HIV-exposed children account for more than half of 24-month mortality in Botswana

Zash, Rebecca; Souda, Sajini; Leidner, Jean; Ribaudo, Heather; Binda, Kelebogile; Moyo, Sikhulile; Powis, Kathleen M.; Petlo, Chipo; Mmalane, Mompati; Makhema, Joe; Essex, Max; Lockman, Shahin; Shapiro, Roger

doi:10.1186/s12887-016-0635-5

Cited by 40 publications

(40 citation statements)

References 22 publications

(18 reference statements)

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“…Also, HIV-exposed, uninfected (HEU) children have increased morbidity and mortality when compared with HIV unexposed, uninfected (HUU) children. [21,22] While the cause of this increased mortality is multi-factorial, in utero exposure to ART may be a contributing factor. As programs to prevent mother to child transmission of HIV (PMTCT) rapidly move toward universal ART for pregnant women (World Health Organization (WHO) Option B) and continuation of this ART for life (WHO Option B+), an increase in adverse effects has the potential to reduce the impact of improvements in infant morbidity and mortality from decreased vertical HIV transmission.…”

Section: Introductionmentioning

confidence: 99%

Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges

Zash

Williams

Sibiude

et al. 2016

Expert Opinion on Drug Safety

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Introduction The use of antiretroviral therapy (ART) in pregnancy to prevent vertical HIV transmission has been one of the most successful public health programs in the last decade. As a result, an unprecedented number of women are taking ART at conception and during pregnancy. Given few randomized studies evaluating safety of different ART regimens in pregnancy, ongoing drug safety surveillance is critical. Areas Covered This review aims to provide a rationale for ART drug safety surveillance, describe changing patterns of ART use and summarize current surveillance efforts in both low-resource and high-resource settings. Additionally, biostatistical approaches to and challenges in analysis of observational surveillance data are discussed. Expert Opinion The global landscape of ART use in pregnancy is rapidly increasing and evolving. Any increase in adverse effects of in-utero exposure to ART has the potential to reduce the impact of improvements in infant morbidity and mortality gained from decreased vertical HIV transmission. ART drug safety surveillance should therefore be a critical piece of programs to prevent mother to child transmission in both high- and low-resource settings. Current surveillance efforts could be strengthened with long-term follow-up of exposed children, pooling of data across cohorts and standardized approaches to analysis.

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Section: Introductionmentioning

confidence: 99%

Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges

Zash

Williams

Sibiude

et al. 2016

Expert Opinion on Drug Safety

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“…The 12-month infant mortality risk among HEI in our study (88.7/1,000) was higher than the national infant mortality rate of 65/1,000 (2). Our study was unable to tease out whether transmitted HIV infection or the state of being HIV-exposed were direct causes or contributing factors to in-and ex utero deaths, however we postulate a high likelihood that this is the case: prior studies report higher mortality rates among HIVexposed uninfected infants compared to non-HIV exposed infants (35,(39)(40)(41)(42). The mortality risk results should however be interpreted with caution given our relatively small sample size.…”

Section: Discussionmentioning

confidence: 66%

“…Infectious and respiratory diseases have been reported as the major causes of death among HEI in low-resource, high-burden countries (45). Speci cally, pneumonia, diarrhea, septicemia and malnutrition have been reported as the most common causes of death among HEI in sub-Saharan Africa (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Our study agrees with previous HEI mortality studies, which report diarrhea, birth asphyxia/perinatal conditions and sepsis as major causes of death among HIV-exposed infants and children under 24 months (28,35,46,47).…”

