HIV and maternal mortality

Lathrop, Eva; Jamieson, Denise J.; Danel, Isabella

doi:10.1016/j.ijgo.2014.05.024

Cited by 47 publications

(40 citation statements)

References 23 publications

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“…Failure to access antenatal care is of concern as antenatal care remains the cornerstone for detection of HIV infection and identification of obstetric complications. Although antenatal care cannot impact on all causes of maternal mortality, it can have a significant impact in decreasing HIV‐related mortality in high HIV prevalence settings, with early diagnosis and treatment of pregnant women identified as HIV‐infected . In our study, the majority of HIV‐infected women were diagnosed during pregnancy and this points to a need to increase routine HIV testing outside of pregnancy to allow linkage to care and early initiation of ART.…”

Section: Discussionmentioning

confidence: 79%

“…Respiratory infections are among the most important non‐pregnancy related infectious causes of death among HIV‐infected women . Physiologic and immunologic changes in pregnancy, and immune suppression related to HIV infection, are all thought to increase susceptibility to infections, including respiratory infections . In our study, no data were available on the use of cotrimoxazole and isoniazid, both effective prophylactic interventions in HIV‐infected individuals .…”

Section: Discussionmentioning

confidence: 90%

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Trends in maternal deaths in HIV‐infected women, on a background of changing HIV management guidelines in South Africa: 1997 to 2015

et al. 2017

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IntroductionAs work begins towards the Sustainable Development Goal target of reducing the global maternal mortality ratio (MMR) to less than 70 deaths per 100,000 live births by 2030, much needs to be done in ending preventable maternal deaths. After 1990, South Africa experienced a reversal of gains in decreasing maternal mortality, with an increase in HIV‐related maternal deaths. In this study, we assessed trends in maternal mortality in HIV‐infected women, on a background of an evolving HIV care programme.MethodsThis was a cross‐sectional, retrospective record review of maternal deaths in the obstetrics unit at Chris Hani Baragwanath Academic Hospital, in Johannesburg, South Africa, a referral hospital in a high HIV prevalence setting where the prevalence among pregnant women has plateaued around 29.0% for the past decade. Trends in HIV diagnosis and management in pregnancy, and causes of maternal deaths in HIV‐infected women were analysed over different time periods (1997 to 2003, 2004 to 2009, 2010 to 2012, and 2013 to 2015) reflecting major guideline changes.ResultsFrom January 1997 to December 2015, there were 692 maternal deaths in the obstetrics unit. Of the 490 (70.8%) maternal deaths with a documented HIV status, 335 (68.4%) were HIV‐infected. A Chi‐squared test for trends showed that the institutional MMR (iMMR) in women known to be HIV‐infected peaked in the period 2004 to 2009 at 380 (95% CI 319 to 446) per 100,000 live births, with a decline to 267 (95% CI 198 to 353) in 2013 to 2015, p = 0.049. This decrease coincided with changes in the South African HIV management guidelines, mainly increased availability of antiretroviral therapy (ART). Non‐pregnancy related infections were the leading cause of death throughout the review period, accounting for 61.5% (206/335) of deaths. Only 23.3% (78/335) of the women who died were on ART at the time of death, this in the context of advanced immune suppression and an overall median CD4 count of 136 cells/μl (interquartile ranges (IQR) 45 to 301).ConclusionIn this 19‐year review of maternal deaths in Johannesburg, South Africa, there was evidence of a decrease in the iMMR among HIV‐infected women, but it remains unacceptably high. Efforts to address drivers of mortality and barriers to accessing ART need to be accelerated if we are to see substantial decreases in maternal mortality.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 90%

Trends in maternal deaths in HIV‐infected women, on a background of changing HIV management guidelines in South Africa: 1997 to 2015

et al. 2017

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“…Early diagnosis of infectious diseases, such as human immunodeficiency virus (HIV) and tuberculosis (TB), and rapid initiation to treatment is a key strategy to control these diseases [7]. HIV/AIDS is known as the leading cause of death in the HIV pandemic areas, contributing to between 19,000 and 56,000 maternal deaths in 2011 (6%–20% of total maternal deaths) [8]. South Africa accounts for 18% of global HIV infections, with approximately 6.7 million people infected [9].…”

Section: Introductionmentioning

confidence: 99%

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

et al. 2017

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Introduction: Key stakeholders’ involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. Method: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. Results: 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients’ needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Conclusions: Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

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“… 5 22 23 Many of these deaths are believed to be preventable with the implementation of high-quality obstetric care, prevention and treatment of common co-infections, and appropriate ART regimens. 24 Diagnostics are a fundamental component of medical practice. Early disease diagnosis is key to the improvement of disease prognosis, particularly in the current era of drug resistance.…”

Section: Discussionmentioning

confidence: 99%

Impact of point-of-care diagnostics on maternal outcomes in HIV-infected women: systematic review and meta-analysis protocol

et al. 2016

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IntroductionStudies indicate substandard diagnostic care, delayed and missed diagnosis as some of the contributing factors to maternal mortality. The clinical impact of point-of-care (POC) diagnostics has been shown in the monitoring and treatment of a variety of infectious diseases, including HIV/AIDS and tuberculosis. The objective of this systematic review is to investigate the impact of POC diagnostics on maternal outcomes for HIV-infected women.MethodsWe will conduct a systematic review to evaluate the impact of POC diagnostics for improving desired healthcare outcomes for HIV-infected women. The search strategy will involve electronic databases including: Cochrane Infectious Disease Group Specialised Register; Cochrane Central Register of Control Trials, published in The Cochrane Library; PubMed; EBSCOhost and LILACS. The studies will be mapped in 2 stages: stage 1 will map studies descriptively by focus and method; stage 2 will involve additional inclusion criteria, quality assessment and data extraction undertaken by 2 reviewers in parallel. Evidence will be synthesised using relevant systematic research tools: meta-analysis and subgroup analysis will be conducted using RevMan and Stata 13 will be used for meta-regressions. We will follow recommendations described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Cochrane Handbook for Intervention Reviews.Ethics and disseminationWe anticipate finding a large number of studies on POC diagnostic interventions on maternal outcomes in HIV-infected women, which, once summarised, will be useful to guide future diagnostic interventions. The protocol for the systematic review has been registered in PROSPERO. The study will be disseminated electronically and in print. It will also be presented to conferences related to HIV/AIDS, POC diagnostics and maternal health.Trial registration numberPROSPERO CRD42014015439.

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HIV and maternal mortality

Cited by 47 publications

References 23 publications

Trends in maternal deaths in HIV‐infected women, on a background of changing HIV management guidelines in South Africa: 1997 to 2015

Trends in maternal deaths in HIV‐infected women, on a background of changing HIV management guidelines in South Africa: 1997 to 2015

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

Impact of point-of-care diagnostics on maternal outcomes in HIV-infected women: systematic review and meta-analysis protocol

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