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

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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2017 HIVMA of IDSA Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With HIV

Clinical Infectious Diseases ◽

10.1093/cid/cix636 ◽

2017 ◽

Vol 65 (10) ◽

pp. e1-e37 ◽

Cited By ~ 38

Author(s):

R Douglas Bruce ◽

Jessica Merlin ◽

Paula J Lum ◽

Ebtesam Ahmed ◽

Carla Alexander ◽

...

Keyword(s):

Chronic Pain ◽

Clinical Practice ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Living With Hiv

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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 ◽

10.1371/journal.pone.0246467 ◽

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.

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Care of pregnant women with decreased fetal movements: Update of a clinical practice guideline for Australia and New Zealand

Australian and New Zealand Journal of Obstetrics and Gynaecology ◽

10.1111/ajo.12762 ◽

2018 ◽

Vol 58 (4) ◽

pp. 463-468 ◽

Cited By ~ 13

Author(s):

Lisa M. Daly ◽

Glenn Gardener ◽

Victoria Bowring ◽

Wendy Burton ◽

Yogesh Chadha ◽

...

Keyword(s):

Clinical Practice ◽

New Zealand ◽

Pregnant Women ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Fetal Movements

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Beneficios de la hidroterapia en el trabajo de parto. Estudio de revisión.

MUSAS ◽

10.1344/musas2020.vol5.num1.2 ◽

2020 ◽

Vol 5 (1) ◽

Author(s):

Andrea Benavides-Navarro ◽

Andrea Benavides-Navarro

Keyword(s):

Clinical Practice ◽

Pregnant Women ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Cochrane Library ◽

Safety And Efficacy ◽

Interventional Techniques ◽

Normal Birth ◽

Alternative Techniques

Introduction The growing demand of pregnant women to achieve a delivery as physiological as possible has led to a decrease in interventional techniques and consequently a rise in the search for alternative techniques for the relief of pain during labor, among which we can highlight hydrotherapy. Objectives To describe the effectiveness of the use of hydrotherapy in relation to the perception of pain during labor. Methodology Bibliographic review using the databases PubMed, Cuiden, Cuidatge, Cochrane Library and CINHAL. Results A total of 17 articles have been included: 13 original articles and 4 bibliographic reviews. In addition to this, the Clinical Practice Guideline on Normal Birth Care has been used. The articles refer to the maternal and perinatal results of the use of hydrotherapy in the dilatation phase and the expulsive phase, as well as the perceptions of midwives, nurses and pregnant women of its use. Conclusions The use of the hydrotherapy during the dilation phase of labor decreases the perception of pain and the use of pharmacological measures. However, the safety and efficacy of immersion in water in the expulsive phase have not been established and no benefits have been associated for the mother or the foetus.

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

Journal of Public Administration and Governance ◽

10.5296/jpag.v9i1.14337 ◽

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.

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

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2627-6 ◽

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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