Does in utero HIV exposure and the early nutritional environment influence infant development and immune outcomes? Findings from a pilot study in Pretoria, South Africa

Abstract Background As mother-to-child transmission of HIV decreases, and the population of infants who are born HIV-exposed, but uninfected (HEU) continues to rise, there is a growing need to understand the development and health outcomes of infants who are HEU to ensure that they have the healthiest start to life. Methods In a prospective cohort pilot study at Kalafong Hospital, Pretoria, South Africa, we aimed to determine if we could recruit new mothers living with HIV on antiretrovirals (ART; n = 20) and not on ART (n = 20) and new mothers without HIV (n = 20) through our clinics to study the effects of HEU on growth and immune- and neurodevelopment in infants in early life, and test the hypothesis that infants who were HEU would have poorer health outcomes compared to infants who were HIV-unexposed, uninfected (HUU). We also undertook exploratory analyses to investigate relationships between the early nutritional environment, food insecurity and infant development. Infant growth, neurodevelopment (Guide for Monitoring Child Development [GMCD]) and levels of monocyte subsets (CD14, CD16 and CCR2 expression [flow cytometry]) were measured in infants at birth and 12 weeks (range 8–16 weeks). Results We recruited 33 women living with HIV on ART and 22 women living without HIV within 4 days of delivery from June to December 2016. Twenty-one women living with HIV and 10 without HIV returned for a follow-up appointment at 12 weeks postpartum. The high mobility of this population presented major challenges to participant retention. Preliminary analyses revealed lower head circumference and elevated CCR2+ (% and median fluorescence intensity) on monocytes at birth among infants who were HEU compared to HUU. Maternal reports of food insecurity were associated with lower maternal nutrient intakes at 12 weeks postpartum and increased risk of stunting at birth for infants who were HEU, but not infants who were HUU. Conclusions Our small feasibility pilot study suggests that HEU may adversely affect infant development, and further, infants who are HEU may be even more vulnerable to the programming effects of suboptimal nutrition in utero and postnatally. This pilot and preliminary analyses have been used to inform our research questions and protocol in our ongoing, full-scale study.

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Does in utero HIV-exposure and the early nutritional environment influence infant development and immune outcomes? Findings from a pilot study in Pretoria, South Africa

10.1101/19003889 ◽

2019 ◽

Author(s):

Marina White ◽

Ute D Feucht ◽

Eleanor Duffley ◽

Felicia Molokoane ◽

Chrisna Durandt ◽

...

Keyword(s):

South Africa ◽

Pilot Study ◽

Health Outcomes ◽

Food Insecurity ◽

Infant Development ◽

In Utero ◽

New Mothers ◽

Women Living With Hiv ◽

Nutritional Environment ◽

Living With Hiv

AbstractBackgroundAs mother-to-child-transmission of HIV decreases, and the population of infants who are born HIV-exposed, but uninfected (HEU) continues to rise, there is growing need to understand the development and health outcomes of infants who are HEU to ensure that they have the healthiest start to life.MethodsIn a prospective cohort pilot study at Kalafong Hospital, Pretoria, South Africa, we aimed to determine if we could recruit new mothers living with HIV on antiretrovirals (ART; n=20) and not on ART (n=20), and new mothers without HIV (n=20) through our clinics to study the effects of HEU on growth, immune- and neuro-development in infants in early life, and test the hypothesis that infants who were HEU would have poorer health outcomes compared to infants who were HIV-unexposed, uninfected (HUU). We also undertook exploratory analyses to investigate relationships between the early nutritional environment, food insecurity, and infant development. Infant growth, neurodevelopment (Guide for Monitoring Child Development [GMCD]) and levels of monocyte subsets (CD14, CD16, and CCR2 expression [flow cytometry]) were measured in infants at birth and 12 weeks (range 8-16 weeks).ResultsWe recruited 33 women living with HIV on ART, and 22 women living without HIV within four days of delivery from June-December 2016. 21 women living with HIV and 10 without HIV returned for a follow-up appointment at 12 weeks postpartum. The high mobility of this population presented major challenges to participant retention. Preliminary analyses revealed lower head circumference and elevated CCR2+ (% and median fluorescence intensity) on monocytes at birth among infants who were HEU compared to HUU. Maternal reports of food insecurity were associated with lower maternal nutrient intakes at 12 weeks postpartum and increased risk of stunting at birth for infants who were HEU, but not infants who were HUU.ConclusionsOur small feasibility pilot study suggests that HEU may adversely affect infant development, and further, infants who are HEU may be even more vulnerable to the programming effects suboptimal nutrition in utero and postnatally. This pilot and preliminary analyses have been used to inform our research questions and protocol in our ongoing, full-scale study.

