Effectiveness of the WHO/UNICEF guidelines on infant feeding for HIV-positive women: results from a prospective cohort study in South Africa

ObjectivesTo assess delays to antiretroviral therapy (ART) initiation before and after the Universal Test and Treat (UTT) and the same-day initiation (SDI) of ART policy periods in Johannesburg, South Africa.DesignProspective cohort study.SettingPatients were recruited from six primary health clinics in Johannesburg.ParticipantsOverall, 1029 newly diagnosed HIV positive adults (≥18 years) were consecutively enrolled by referral from the testing counsellor between April and December 2015 (pre-UTT n=146), July and August 2017 (UTT, n=141) and October 2017 and August 2018 (SDI, n=742).Main outcome measuresCox proportional hazards regression was used to assess predictors of 30 days ART initiation. Additionally, predictors of immediate ART initiation were evaluated using Poisson regression.ResultsOverall, 30 days ART proportions were 71.9% overall, 36.9% pre-UTT (44.3% of those eligible), 65.9% under UTT and 79.9% under the SDI policy. The median days to ART initiation declined from 21 pre-UTT (IQR: 15–30) to 8 (IQR: 6–16) under UTT and 5 days (IQR: 0–8) under the SDI policy. However, only 150 (20.2%) of the SDI cohort-initiated ART immediately after HIV diagnosis. Living in a two-adult home (adjusted HR (aHR) 1.2 vs living alone, 95% CI 1.0 to 1.5) increased the likelihood of 30-day ART. Missing baseline cluster of differentiation four (CD4) data decreased the likelihood of 30 days ART by 40% (aHR 0.6 vs CD4 <350 cells/µL, 95% CI 0.5 to 0.7). More women took up immediate ART (adjusted relative risk (aRR) 1.3, 95% CI 1.0 to 1.9). Participants ≥40 years (aRR 0.6 vs 18–24 years, 95% CI 0.4 to 0.9) were less likely to start ART immediately after HIV diagnosis. However, immediate ART rates increased with longer policy implementation time (aRR 0.2 for <3 months vs >10 months, 95% CI 0.1 to 0.4).ConclusionsThe study results highlight a positive move towards earlier ART initiation during the UTT and SDI periods and emphasise a need to increase same-day ART implementation further.

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The predictive value of an admission CD4 count in HIV positive and HIV negative patients with brain tumours at a single Neurosurgical centre in South Africa – A prospective cohort study

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2020.100888 ◽

2021 ◽

Vol 23 ◽

pp. 100888

Author(s):

Adrian Kelly ◽

Patrick Lekgwara

Keyword(s):

South Africa ◽

Cohort Study ◽

Prospective Cohort Study ◽

Predictive Value ◽

Prospective Cohort ◽

Brain Tumours ◽

Cd4 Count ◽

Hiv Positive ◽

Hiv Negative

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Correlates of reported modern contraceptive use among postpartum HIV-positive women in rural Nigeria: an analysis from the MoMent prospective cohort study

Reproductive Health ◽

10.1186/s12978-018-0663-8 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 2

Author(s):

Eric E. Chinaeke ◽

Chinenye Fan-Osuala ◽

Miriam Bathnna ◽

Chamberline E. Ozigbu ◽

Babayemi Olakunde ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Contraceptive Use ◽

Hiv Positive ◽

Modern Contraceptive ◽

Hiv Positive Women ◽

Rural Nigeria ◽

Modern Contraceptive Use ◽

The Moment

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Prospective cohort study of mortality in very low birthweight infants in a single centre in the Eastern Cape province, South Africa

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000918 ◽

2021 ◽

Vol 5 (1) ◽

pp. e000918

Author(s):

Isabel A Michaelis ◽

Ingeborg Krägeloh-Mann ◽

Ncomeka Manyisane ◽

Mikateko C Mazinu ◽

Esme R Jordaan

Keyword(s):

South Africa ◽

Cohort Study ◽

Birth Weight ◽

Mortality Rate ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Low Birthweight ◽

Eastern Cape Province ◽

Eastern Cape ◽

Overall Mortality

BackgroundNeonatal mortality is a major contributor worldwide to the number of deaths in children under 5 years of age. The primary objective of this study was to assess the overall mortality rate of babies with a birth weight equal or below 1500 g in a neonatal unit at a tertiary hospital in the Eastern Cape Province, South Africa. Furthermore, different maternal-related and infant-related factors for higher mortality were analysed.MethodsThis is a prospective cohort study which included infants admitted to the neonatal wards of the hospital within their first 24 hours of life and with a birth weight equal to or below 1500 g. Mothers who consented answered a questionnaire to identify factors for mortality.Results173 very low birth weight (VLBW) infants were recruited in the neonatal department between November 2017 and December 2018, of whom 55 died (overall mortality rate 32.0%). Twenty-three of the 44 infants (53,5%) with a birth weight below 1000 g died during the admission. One hundred and sixty-one mothers completed the questionnaire and 45 of their babies died.Main factors associated with mortality were lower gestational age and lower birth weight. Need for ventilator support and sepsis were associated with higher mortality, as were maternal factors such as HIV infection and age below 20 years.ConclusionThis prospective study looked at survival of VLBW babies in an underprivileged part of the Eastern Cape of South Africa. Compared with other public urban hospitals in the country, the survival rate remains unacceptably low. Further research is required to find the associated causes and appropriate ways to address these.

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