Factors Associated with Postpartum Loss to Follow-Up and Detectable Viremia After Delivery Among Pregnant Women Living with HIV

2019 ◽  
Vol 33 (1) ◽  
pp. 14-20
Author(s):  
Emily H. Adhikari ◽  
Casey S. Yule ◽  
Scott W. Roberts ◽  
Vanessa L. Rogers ◽  
Jeanne S. Sheffield ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Loss To Follow Up ◽  
Factors Associated ◽  
Women Living With Hiv ◽  
Living With Hiv

Investigation of factors associated with spontaneous preterm birth in pregnant women living with HIV

AIDS ◽  
2020 ◽  
Vol 34 (5) ◽  
pp. 719-727
Author(s):  
Arianne Y.K. Albert ◽  
Chelsea Elwood ◽  
Emily C. Wagner ◽  
Zahra Pakzad ◽  
Tessa Chaworth-Musters ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Spontaneous Preterm Birth ◽  
Factors Associated ◽  
Women Living With Hiv ◽  
Living With Hiv

scholarly journals Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038311
Author(s):  
Angela Kelly-Hanku ◽  
Claire Elizabeth Nightingale ◽  
Minh Duc Pham ◽  
Agnes Mek ◽  
Primrose Homiehombo ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Papua New Guinea ◽  
Hiv Positive ◽  
Newly Diagnosed ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Loss To Follow Up ◽  
Factors Associated ◽  
Mother To Child

IntroductionDespite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua New Guinea remains suboptimal. An unacceptable number of babies are infected with HIV and mothers not retained in treatment. This study aimed to describe the characteristics of this programme and to investigate the factors associated with programme performance outcomes.MethodsWe conducted a retrospective analysis of clinical records of HIV-positive pregnant women at two hospitals providing prevention of mother to child transmission services. All women enrolled in the prevention of mother to child transmission programme during the study period (June 2012–June 2015) were eligible for inclusion. Using logistic regression, we examined the factors associated with maternal loss to follow-up (LTFU) before birth and before infant registration in a paediatric ARV programme.Results763 of women had records eligible for inclusion. Demographic and clinical differences existed between women at the two sites. Almost half (45.1%) of the women knew their HIV-positive status prior to the current pregnancy. Multivariate analysis showed that women more likely to be LTFU by the time of birth were younger (adjusted OR (AOR)=2.92, 95% CI 1.16 to 7.63), were newly diagnosed with HIV in the current/most recent pregnancy (AOR=3.50, 95% CI 1.62 to 7.59) and were in an HIV serodiscordant relationship (AOR=2.94, 95% CI 1.11 to 7.84). Factors associated with maternal LTFU before infant registration included being primipara at the time of enrolment (AOR=3.13, 95% CI 1.44 to 6.80) and being newly diagnosed in that current/most recent pregnancy (AOR=2.49, 95% CI 1.31 to 4.73). 6.6% (50 of 763) of exposed infants had a positive HIV DNA test.ConclusionsOur study highlighted predictors of LTFU among women. Understanding these correlates at different stages of the programme offers important insights for targets and timing of greater support for retention in care.

scholarly journals Prevention measures for vertical HIV transmission: monitoring infected pregnant women and exposed children

2021 ◽  
Vol 21 (1) ◽  
pp. 207-215
Author(s):  
Cristina Silvana da Silva Vasconcelos ◽  
Renata Junqueira Pereira ◽  
Adiléia Fernandes Barros da Silva Santos ◽  
Lúcia Helena Almeida Gratão
Keyword(s):  
Pregnant Women ◽  
Healthcare Service ◽  
Service Use ◽  
The State ◽  
Public Healthcare ◽  
Prevention Measures ◽  
Cross Sectional ◽  
Women Living With Hiv ◽  
Living With Hiv

Abstract Objectives: to present an analysis of the follow-up of exposed children and pregnant women living with HIV who are assisted in a reference public healthcare service of a Brazilian capital. Methods: this is a cross-sectional study with sociodemographic and clinical data obtainedfrom physical and electronic medical records of women living with HIV and exposed children, treated between 2000 and 2018, in a secondary healthcare service. For associations, the chi-square test at 5% significance was used. Results: the data about 183 pregnancies and 214 children from the capital or other municipalities in the state were analyzed. The women have low schooling, are brown or black, single, multiparous, diagnosed with HIV during prenatal care, with the start of follow-up from the third trimester of pregnancy and the use of prophylaxis during childbirth. As for children, the associations were significant for notification on SINAN, admission to the health service, use of prophylaxis indicating better monitoring for those who live in the state capital. Conclusions: the prevention measures recommended by the Ministry of Health, in general, were followed, but children and pregnant women who live in other cities were worse off than those ones in the capital. Unnotified cases were identified on SINAN. These issues may contribute to new cases of vertical transmission of HIV.

scholarly journals Factors Associated with Follow-Up of Children Exposed to Mother-to-Child Transmission of HIV: A Historical Cohort Study Form 2000 to 2017, in Porto Alegre, Brazil.