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How do maternal HIV infection and the early nutritional environment influence the development of infants exposed to HIV in utero?

10.1101/19003871 ◽

2019 ◽

Author(s):

Marina White ◽

Eleanor Duffley ◽

Ute D. Feucht ◽

Theresa Rossouw ◽

Kristin L. Connor

Keyword(s):

Hiv Infection ◽

Food Insecurity ◽

Infant Development ◽

Dietary Diversity ◽

In Utero ◽

Nutrient Intakes ◽

Increased Risk ◽

Maternal Hiv ◽

Nutritional Environment ◽

Maternal Hiv Infection

AbstractMalnutrition and infectious disease often coexist in socially inequitable contexts. Malnutrition in the perinatal period adversely affects offspring development and lifelong non-communicable disease risk. Less is known about the effects of infectious disease exposure during critical windows of development and health, and links between in utero HIV-exposure in the absence of neonatal infection, perinatal nutritional environments, and infant development are poorly defined. In a pilot feasibility study at Kalafong Hospital, Pretoria, South Africa, we aimed to better understand relationships between maternal HIV infection and the early nutritional environment of in utero HIV exposed uninfected (HEU) infants. We also undertook exploratory analyses to investigate relationships between food insecurity and infant development. Mother-infant dyads were recruited after delivery and followed until 12 weeks postpartum. Household food insecurity, nutrient intakes and dietary diversity scores did not differ between mothers living with or without HIV. Maternal reports of food insecurity were associated with lower maternal nutrient intakes 12 weeks postpartum, and in infants, higher brain-to-body weight ratio at birth and 12 weeks of age, and attainment of fewer large movement and play activities milestones at 12 weeks of age, irrespective of maternal HIV status. Reports of worry about food runout were associated with increased risk of stunting for HEU, but not unexposed, uninfected infants. Our findings suggest that food insecurity, in a vulnerable population, adversely affects maternal nutritional status and infant development. In utero exposure to HIV may further perpetuate these effects, which has implications for early child development and lifelong human capital.

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Condom use promotion among isiXhosa speaking women living with HIV in the Western Cape Province, South Africa: a pilot study

AIDS Care ◽

10.1080/09540120802537823 ◽

2009 ◽

Vol 21 (7) ◽

pp. 817-825 ◽

Cited By ~ 22

Author(s):

Dorina Saleh-Onoya ◽

Priscilla S. Reddy ◽

Robert A.C. Ruiter ◽

Sibusiso Sifunda ◽

Gina Wingood ◽

...

Keyword(s):

South Africa ◽

Pilot Study ◽

Condom Use ◽

Western Cape ◽

Western Cape Province ◽

Women Living With Hiv ◽

Living With Hiv

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Intensity of Social Support Matters: A Latent Class Analysis to Identify Levels of Social Support Associated with Optimal Health Outcomes Among Women Living with HIV

AIDS and Behavior ◽

10.1007/s10461-021-03377-8 ◽

2021 ◽

Author(s):

Aruna Chandran ◽

Fiona Bhondoekhan ◽

Tracey E. Wilson ◽

Joel Milam ◽

Mardge H. Cohen ◽

...

Keyword(s):

Social Support ◽

Health Outcomes ◽

Latent Class Analysis ◽

Latent Class ◽

Class Analysis ◽

Women Living With Hiv ◽

Optimal Health ◽

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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Feasibility of SMS to remind pregnant and breastfeeding women living with HIV to take antiretroviral treatment in Kilimanjaro region, Tanzania: a pilot study

East African Health Research Journal ◽

10.24248/eahrj.v4i2.637 ◽

2020 ◽

Vol 4 (2) ◽

pp. 140-148

Author(s):

Kennedy M Ngowi ◽

Eusebious Maro ◽

Rob E Aarnoutse ◽

Blandina T Mmbaga ◽

Mirjam A. G Sprangers ◽

...

