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

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

Unintended pregnancy and viral suppression in pregnant women living with HIV

2018 ◽  
Vol 219 (6) ◽  
pp. 651
Author(s):  
Annie M. Dude ◽  
Emily S. Miller ◽  
Patricia M. Garcia ◽  
Lynn M. Yee
Keyword(s):  
Pregnant Women ◽  
Unintended Pregnancy ◽  
Viral Suppression ◽  
Women Living With Hiv ◽  
Living With Hiv

scholarly journals Antiretroviral therapy in pregnant women living with HIV: a clinical practice guideline

BMJ ◽  
2017 ◽  
pp. j3961 ◽  
Author(s):  
Reed A C Siemieniuk ◽  
Lyubov Lytvyn ◽  
Jinell Mah Ming ◽  
Rhonda Marama Mullen ◽  
Florence Anam ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Women Living With Hiv ◽  
Living With Hiv

scholarly journals 483: Social vulnerability among foreign-born pregnant women and maternal virologic control of HIV

2020 ◽  
Vol 222 (1) ◽  
pp. S316
Author(s):  
Ashish Premkumar ◽  
Lynn M. Yee ◽  
Lia R. Benes ◽  
Emily S. Miller
Keyword(s):  
Pregnant Women ◽  
Social Vulnerability ◽  
Foreign Born ◽  
Virologic Control

scholarly journals 993. Risk Factors for Periconception Non-Suppression Among Women Living with HIV in Kisumu, Kenya

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S525-S525
Author(s):  
Ephrat Fisseha ◽  
Karen Hampanda ◽  
Patrick Oyaro ◽  
Evelyn Brown ◽  
Irene Mukui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Viral Suppression ◽  
Univariate Analysis ◽  
Transcriptase Inhibitor ◽  
Viral Loads ◽  
Study Enrollment ◽  
Women Living With Hiv ◽  
Women With Hiv ◽  
Living With Hiv

Abstract Background Pregnant and postpartum women living with HIV (WLHIV) are a priority population for virologic monitoring and efforts to ensure viral suppression to reduce the risk for vertical-transmission and poor maternal health outcomes. Few studies have examined the role of parity on viral suppression during periconception in WLHIV. Methods We present data from the ongoing Opt4Mamas study which enrolled pregnant women with HIV on antiretroviral therapy between March and November 2019 attending antenatal care in five public health facilities in Kisumu County, Kenya. We evaluated associations between various sociodemographic and psychosocial factors and periconception viral suppression (< 40 copies/mL) within 12 months of study enrollment. We conducted univariate and multivariate logistic regressions, calculating odds ratios (OR) and 95% confidence intervals (CI). Results Among 497 women enrolled, mean age 29.9 years, 301 (61%) had viral load results available within 12 months of study enrollment. Viral loads were available a median of 18 days from conception (interquartile range 71 days before to 90 days after conception), and 237 women (79%) were virally suppressed. The majority (90%) of women were on a non-nucleoside reverse transcriptase inhibitor and 23 (9%) were on a protease inhibitor-containing regimen. In univariate analysis, women younger than 25 and primigravida women were less likely to be virally suppressed (OR 0.31, 95% CI [0.16 - 0.60] and OR 0.25, 95% CI [0.11 - 0.61] respectively; Table 1). The relationship between primigravida and periconception viral suppression is modified by age and duration on ART. Primigravida women who were younger than 25 years or who had less than 1 year of ART had significantly reduced odds of achieving viral suppression in the past year compared to primigravida women who were older or who had more experience taking ART (OR 0.09, 95%CI [0.03-0.31] and OR 0.09, 95%CI [0.02-0.48] respectively; Table 2). Table 1: Comparison of Pregnant Women with HIV by Periconception Viral Suppression Table 2: Interaction Effects with Primigravida Status Conclusion Risk factors for non-suppression around the time of conception in WLHIV include primigravida status, which is modified by age and duration on ART. Interventions targeting viral suppression among WLHIV leading up to their first pregnancy are needed, particularly among those who are newly initiated onto ART or younger age. Disclosures All Authors: No reported disclosures

scholarly journals The syndemic effects of mental ill health, household hunger, and intimate partner violence on adherence to antiretroviral therapy among pregnant women living with HIV in Yaoundé, Cameroon

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246467
Author(s):  
Evette Cordoba ◽  
Angela M. Parcesepe ◽  
John A. Gallis ◽  
Jennifer Headley ◽  
Claudian Soffo ◽  
...  
Keyword(s):  
Intimate Partner Violence ◽  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Partner Violence ◽  
Common Mental Disorders ◽  
Intimate Partner ◽  
Art Adherence ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
The Relationship

Background This research advances understanding of interrelationships among three barriers to adherence to antiretroviral therapy (ART) among pregnant women living with HIV (WLWH) in Cameroon: probable common mental disorders (CMD), intimate partner violence (IPV), and hunger. Methods The sample included 220 pregnant WLWH in Cameroon. Multivariable modified Poisson regression was conducted to assess the relationship between IPV, hunger, and CMD on ART adherence. Results Almost half (44%) of participants recently missed/mistimed an ART dose. Probable CMD was associated with greater risk of missed/mistimed ART dose (aRR 1.5 [95% CI 1.1, 1.9]). Hunger was associated with greater risk of missed/mistimed ART dose among those who reported IPV (aRR 1.9 [95% CI 1.2, 2.8]), but not among those who did not (aRR 0.8 [95% CI 0.2, 2.3]). Conclusion Suboptimal ART adherence, CMD, and IPV were common among pregnant WLWH in Cameroon. Pregnant WLWH experiencing IPV and hunger may be especially vulnerable to suboptimal ART adherence.