2021 ◽  
Author(s):  
Karen da Silva Calvo ◽  
Daniela Riva Knauth ◽  
Bruna Hentges ◽  
Andrea Fachel Leal ◽  
Mariana Alberto da Silva ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prenatal Care ◽  
Pregnant Women ◽  
Epidemiological Surveillance ◽  
Historical Cohort ◽  
Loss To Follow Up ◽  
Factors Associated ◽  
Historical Cohort Study ◽  
Years Of Schooling

Abstract Background: There are many inequalities in terms of prevention and treatment for pregnant women with HIV and exposed children in low and middle income countries. The Brazilian protocol for prenatal care includes rapid diagnostic testing for HIV, compulsory notification, and monitoring by the epidemiological surveillance of children exposed to HIV until 18 months after delivery. The case is closed after HIV serology results are obtained. Loss to follow-up is defined as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Loss to follow-up is a current problem and has been documented in other countries. This study analyzed the incidence of loss to follow-up of children exposed to HIV and the sociodemographic, behavioral and health variables of associated pregnant women. Methods: This historical cohort study included information on pregnant women living with HIV and the outcome of the child’s exposure to HIV. The association between predictors and the child’s outcome as a loss to follow-up was investigated using the Poisson Regression model. Relative Risk calculations were performed. The significance level of 5% was adopted for variables in the adjusted model. Results: Between 2000 and 2017, of 6,836 children exposed to HIV, 1,763 (25.8%) were classified as loss to follow-up. The factors associated were: maternal age of up to 22 years (aRR 1.25, 95% CI: 1.09-1.43), the mother’s self-declared race/color being black or mixed (aRR 1.13, 95% CI: 1.03-1.25), up to three years of schooling (aRR 1.45, 95% CI: 1.26-1.67), between four and seven years of schooling (aRR 1.14, 95% CI: 1.02-1.28), intravenous drug use (aRR 1.29, 95% CI: 1.12-1.50), and HIV diagnosis during prenatal care or at delivery (aRR 1.37, 95% CI: 1.24-1.52). Conclusion: Variables related to the individual, social and programmatic vulnerability of pregnant women were evidenced.

scholarly journals The relationship between intimate partner violence and HIV outcomes among pregnant women living with HIV in Malawi

2021 ◽  
Vol 33 (4) ◽  
pp. 242-252
Author(s):  
Elizabeth C. Wetzel ◽  
Tapiwa Tembo ◽  
Elaine J. Abrams ◽  
Alick Mazenga ◽  
Mike J. Chitani ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Psychosocial Factors ◽  
Partner Violence ◽  
Health Concern ◽  
Art Adherence ◽  
Global Public Health ◽  
Women Living With Hiv ◽  
Current Partner ◽  
Living With Hiv

BackgroundIntimate partner violence (IPV) is a global public health concern particularly in pregnancy where IPV can have negative health implications for the mother and child. Data suggest IPV disproportionately affects pregnant women living with HIV (PWLWH) compared to those without HIV. HIV-related outcomes are worse among women experiencing IPV. Despite this knowledge, there is paucity of data concerning PWLWH and IPV in Malawi, where there is a high HIV prevalence (10.6%). ObjectivesWe aim to characterize IPV amongst PWLWH in Malawi and describe its relationship to demographic characteristics, psychosocial factors, and HIV-related outcomes. MethodsThis analysis used data from the VITAL Start pilot study, which is a video-based intervention targeting retention and ART adherence amongst PWLWH in Malawi. PWLWH not on ART were recruited at antenatal clinic and given study questionnaires to assess demographics, IPV, and psychosocial factors. Questionnaires were also administered at one-month follow-up to assess outcomes related to HIV. Descriptive statistics and logistic regression models were used to explore the risk factors associated with IPV.ResultsThirty-nine percent of participants reported ever experiencing IPV from their current partner. The majority (53%) reporting IPV experienced more than one type of violence. IPV was associated with being married (p=0.04) and depression (p<0.0001) in the univariable analysis. For women retained at one-month, IPV was associated with reporting a missed ART dose in the past month but not with adherence measured by pill count.ConclusionsA large proportion of PWLWH experienced IPV from their current partner and IPV was associated with worse self-reported ART adherence at one-month follow-up. Further evidence is needed to understand how IPV impacts PWLWH throughout postpartum and beyond. Given the detrimental impact on health outcomes among PWLWH in Malawi, additional focus on IPV is essential to identify mechanisms to prevent, screen, and manage IPV among this population.

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

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