Keyword(s):

Pilot Study ◽

Antiretroviral Treatment ◽

Network Failure ◽

Women Living With Hiv ◽

Resource Limited ◽

Sms Reminders ◽

Kilimanjaro Christian Medical Centre ◽

Living With Hiv ◽

Lost To Follow Up ◽

Privacy Issues

Background: Pregnant and breastfeeding Women Living with HIV (WLHIV) often have difficulties in reaching adequate levels of adherence (>95%) to Antiretroviral treatment. “Forgetting” is the most commonly mentioned reason. Sending reminders via SMS is expected to improve adherence. We conducted a pilot study to investigate acceptability, user experience and technical feasibility of sending reminder-SMS to WLHIV. Methods: This was a 6-months observational pilot-study among WLHIV attending antenatal and postnatal care at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. Women received a reminder-SMS 30 minutes before usual time of intake. One hour later, they received an SMS asking whether they took medication to which they could reply with ‘Yes’ or ‘No’. Messages were sent 3 times a week on randomly chosen days to prevent reliance on daily messages. We calculated the percentage of number of SMS delivered, failed to be delivered, and replied to. We analysed feedback from exit-interviews about experience with the SMS-reminders. Results: 25 women were enrolled (age 18-45), 2 were lost to follow up. 5,054 messages were sent of which 53 failed to be delivered (1%). 1,880 SMS were sent with a question if medication was taken; 1,012 (54%) messages were replied to, of which 1,003 (99%) were replied with ‘YES’ and closely to ‘YES’, and a total of 9 (1%) with ‘NO’ and ‘closely to NO’. 868 messages (46%) were not responded to due to either dropout, change of phone number, loss of phone or network failure. Results from 18 interviews showed that 16 (89%) women were satisfied with SMS reminders. 2 (11%) were concerned about unwanted disclosure because of the content ‘don’t forget to take medication’ and one reported other privacy issues (6%). 3 (17%) women experienced stigma. Conclusion: 99%of SMS being delivered indicates that SMS reminders in this resource-limited setting are technically feasible. However, concerns regarding privacy were noted, specifically the risk of unwanted disclosure and the experience of stigma. Participants indicated that being made aware of their adherence, motivated them to adhere better. However, personalised and more neutral content of the SMS might be a way to improving the intervention.

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Utility and acceptability of text messages for PMTCT: a qualitative assessment of user experiences (Preprint)

10.2196/preprints.32272 ◽

2021 ◽

Author(s):

Melinda Brown ◽

May Maloba ◽

Catherine Wexler ◽

Natabhona Mabachi ◽

Sharon Koech ◽

...

Keyword(s):

Medication Adherence ◽

Pilot Study ◽

Clinical Care ◽

Text Messages ◽

Hiv Care ◽

Qualitative Assessment ◽

Women Living With Hiv ◽

Pregnancy And Postpartum ◽

Living With Hiv ◽

The Impact

BACKGROUND Evidence that text messages can support patient adherence to HIV care is growing. We conducted a pilot study of the HIV Infant Tracking System (HITSystem 2.0), an intervention that includes SMS to patients to support maternal medication adherence, appointment attendance, and hospital-based deliveries during the antenatal period. OBJECTIVE The objective of this study was to qualitatively assess women’s experiences receiving SMS to understand message utility and acceptability with the goal of refining and strengthening the intervention. METHODS As part of an intervention development pilot study, we conducted semi-structured interviews with 33 women living with HIV who received SMS through the HITSystem 2.0 throughout their pregnancy and postpartum period. Interview questions assessed women’s feedback of the SMS, the impact of the SMS on their PMTCT care, and suggestions for improvement. RESULTS Participants described how SMS reinforced existing strategies for medication adherence and served as cues to action for antenatal appointments and hospital-based deliveries. SMS also provided encouragement and enhanced their sense of engagement with their clinical care team. Given the neutral content of the messages, most women reported no concerns about message confidentiality. Recommendations to enhance utility included greater customizability (timing and frequency of messages) and a few women suggested more comprehensive counseling regarding the SMS content to anticipate at the time of enrollment. CONCLUSIONS SMS content was deemed useful and acceptable by pregnant and postpartum women living with HIV and engaged in PMTCT services. Participant recommendations to increase message customization options have been adopted to enhance the intervention. CLINICALTRIAL Trial registration: clinicaltrials.gov, NCT02726607. Registered 01 April 2016. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02726607

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