Cohort profile: the Hlabisa pregnancy cohort, KwaZulu-Natal, South Africa

Abstract

PurposeThe Hlabisa pregnancy cohort was established to evaluate the effectiveness of prevention of mother-to-child transmission (PMTCT) guideline revisions. The objectives of the Hlabisa pregnancy cohort are to: (1) provide cohort-level information on maternal health up to 6 weeks postpartum in a high HIV prevalence setting; and to (2) evaluate aspects of PMTCT care that have policy relevance.ParticipantsThe pregnancy cohort is located in primary health clinics in the Hlabisa subdistrict of rural KwaZulu-Natal, South Africa. Baseline data collection between 2010 and 2014 has been completed with the enrolment of 25 608 pregnancies; age ranged from 15–49 years. Pregnant women were assessed during routine antenatal visits: first visit, follow-up 1 week later, 32 weeks (HIV test), infant delivery and 6 weeks postpartum. Demographic, pregnancy, clinical, laboratory and HIV data were collected through Department of Health interviews, laboratory tests and routine data linkage. Treatment data for HIV-infected pregnant women were linked to the Africa Centre Hlabisa HIV Treatment and Care Programme for detailed antiretroviral therapy (ART) history and laboratory tests.Findings to dateThe proportion of women initiated on ART post-2013 were higher (n=437; 100%) than pre-2013 (n=768; 84.2%). The proportion of women in care at 6 weeks (73.8%) was also higher post-2013 relative to earlier years (58.5%). The majority of HIV-infected pregnant women were either on lifelong ART or ART prophylaxis; pre-2013, ∼ 9.6% of women were not on any ART. Pregnancy viral load monitoring was inadequate.Future plansThis cohort will be used to: (1) determine HIV acquisition risk during pregnancy and postpartum; (2) determine the effect of HIV and ART on birth outcomes; (3) examine the effect of pregnancy on virological response to ART; and (4) characterise the effect of sequential pregnancies on access to clinical care, response to prolonged ART and birth outcomes.

Persistently high incidence of HIV and poor service uptake in adolescent girls and young women in rural KwaZulu-Natal, South Africa prior to DREAMS

“…Less than one in three 15–19 year olds had tested for HIV in the past 12 months, or visited a clinic in the past six months. Whilst, 20-24-year-olds reports of visiting clinics and HIV testing was associated with their self-reported pregnancies, suggesting that the HIV testing and clinics visits were related to antenatal care in this setting with excellent prevention of mother to child transmission of HIV (PMCT) programme [ 15 ].…”

“…Further, we found a positive association between current use of contraception and knowledge of where to get ART—a proxy measure of health-related knowledge of access to services. This and the poor service usage in younger girls and those who are not yet pregnant may in part reflect the success of the PMTCT programme in reaching women once they become pregnant [ 15 ]. These finding are in keeping with a study in rural Western Cape that also found that having one or more children was associated with increased contraception [ 20 ].…”

“…We use ever being pregnant as a surrogate for potential access to antenatal care as the focus on Prevention of Mother to Child Transmission (PMCT) in South Africa has led to good antenatal coverage in uMkhanyakude district where this study is based. A pregnancy cohort from this district found that over 90% of the HIV positive pregnant women were identified and started on ART for PMCT and a drop in Mother to Child transmission rates to 0.5% in 2015 [ 15 ]. Sexual behaviour with male partners included the number of lifetime partners and whether she had ever had sex or had sex in the past 12 months.…”

Preterm delivery and small-for-gestation outcomes in HIV-infected pregnant women on antiretroviral therapy in rural South Africa: Results from a cohort study, 2010-2015

“…Between 2010 and 2012, HIV-infected pregnant women attending any one of the 17 antenatal clinics in the Hlabisa HIV Treatment and Care Programme, northern KwaZulu-Natal, South Africa were eligible for inclusion [ 31 ]. Thereafter enrolment was limited to seven clinics within the Africa Centre surveillance area which allowed data linkage (clinics were from the original cohort with 40% of patients generally representative of Hlabisa) [ 32 ]; the additional clinic (Mtubatuba) was one of the busiest in the sub-district [ 33 ].…”

Awareness of HIV-positive status and linkage to treatment prior to pregnancy in the “test and treat” era: A national antenatal sentinel survey, 2017, South Africa

“…Prevention of mother-to-child transmission (PMTCT) is a significant pathway and an effective HIV testing modality for diagnosing and linking women to ART. The first and the second 90 in the PMTCT programme has been reported to be >90% in South Africa (SA), but knowledge of HIV status and ART initiation prior to pregnancy has been reported to be low [4,5]. In 2016, SA adopted the universal test and treat (UTT) strategy, which makes provision for ART initiation immediately after an HIV-positive test [6].…”