Intermittent Preventive Therapy for Malaria During Pregnancy Using 2 vs 3 or More Doses of Sulfadoxine-Pyrimethamine and Risk of Low Birth Weight in Africa

Kayentao, Kassoum; Garner, Paul; Eijk, Anna Maria van; Naidoo, Inbarani; Roper, Cally; Mulokozi, Abdunoor; MacArthur, John; Luntamo, Mari; Ashorn, Per; Doumbo, Ogobara K.; Kuile, Feiko O. ter

doi:10.1001/jama.2012.216231

Cited by 264 publications

(278 citation statements)

References 42 publications

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“…This analysis has several limitations. First, we modeled the effects of each strategy based on published meta-analytic data and results from randomized trials [19,21,29,45]. Due to lack of data directly comparing the prevention strategies, results from randomized trial and meta-analytic data were combined, and the relative risks/benefits of each strategy compared to the Reference Strategy were calculated.…”

Section: Discussionmentioning

confidence: 99%

“…Due to lack of data directly comparing the prevention strategies, results from randomized trial and meta-analytic data were combined, and the relative risks/benefits of each strategy compared to the Reference Strategy were calculated. In addition, the meta-analytic data had some potential sources of bias, which could have led to overestimation of the effectiveness of the 3-IPT strategies [29]. Second, the rate of malaria infection was modeled as a function of CD4 cell count and preventive treatment status, and malaria parasite transmission by mosquitoes was not modeled because the interventions would not differentially affect the transmission dynamics in the homogeneously simulated population, and thus malaria transmission risks.…”

Section: Discussionmentioning

confidence: 99%

“…To estimate the effectiveness of 2 versus 3 IPTp-SP doses, published meta-analytic estimates were used for the reduction in the incidence of primary health outcomes, based on synthesized data from seven trials in six countries [29]. The outcomes included in our analysis were maternal anaemia (haemoglobin < 60 g/L), maternal malaria parasitaemia (blood films found to be positive for Plasmodium parasites), and low birth weight (LBW < 2500 g).…”

Section: Treatment Effectivenessmentioning

confidence: 99%

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Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa

Choi

Brandeau

Bendavid

2017

Malar J

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Background: Malaria is a leading cause of morbidity and mortality among HIV-infected pregnant women in subSaharan Africa: at least 1 million pregnancies among HIV-infected women are complicated by co-infection with malaria annually, leading to increased risk of premature delivery, severe anaemia, delivery of low birth weight infants, and maternal death. Current guidelines recommend either daily cotrimoxazole (CTX) or intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) for HIV-infected pregnant women to prevent malaria and its complications. The cost-effectiveness of CTX compared to IPTp-SP among HIV-infected pregnant women was assessed.Methods: A microsimulation model of malaria and HIV among pregnant women in five malaria-endemic countries in sub-Saharan Africa was constructed. Four strategies were compared: (1) 2-dose IPTp-SP at current IPTp-SP coverage of the country ("2-IPT Low"); (2) 3-dose IPTp-SP at current coverage ("3-IPT Low"); (3) 3-dose IPTp-SP at the same coverage as antiretroviral therapy (ART) in the country ("3-IPT High"); and (4) daily CTX at ART coverage. Outcomes measured include maternal malaria, anaemia, low birth weight (LBW), and disability-adjusted life years (DALYs). Sensitivity analyses assessed the effect of adherence to CTX. Results:Compared with the 2-IPT Low Strategy, women receiving CTX had 22.5% fewer LBW infants (95% CI 22.3-22.7), 13.5% fewer anaemia cases (95% CI 13.4-13.5), and 13.6% fewer maternal malaria cases (95% CI 13.6-13.7). In all simulated countries, CTX was the preferred strategy, with incremental cost-effectiveness ratios ranging from costsaving to $3.9 per DALY averted from a societal perspective. CTX was less effective than the 3-IPT High Strategy when more than 18% of women stopped taking CTX during the pregnancy. Conclusion:In malarious regions of sub-Saharan Africa, daily CTX for HIV-infected pregnant women regardless of CD4 cell count is cost-effective compared with 3-dose IPTp-SP as long as more than 82% of women adhere to daily dosing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Treatment Effectivenessmentioning

confidence: 99%

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Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa

Choi

Brandeau

Bendavid

2017

Malar J

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“…Recently, the World Health Organization (WHO) recommended that SP-IPTp should be administered at each scheduled antenatal care visit rather than only twice during pregnancy-as was first recommended-on the basis that three doses of SP are more efficacious than two doses in the prevention of the deleterious consequences of MiP. 3 Although the strategy still remains efficacious for the prevention of MiP in areas of high SP resistance, 4 important concerns have been raised about the useful lifespan of SP for IPTp, so new drugs or strategies are urgently needed. At present, no antimalarial drugs meet all the ideal properties for IPTp so alternatives need to be evaluated on the basis of their benefit-risk ratio.…”