Section: Discussionmentioning

confidence: 99%

Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

Ozigbu

Erekaha

Chinaeke

et al. 2020

Preprint

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Background HIV-exposed infants (HEI) who die before diagnosis or treatment initiation, or who die in spite of being HIV-free constitute missed opportunities for reducing infant mortality. Verbal autopsy (VA) has been successfully applied in the collection of data to determine symptoms and circumstances surrounding death among infants, children and adults among populations that lack vital registration systems. There is little available data on rates and causes of death among HIV-exposed infants (HEI) in Nigeria. We used VA to characterize attributable causes and predictors of mortality among HEI in rural North-Central Nigeria.Methods Pregnant women living with HIV and HEI were enrolled at rural primary healthcare facilities and followed-up for 12 months, post-delivery. A simple 21-item VA instrument was used to collect infant mortality information from mothers, other family members, mentor mothers, and/or healthcare workers. Attributable causes of death were determined by physician coding. Multivariate logistic regression was performed to determine independent predictors of mortality.Results Data from 455 HIV-exposed infected and uninfected fetus/infant-mother pairs were analyzed. All mothers received anti-retroviral therapy. Seventy-five (16.5%) fetuses/infants died during gestation and within 12 months post-delivery. Forty (53.3%) deaths occurred in utero . The 12-month infant mortality risk among HEI in our study was 88.7/1,000. Among the 35 live-born infants, birth asphyxia (6/17, 35.3%) and sepsis (7/18, 38.9%) were the most common causes of death in the neonatal and post-neonatal periods, respectively. Unadjusted estimates showed that a greater proportion of deceased infants had mothers who did not deliver at a health facility (53.3 vs 31.8%, p=0.003), and who were newly HIV-diagnosed during pregnancy (69.3 vs 50.8%, p=0.029). Infants receiving nevirapine prophylaxis within 72 hours were less likely to have died (aOR = 0.40, 95% CI: 0.2-0.9).Conclusions Early HIV diagnosis and treatment among women of child-bearing age, maternal access to facility delivery and timely infant antiretroviral prophylaxis should be programmatically strengthened to reduce HEI mortality. Additionally, robust monitoring and evaluation systems are needed to track and record deaths among HEI.

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“…We had complete follow-up to either 24 months postpartum or death for 2879 (96%); 106 (3.5%) were not followed after death of their child; 9 (0.3%) withdrew from the study; and 6 (0.2%) were lost to follow-up. Among the 106 women not followed after the death of their child, 82 (77%) were HIV infected (reflecting the higher child mortality among HIV-exposed children), 8 otherwise there was no significant differences among women with and without complete followup. The proportion of women completing each follow-up contact ranged from 87.2% (6 month follow-up) to 99.8% (24 month follow-up).…”

Section: Resultsmentioning

confidence: 92%

“…Child mortality during the 24-month follow-up period has been previously described. 8 During the study, HIV-infected women received ART and PMTCT services in the government system according to Botswana national HIV guidelines. From February to May 2012, Botswana followed WHO Option A for PMTCT.…”

Section: Methodsmentioning

confidence: 99%

High Proportion of Deaths Attributable to HIV Among Postpartum Women in Botswana Despite Widespread Uptake of Antiretroviral Therapy

Zash

Souda

Leidner³

et al. 2017

AIDS Patient Care and STDs

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Mortality in the postpartum period may be impacted by antiretroviral therapy (ART) received in pregnancy, and whether ART is continued in the postpartum period. HIV-infected and HIV-uninfected mothers were enrolled within 48 h of delivery at five public hospital maternity wards throughout Botswana and followed for 24 months. Maternal deaths were reported by one of the approved contacts given by the mother at enrollment. Detailed information on the cause of death was not available. Risk factors for 24-month mortality were assessed using Cox proportional hazard models. From February 2012 to March 2013, 3000 mothers (1499 HIV infected and 1501 HIV uninfected) were enrolled, and 2985 (99.5%) were followed to 24 months or death, or until the death of their child. There were 26 total maternal deaths through 24 months postpartum [439 per 100,000 person-years (p-y)], 22 among HIV-infected women (758 per 100,000 p-y) and 4 among HIV-uninfected women (132 per 100,000 p-y). Maternal HIV-infection (aHR 5.0, 95% CI 1.6-15.2) and infant birth injury (aHR 3.8, 95% CI 1.3-11.4) were independent risk factors for maternal death. Universal ART in pregnancy became the standard-of-care after June 2012, and 978 (65%) women received ART in pregnancy; by 24 months postpartum or end of follow-up, 1148 (79%) had started ART overall. There was no significant difference in 24-month mortality among HIV-infected women who took ART in pregnancy and continued throughout the follow-up period compared with HIV-infected women who took ART or zidovudine in pregnancy and stopped postpartum (aHR 0.6, 95% CI 0.2-1.7). Despite high uptake of ART in pregnancy and postpartum, women with HIV infection in Botswana are five times more likely to die than HIV-uninfected women in the 24 months postpartum.

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HIV-exposed children account for more than half of 24-month mortality in Botswana

Cited by 40 publications

References 22 publications

Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges

Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges

Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

High Proportion of Deaths Attributable to HIV Among Postpartum Women in Botswana Despite Widespread Uptake of Antiretroviral Therapy

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