scholarly journals COVID-19 Pandemic: Engagement in Obstetric Care for Women with HIV and Substance Use Disorder

2021 ◽  
Vol 6 (2) ◽  
Keyword(s):  
Substance Use ◽  
Literature Review ◽  
Pregnant Women ◽  
Substance Use Disorder ◽  
Obstetric Care ◽  
Obstetric Outcomes ◽  
Engagement In Care ◽  
Women Living With Hiv ◽  
Women With Hiv ◽  
Living With Hiv

Background: HIV and substance use disorder are major risk factors for poor obstetric outcomes and women who live with both conditions should be closely monitored during pregnancy and postpartum. It is unclear what engagement in obstetric care for women living with HIV and substance use disorder look like before and during the COVID-19 pandemic. This literature review aims to examine engagement in obstetric care for women living with HIV and substance use disorder before and during the COVID-19 pandemic and offer strategies to increase engagement in care during the COVID-19 pandemic for this vulnerable population. Methods: A literature review was conducted on January 12, 2021 across major databases including Pubmed, PsychInfo, Cochrane, and CINAHL. Results: A total of 6 studies were included in this review. Studies either assessed outcome of engagement in care among pregnant women living with HIV or pregnant women with substance use disorder. Our findings demonstrate that pregnant women with HIV or substance use disorder tend to have comorbid conditions and are less likely to be engaged in obstetric care, and this trend is aggravated by the COVID-19 pandemic. Approaches to care during the COVID-19 pandemic included expanding services outside of the clinic to virtual visits, telephonic engagement, text messaging, or electronic mail. Conclusion: Pregnant women with HIV and/or substance use disorder are at much higher risk for poor engagement in obstetric care, suboptimal financial and social support, and adverse outcomes. We recommend each in-person clinic visit be accompanied by thorough screening for mental health issues, and psychosocial difficulties. Referral services should be ready and accessible if the woman screens positive. Nurses are an integral part of ensuring proper care coordination and follow-up. More research is needed to examine engagement in obstetric care for women with both HIV and substance use disorder during the COVID-19 pandemic.

scholarly journals Increasing Number and Proportion of Adverse Obstetrical Outcomes among Women Living with HIV in the Ottawa Area: A 20-Year Clinical Case Series

2016 ◽  
Vol 2016 ◽  
pp. 1-9
Author(s):  
Sarah Buchan ◽  
Katherine A. Muldoon ◽  
Johanna N. Spaans ◽  
Louise Balfour ◽  
Lindy Samson ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Clinical Case ◽  
Case Series ◽  
Preterm Births ◽  
Estimating Equation ◽  
Equation Modeling ◽  
Women Living With Hiv ◽  
Obstetrical Outcomes ◽  
Women With Hiv ◽  
Living With Hiv

Background. The prevalence and associated risks with adverse obstetrical outcomes among women living with HIV are not well measured. The objective of this study was to longitudinally investigate the prevalence and correlates of adverse obstetrical outcomes among women with HIV.Methods. This 20-year (1990–2010) clinical case series assessed the prevalence of adverse obstetrical outcomes among pregnant women with HIV receiving care at The Ottawa Hospital (TOH). General estimating equation modeling was used to identify factors independently associated with adverse obstetrical outcomes, while controlling for year of childbirth clustering.Results. At TOH, there were 127 deliveries among 94 women (1990–2010): 22 preterm births, 9 births with low birth weight, 12 births small for gestational age, and 4 stillbirths. Per year, the odds of adverse obstetrical outcomes increased by 15% (OR: 1.15, 95% CI: 1.03–1.30). Psychiatric illness (AOR: 2.64, 95% CI: 1.12–6.24), teen pregnancy (AOR: 3.35, 95% CI: 1.04–1.46), and recent immigrant status (AOR: 7.24, 95% CI: 1.30–40.28) were the strongest correlates of adverse obstetrical outcomes.Conclusions. The increasing number and proportion of adverse obstetrical outcomes among pregnant women with HIV over the past 20 years highlight the need for social supports and maternal and child health interventions, especially among adolescents, new immigrants, and those with a history of mental illness.

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

Seeking Safety Group Therapy for Co-Occurring Substance Use Disorder and PTSD among Transgender Women Living with HIV: A Pilot Study

2017 ◽  
Vol 49 (4) ◽  
pp. 344-351 ◽  
Author(s):  
Susannah Empson ◽  
Yvette P. Cuca ◽  
Jennifer Cocohoba ◽  
Carol Dawson-Rose ◽  
Katy Davis ◽  
...  
Keyword(s):  
Substance Use ◽  
Pilot Study ◽  
Group Therapy ◽  
Substance Use Disorder ◽  
Transgender Women ◽  
Seeking Safety ◽  
Women Living With Hiv ◽  
Living With Hiv

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

scholarly journals Examining engagement in care of women living with HIV in South India

2019 ◽  
Vol 41 (5) ◽  
pp. 553-566
Author(s):  
Sara Chandy ◽  
Elsa Heylen ◽  
B. N. Ravikumar ◽  
Maria L. Ekstrand
Keyword(s):  
South India ◽  
Engagement In Care ◽  
Women Living With Hiv ◽  
Living With Hiv
Sign in / Sign up

Export Citation Format

Share Document