High blood pressure at entry into antenatal care and birth outcomes among a cohort of HIV-uninfected women and women living with HIV initiating antiretroviral therapy in South Africa

Abstract Background South Africa is home to more people living with HIV than any other country, including nearly one in three pregnant women attending antenatal care. Access to antiretroviral therapy (ART) has increased substantially since the start of the national ART program in 2004, with > 95% ART coverage during pregnancy and delivery, and vertical transmission of HIV greatly reduced. However, women who initiate ART during pregnancy are at heightened risk of dropping out of care, particularly after delivery, leading to the potential for viral transmission, morbidity and mortality. It is difficult to evaluate the success of policies of expanded access to ART care, and assess continuity of care, due to the lack of a national longitudinal HIV care database. Also, patient movement between unlinked facilities. For the first time on a national level, we propose to utilize routinely-collected laboratory data to develop and validate a cohort of pregnant women living with HIV in South Africa in a way that is uniquely robust to facility transfer. Methods Using laboratory test data matched to facility type, we will identify entry to antenatal care to build the cohort, then describe key treatment milestones, including 1) engagement in antenatal care, 2) initiation of ART, 3) HIV viremia, and 4) continuity of HIV care in the postpartum period. Second, we will measure the effect of system-wide factors impacting continuity of care among pregnant women. We will assess policies of expanded treatment access on continuity of care using regression-discontinuity analyses. We then will assess mobility and its effect on continuity of care during and after pregnancy. Third, we will identify individual-level risk factors for loss from HIV care in order to develop targeted interventions to improve engagement in HIV care. Discussion This work will create the world’s largest national cohort of pregnant women living with HIV. This novel cohort will be a powerful tool available to policymakers, clinicians and researchers for improving our understanding of engagement in care among pregnant women in South Africa and assessing the performance of the South African national ART program in caring for pregnant women living with HIV. Trial registration N/A (not a clinical trial).

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The effect of eligibility for antiretroviral therapy on body mass index and blood pressure in KwaZulu-Natal, South Africa

Scientific Reports ◽

10.1038/s41598-021-94057-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Aditi Kuber ◽

Anna Reuter ◽

Pascal Geldsetzer ◽

Natsayi Chimbindi ◽

Mosa Moshabela ◽

...

Keyword(s):

South Africa ◽

Blood Pressure ◽

Body Mass Index ◽

Antiretroviral Therapy ◽

Body Mass ◽

Treatment Guidelines ◽

Causal Effect ◽

Regression Discontinuity Design ◽

National Treatment ◽

Kwazulu Natal

AbstractWe use a regression discontinuity design to estimate the causal effect of antiretroviral therapy (ART) eligibility according to national treatment guidelines of South Africa on two risk factors for cardiovascular disease, body mass index (BMI) and blood pressure. We combine survey data collected in 2010 in KwaZulu-Natal, South Africa, with clinical data on ART. We find that early ART eligibility significantly reduces systolic and diastolic blood pressure. We do not find any significant effects on BMI. The effect on blood pressure can be detected up to three years after becoming eligible for ART.

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Social Vulnerability among Foreign-Born Pregnant Women and Maternal Virologic Control of HIV

American Journal of Perinatology ◽

10.1055/s-0040-1721714 ◽

2020 ◽

Author(s):

Ashish Premkumar ◽

Lynn M. Yee ◽

Lia Benes ◽

Emily S. Miller

Keyword(s):

Antiretroviral Therapy ◽

Pregnant Women ◽

Median Time ◽

Social Vulnerability ◽

Viral Suppression ◽

Foreign Born ◽

Women Living With Hiv ◽

Virologic Control ◽

Clinical Records ◽

Living With Hiv

Objective The aim of this study was to assess whether social vulnerability among foreign-born pregnant women living with HIV is associated with maternal viremia during pregnancy. Study Design This retrospective cohort study included all foreign-born pregnant women living with HIV who received prenatal care in a multidisciplinary prenatal clinic between 2009 and 2018. A licensed clinical social worker evaluated all women and kept detailed clinical records on immigration status and social support. Social vulnerability was defined as both living in the United States for less than 5 years and reporting no family or friends for support. The primary outcome was evidence of viral non-suppression after achievement of initial suppression. Secondary outcomes were the proportion of women who required > 12 weeks after starting antiretroviral therapy to achieve viral suppression, median time to first viral suppression (in weeks) after initiation of antiretroviral therapy, and the proportion who missed ≥ 5 doses of antiretroviral therapy. Bivariable analyses were performed. Results A total of 111 foreign-born women were eligible for analysis, of whom 25 (23%) were classified as socially vulnerable. Social and clinical characteristics of women diverged by social vulnerability categorization but no differences reached statistical significance. On bivariable analysis, socially-vulnerable women were at increased risk for needing > 12 weeks to achieve viral suppression (relative risk: 1.78, 95% confidence interval: 1.18–2.67), though there was no association with missing ≥ 5 doses of antiretroviral therapy or median time to viral suppression after initiation of antiretroviral therapy. Conclusion Among foreign-born, pregnant women living with HIV, markers of virologic control during pregnancy were noted to be worse among socially-vulnerable women. Insofar as maternal viremia is the predominant driver of perinatal transmission, closer clinical surveillance and support may be indicated in this population. Key Points

