Background HIV incidence is higher among pregnant women than their non-pregnant counterparts in some sub-Saharan African settings. Our aims were (1) to estimate HIV incidence during pregnancy and (2) to compare sexual activity between pregnant, postpartum, and non-pregnant women. Methods We examined a retrospective cohort of 1087 women to identify seroconverters using antenatal and labor ward HIV test results. We also conducted a cross-sectional survey, including a quantitative questionnaire (n = 200) and in-depth interviews (n = 20) among women in early pregnancy, late pregnancy, postpartum, and non-pregnancy. Outcomes included measures of sexual activity, reported spouse’s risky behavior, and beliefs about abstinence. Results 11 of 1087 women seroconverted during pregnancy yielding a 1% seroconversion risk and an incidence rate of 4.0/100 person years (95% CI 2.2–7.2). The reported sexual activity of the early pregnancy and non-pregnancy groups was similar, but significantly higher than the late pregnancy and postpartum groups (p<0.001). During pregnancy, sex acts decreased as gestation increased (p = 0.001). There was no reported difference in the spouse’s risky behavior. Most women believed that sex should cease between the 6 th and 8 th month of pregnancy and should not resume until 6 months postpartum. Some talked about conflict between their cultural obligation to abstain and fear of HIV infection if their spouses find other partners. Conclusions HIV incidence is high among pregnant women in Malawi, and sexual activity decreases during pregnancy and postpartum. Pregnant women need to be informed of their increased risk for HIV and the importance of using condoms throughout pregnancy and the postpartum period.
Objective. To compare HIV drug resistance in pregnant women with perinatal HIV (PHIV) and those with nonperinatal HIV (NPHIV) infection. Methods. We conducted a multisite cohort study of PHIV and NPHIV women from 2000 to 2014. Sample size was calculated to identify a fourfold increase in antiretroviral (ARV) drug resistance in PHIV women. Continuous variables were compared using Student's t-test and Wilcoxon rank-sum tests. Categorical variables were compared using χ 2 and Fisher's exact tests. Univariate analysis was used to determine factors associated with antiretroviral drug resistance. Results. Forty-one PHIV and 41 NPHIV participants were included. Women with PHIV were more likely to have drug resistance than those with NPHIV ((55% versus 17%, p = 0.03), OR 6.0 (95% CI 1.0–34.8), p = 0.05), including multiclass resistance (15% versus 0, p = 0.03), and they were more likely to receive nonstandard ARVs during pregnancy (27% versus 5%, p = 0.01). PHIV and NPHIV women had similar rates of preterm birth (11% versus 28%, p = 0.08) and cesarean delivery (47% versus 46%, p = 0.9). Two infants born to a single NPHIV woman acquired HIV infection. Conclusions. PHIV women have a high frequency of HIV drug resistance mutations, leading to nonstandard ARVs use during pregnancy. Despite nonstandard ARV use during pregnancy, PHIV women did not experience increased rates of adverse pregnancy outcomes.
The Home-Delivered Meals Program (HDM) is an essential component of home-and community-based services available through the National Aging Service Network in the United States. It has the potential to help delay institutionalization and stem rising health care costs for older Americans; little is known, however, about the targeting practices used for HDM. A nationally representative telephone survey of state and local program providers showed that a variety of outreach measures were being employed, but challenges such as inadequate resources, waiting lists, rural delivery, and misconceptions about the program require resolution to ensure optimal service outcomes.
T. vaginalis infection is a rare condition in a tertiary care vaginitis center and often requires nonstandard treatments. Among those who returned for follow-up, the cure rate was 100%.
BackgroundPerinatally HIV-infected (PHIV) women are reaching childbearing age, but little is known about the impact of long-term exposure to HIV and antiretroviral therapy on pregnancy outcomes of PHIV women, including the impact on neonatal health and placental pathology.MethodsWe performed a retrospective cohort analysis over a 10-year period (2007–2017) of PHIV women, matched by age and date of delivery in 1:2 ratio, to behaviorally HIV-infected women (BHIV). The primary maternal outcome variable included virologic suppression (viral load ≤ 400 copies/mL) at delivery. Secondary outcome variables included hospital length of stay (LOS), mode of delivery, infectious (chorioamnionitis, funisitis) and vascular (vasculitis) placental complications based on histopathological analysis of placental specimen (composite variable). The primary neonatal outcome was preterm birth (<37 weeks); secondary neonatal outcomes included APGAR scores and infant HIV status. Primary and secondary maternal and neonatal outcomes were compared between PHIV and BHIV women. Logistic regression models measured the association between primary maternal and neonatal outcomes and perinatal status, adjusting for age and race.ResultsA total of 60 deliveries were evaluated during the study period (20 from women with PHIV and 40 from BHIV). Women with PHIV were significantly younger (20 vs. 29, P < 0.05) and less likely to be suppressed at delivery (55% vs. 90%, P < 0.05) compared with women with BHIV. A total of 19 women experienced placental pathologies but no differences were found by perinatal status (31% vs. 36%, P = 0.7, among PHIV and BHIV, respectively). Other than viral suppression, there were no significant differences among maternal and neonatal outcomes of interest by mode of HIV acquisition. In the multivariable regression, women with PHIV were significantly less likely to be suppressed after adjusting for age and race (AOR 0.07, 95% CI 0.01–0.80). There was no significant difference for preterm birth.ConclusionWomen with PHIV were significantly less likely to be suppressed at delivery but did not experience other complications at birth. Neonatal outcomes were similar among women with PHIV and BHIV.Disclosures All authors: No reported disclosures.
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