183. [PMID: 31198816 PMCID: PMC6545466 DOI: 10.1093/ofid/ofz183] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/08/2019] [Indexed: 11/14/2022] Open
Abstract
In a high-volume clinic in the Southeastern United States, pregnant women living with human immunodeficiency virus (HIV) had improved HIV outcomes up to 6 months after delivery following the introduction of a multidisciplinary perinatal care coordination team.
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Affiliation(s)
| | - Martina L Badell
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Atlanta, Georgia
| | | | | | - Jeronia Blue
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia
| | - Lisa Curtin
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia
| | - Andres Camacho-Gonzalez
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Pediatrics, Division of Infectious Diseases, Atlanta, Georgia
| | - Ann Chahroudi
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Pediatrics, Division of Infectious Diseases, Atlanta, Georgia
| | - Rana Chakraborty
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Pediatrics, Division of Infectious Diseases, Atlanta, Georgia
| | - Minh Ly T Nguyen
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
| | - Melody P Palmore
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
| | - Anandi N Sheth
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
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HIV Care Continuum among Postpartum Women Living with HIV in Atlanta. Infect Dis Obstet Gynecol 2019; 2019:8161495. [PMID: 30894788 PMCID: PMC6393891 DOI: 10.1155/2019/8161495] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/04/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction While increased healthcare engagement and antiretroviral therapy (ART) adherence occurs during pregnancy, women living with HIV (WLWH) are often lost to follow-up after delivery. We sought to evaluate postpartum retention in care and viral suppression and to identify associated factors among WLWH in a large public hospital in Atlanta, Georgia. Methods Data from the time of entry into prenatal care until 24 months postpartum were collected by chart review from WLWH who delivered with ≥20 weeks gestational age from 2011 to 2016. Primary outcomes were retention in HIV care (two HIV care visits or viral load measurements >90 days apart) and viral suppression (<200 copies/mL) at 12 and 24 months postpartum. Obstetric and contraception data were also collected. Results Among 207 women, 80% attended an HIV primary care visit in a mean 124 days after delivery. At 12 and 24 months, respectively, 47% and 34% of women were retained in care and 41% and 30% of women were virally suppressed. Attending an HIV care visit within 90 days postpartum was associated with retention in care at 12 months (aOR 3.66, 95%CI 1.72-7.77) and 24 months (aOR 4.71, 95%CI 2.00-11.10) postpartum. Receiving ART at pregnancy diagnosis (aOR 2.29, 95%CI 1.11-4.74), viral suppression at delivery (aOR 3.44, 95%CI 1.39-8.50), and attending an HIV care visit within 90 days postpartum (aOR 2.40, 95%CI 1.12-5.16) were associated with 12-month viral suppression, and older age (aOR 1.09, 95% CI 1.01-1.18) was associated with 24-month viral suppression. Conclusions Long-term retention in HIV care and viral suppression are low in this population of postpartum WLWH. Prompt transition to HIV care in the postpartum period was the strongest predictor of optimal HIV outcomes. Efforts supporting women during the postpartum transition from obstetric to HIV primary care may improve long-term HIV outcomes in women.
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Andrews MM, Storm DS, Burr CK, Aaron E, Hoyt MJ, Statton A, Weber S. Perinatal HIV Service Coordination: Closing Gaps in the HIV Care Continuum for Pregnant Women and Eliminating Perinatal HIV Transmission in the United States. Public Health Rep 2018; 133:532-542. [PMID: 30096026 DOI: 10.1177/0033354918789912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Eliminating perinatal transmission of HIV and improving the care of childbearing women living with HIV in the United States require public health and clinical leadership. The Comprehensive Care Workgroup of the Elimination of Perinatal HIV Transmission Stakeholders Group, sponsored by the Centers for Disease Control and Prevention, developed a concept of perinatal HIV service coordination (PHSC) and identified 6 core functions through (1) semistructured exploratory interviews with contacts in 11 state or city health departments from April 2011 through February 2012, (2) literature review and summary of data on gaps in services and outcomes, and (3) group meetings from August 2010 through June 2017. We discuss leadership strategies for implementing the core functions of PHSC: strategic planning, access to services, real-time case finding, care coordination, comprehensive care, and data and case reviews. PHSC provides a systematic approach to optimize services and close gaps in perinatal HIV prevention and the HIV care continuum for childbearing women that can be individualized for jurisdictions with varying needs.
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Affiliation(s)
- Mary-Margaret Andrews
- 1 Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Deborah S Storm
- 2 François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Carolyn K Burr
- 2 François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Erika Aaron
- 3 Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.,4 AIDS Activities Coordination Office, Philadelphia Department of Health, Philadelphia, PA, USA
| | - Mary Jo Hoyt
- 2 François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Anne Statton
- 5 Pediatric AIDS Chicago Prevention Initiative, Chicago, IL, USA
| | - Shannon Weber
- 6 Perinatal HIV Hotline, HIVE, University of California San Francisco, San Francisco, CA, USA
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