Section: Introductionmentioning

confidence: 99%

Mefloquine Versus Sulfadoxine–Pyrimethamine for Intermittent Preventive Treatment in Pregnancy: A Joint Analysis on Efficacy and Tolerability

Briand¹,

Escolano²,

Journot³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Since there is no ideal candidate to replace sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment (IPTp), alternatives need to be evaluated on basis of their benefit-risk ratio. We reanalyzed the first Beninese trial on mefloquine (MQ) versus SP for IPTp using a multiple outcome approach, which allowed the joint assessment of efficacy and tolerability. Overall superiority of MQ to SP was defined as superiority on at least one efficacy outcome (low birth weight [LBW], placental malaria, or maternal anemia), non-inferiority on all of them as well as on tolerability defined as cutaneous or neuropsychiatric adverse events (AEs) or low compliance with the treatment. The analysis included 1,601 women. MQ was found to be overall superior to SP (P = 0.004). Performing several sensitivity analyses to handle both missing data and stillbirths provided similar results. Using MQ for IPTp as an example, we show that a multiple outcome analysis is a pragmatic way to assess the benefits/disadvantages of one drug compared with another. In the current context of a lack of antimalarials that could be used for IPTp, such a statistical approach could be widely used by institutional policy makers for future recommendations regarding the prevention of malaria in pregnancy (MiP).

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“…All laboratory staff were blinded to treatment. For isolation of S. pneumoniae, H. influenzae, and S. aureus, specimens were inoculated onto horse blood agar (HBA), chocolate agar (CA), gentamicin blood agar (GBA) (5% horse blood and 5 l/ml gentamicin), and bacitracin chocolate agar (BCA) (Oxoid, Thermofisher, Australia) and incubated for 24 to 48 h at 37°C in 5% CO 2 .…”

Section: Study Populationmentioning

confidence: 99%

Impact of Intermittent Preventive Treatment in Pregnancy with Azithromycin-Containing Regimens on Maternal Nasopharyngeal Carriage and Antibiotic Sensitivity of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus: a Cross-Sectional Survey at Delivery

et al. 2015

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Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) can prevent low birth weight (LBW; Ͻ2,500 g) and reduces infant morbidity and mortality in resource-limited countries (1, 2). However, high-level resistance of Plasmodium falciparum to SP, recently observed in East Africa, may render IPTp-SP clinically inefficacious (3-5). The development and evaluation of new IPTp regimens are therefore of utmost importance (6, 7).Azithromycin (AZ) is a broad-spectrum macrolide (azalide) antibiotic with favorable antimalarial properties and a good safety profile in pregnancy (8, 9). IPTp with SPAZ prevented LBW and preterm delivery in two clinical trials (10, 11), and confounding may in part explain the observation of no effect in the third (6, 12); this warrants its further evaluation as a potential alternative to SP-IPTp.An integral part of such evaluation is to screen for adverse consequences, including the selection of drug-resistant Streptococcus pneumoniae (13), a principal cause of meningitis and respiratory infections in infants (14). Mass administration (MDA) of AZ to children has been associated with increased nasopharyngeal carriage of macrolide-resistant pneumococci, particularly when MDA was given at 6-to 12-monthly intervals (15)(16)(17)(18)(19)(20). However, this is not a unanimous finding (21) and may in part depend on the prevalence of resistant isolates at baseline (15-18). Longitudinal studies of carriage and resistance patterns indicate that in the event of MDA-driven temporary expansion of macrolide-resistant isolates, a decrease in their prevalence tends to occur 12 to 24 months after the most recent treatment (19,20). Citation Unger HW, Aho C, Ome-Kaius M, Wangnapi RA, Umbers AJ, Jack W, Lafana A, Michael A, Hanieh S, Siba P, Mueller I, Greenhill AR, Rogerson SJ. 2015. Impact of intermittent preventive treatment in pregnancy with azithromycincontaining regimens on maternal nasopharyngeal carriage and antibiotic sensitivity of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus: a cross-sectional survey at delivery.

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Intermittent Preventive Therapy for Malaria During Pregnancy Using 2 vs 3 or More Doses of Sulfadoxine-Pyrimethamine and Risk of Low Birth Weight in Africa

Cited by 264 publications

References 42 publications

Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa

Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa

Mefloquine Versus Sulfadoxine–Pyrimethamine for Intermittent Preventive Treatment in Pregnancy: A Joint Analysis on Efficacy and Tolerability

Impact of Intermittent Preventive Treatment in Pregnancy with Azithromycin-Containing Regimens on Maternal Nasopharyngeal Carriage and Antibiotic Sensitivity of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus: a Cross-Sectional Survey at Delivery

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