Unintended pregnancy and viral suppression in pregnant women living with HIV

2021 ◽  
Vol 3 (2) ◽  
pp. 100300
Author(s):  
Annie M. Dude ◽  
Emily S. Miller ◽  
Patricia M. Garcia ◽  
Lynn M. Yee
Keyword(s):  
Pregnant Women ◽  
Unintended Pregnancy ◽  
Viral Suppression ◽  
Women Living With Hiv ◽  
Living With Hiv

scholarly journals Factors for Low Uptake of Antiretroviral Therapy Among HIV Pregnant Women in Mbeya City Council, Tanzania

2019 ◽  
Vol 9 (1) ◽  
pp. 253
Author(s):  
Lawrencia Dominick Mushi ◽  
Eileen A Mhando
Keyword(s):  
Antiretroviral Therapy ◽  
Health Service ◽  
Pregnant Women ◽  
City Council ◽  
People Living With Hiv ◽  
Health Providers ◽  
Key Informants ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
Depth Interviews

UNAIDS aimed to reach 90% antiretroviral therapy uptake among people living with HIV by 2015. Despite free provision of antiretroviral therapy to pregnant women living with HIV, the uptake remains low. This study describes views of pregnant women about low uptake of antiretroviral therapy among pregnant women living with HIV in Mbeya City Council.The study used a descriptive cross-sectional design and applied mixed research approaches. 44 pregnant women on antiretroviral therapy and 12 health providers were conveniently selected. Four key informants were purposively selected. In-depth interviews with pregnant women and key informants; exit interviews with pregnant women; and observation of health providers were conducted. Audio tape recording from in-depth interviews was transcribed into Swahili to English. Social ecological framework was used in data coding based on individual, social and health service aspects then analysed using Atlas. ti 7. Quantitative data was analyzed in Excel spreadsheet, and presented using tables.The findings from interviews and observations showed that the main individual factors (like treatment-related side effects and religious faith); social factors (like traditional medicine and lack of partner/husband support) and health service factors (like long waiting time and discrepancy in information given to clients during adherence counseling on antiretroviral therapy) were more likely to be associated with low uptake of antiretroviral therapy.This study indicates that various factors at individual, social and health service levels were more likely to cause low uptake of ART. Reasons for discrepant information during counseling by providers remain a question which needs further research.

scholarly journals Initiation of antiretroviral therapy or antiretroviral prophylaxis in pregnant women living with HIV registered in five townships of Mandalay, Myanmar: A cross sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Khine Wut Yee Kyaw ◽  
Aye Aye Mon ◽  
Khaing Hnin Phyo ◽  
Nang Thu Thu Kyaw ◽  
Ajay M. V. Kumar ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Prevalence Ratio ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Hiv Diagnosis ◽  
Cross Sectional ◽  
Women Living With Hiv ◽  
Antiretroviral Prophylaxis ◽  
Living With Hiv

Abstract Background A series of interventions are required to prevent mother to child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) starting from HIV testing of pregnant women, initiating antiretroviral therapy (ART) or antiretroviral prophylaxis to HIV-positive pregnant women to providing HIV prophylaxis to newborn babies. Gaps in each step can significantly affect the effectiveness of PMTCT interventions. We aimed to determine the gap in initiation of ART/antiretroviral prophylaxis for pregnant women living with HIV, delay in initiation of ART/antiretroviral prophylaxis and factors associated with the delay. Methods This is a cross sectional study using routinely collected programme data from five health facilities providing PMTCT services located at Township Health Departments (THD) of Mandalay, Myanmar. Results There were 363 pregnant women living with HIV enrolled between January 2012 and December 2017. Sixty (16%) women were excluded from the study due to missing data on dates of HIV diagnosis. Of 303 (84%) women included in the study, 89/303 (29%) and 214/303 (71%) were diagnosed with HIV before and during current pregnancy respectively. Among 214 women, 180 (84%) women were started on ART by the censor date (31st March 2018). Among those who started ART, 109 (61%) women had a delay of starting ART > 2 weeks from diagnosis. Women residing in township 4 had a significantly higher risk of delay in initiation of ART/antiretroviral prophylaxis compared to women residing in township 1 [adjusted prevalence ratio 4.2 (95% confidence interval 1.2–14.8]. Conclusions We found that one in four women living with HIV knew their HIV status before current pregnancy. Although the rate of ART/antiretroviral prophylaxis initiation was high among pregnant women living with HIV, there was a delay. Early initiation of ART/antiretroviral prophylaxis among newly HIV diagnosed pregnant women needs to be strengthened.

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