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Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis

Journal of Human Hypertension ◽

10.1038/jhh.2015.97 ◽

2015 ◽

Vol 30 (6) ◽

pp. 355-362 ◽

Cited By ~ 48

Author(s):

C U Nduka ◽

S Stranges ◽

A M Sarki ◽

P K Kimani ◽

O A Uthman

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Antiretroviral Therapy ◽

Meta Analysis ◽

People Living With Hiv ◽

Hypertension Risk ◽

Living With Hiv

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Prevalence and Correlates of Snuff Use, and its Association With Tuberculosis, Among Women Living With HIV in South Africa

Nicotine & Tobacco Research ◽

10.1093/ntr/nty137 ◽

2018 ◽

Vol 21 (8) ◽

pp. 1087-1092 ◽

Cited By ~ 1

Author(s):

Jessica L Elf ◽

Ebrahim Variava ◽

Sandy Chon ◽

Limakatso Lebina ◽

Katlego Motlhaoleng ◽

...

Keyword(s):

South Africa ◽

Tobacco Use ◽

Smokeless Tobacco ◽

People Living With Hiv ◽

Potential Health ◽

Adjusted Analysis ◽

Women Living With Hiv ◽

Urine Cotinine ◽

Smokeless Tobacco Use ◽

Living With Hiv

Abstract Introduction A higher proportion of people living with HIV (PLWH) smoke compared to the general population, but little information exists about the prevalence and correlates of smokeless tobacco use among PLWH. In South Africa, dry powdered tobacco is inhaled nasally as snuff. Methods A cross-sectional survey among PLWH attending three HIV clinics was conducted. Snuff use was assessed via self-report and urine cotinine. Results Given the low (3%) prevalence of snuff use among men, analysis was restricted to n = 606 nonsmoking women living with HIV. Half (n = 298, 49%) were snuff users, the majority of whom (n = 244, 84%) had a positive urine cotinine test. In adjusted analysis, snuff use was negatively associated with higher education (relative risk [RR] 0.55; 95% confidence interval [CI]: 0.39, 0.77) and mobile phone ownership (RR 0.83; 95% CI: 0.71, 0.98), and positively associated with ever having tuberculosis (TB) (RR 1.22; 95% CI: 1.03, 1.45). In adjusted analysis, with current TB as the outcome, snuff use was marginally statistically significantly associated with a twofold increase in odds of a current TB diagnosis (odds ratio [OR] 1.99; 95% CI: 0.98, 4.15). Discussion A high proportion of nonsmoking South African women living with HIV use snuff, which was a risk factor for TB. Additional research is needed to understand the relationship between snuff, TB, and other potential health risks. Implications PLWH have a higher prevalence of smoking than their seronegative peers, but there is a paucity of research on smokeless tobacco use in this population, especially in low-resource settings. TB is the leading cause of death among PLWH, and with improvements to HIV treatment and care, PLWH are at greater risk of tobacco-related diseases. We report an extremely high prevalence of snuff use among women living with HIV in South Africa. Further, in this population snuff use is positively associated with ever having a TB diagnosis, as well as currently having TB.

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Occupational barriers to accessing and adhering to antiretroviral therapy for female sex workers living with HIV in South Africa

Occupational and Environmental Medicine ◽

10.1136/oemed-2019-105947 ◽

2020 ◽

Vol 77 (2) ◽

pp. 100-106 ◽

Cited By ~ 2

Author(s):

Lauren E Parmley ◽

Carly A Comins ◽

Katherine Young ◽

Mfezi Mcingana ◽

Deliwe Rene Phetlhu ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

Coping Strategies ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Disclosure ◽

Female Sex ◽

Adherence Support ◽

Wage Loss ◽

Living With Hiv

ObjectivesWhile female sex workers (FSW) are nearly 14 times more likely to be living with HIV than non-FSW, less than 40% of FSW living with HIV are on antiretroviral therapy (ART). We sought to understand how the work environment influences ART access and adherence for FSW in preparation for the Siyaphambili trial.MethodsFSW living with HIV (n=24) and key informants (n=15) were recruited to participate in semistructured in-depth interviews using maximum variation and snowball sampling, respectively. FSW were recruited on key variants including type of sex work venue, primary work time and history of ART use. Data were collected between September and November 2017 in Durban, South Africa. Interviews were audio-recorded, transcribed and translated. Data were then coded applying grounded theory in Atlas.ti.ResultsFSW experienced occupational barriers to adherence including work-related migration, substance use and theft of ART on the job. Fear of wage loss due to HIV disclosure to clients and brothel managers prevented some FSW from accessing ART at their clinic and taking medications while working. FSW employed coping strategies to overcome barriers including sharing ART with colleagues, carrying small supplies of ART and visiting the clinic prior to appointments for ART refills. Further, some FSW received adherence support from colleagues who were also living with HIV.ConclusionsConsidering these occupational pressures on FSW and supporting positive coping strategies are important when designing and implementing HIV treatment programmes. Findings suggest strengthening social cohesion and supporting differentiated care efforts to improve HIV outcomes among FSW living with HIV.

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