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Evaluating the association of antiretroviral therapy and immune status with hypertensive disorders of pregnancy among people with HIV
No full textObjective: The aim of this study was to examine the association of timing of antiretroviral therapy (ART) initiation and ART class with risk of new-onset hypertensive disorders of pregnancy (HDP) among people with HIV (PWH). Design: An observational study of participants in the multisite Surveillance Monitoring for ART Toxicities (SMARTT) study. Methods: Data were abstracted from medical records of pregnant PWH enrolled in SMARTT (January 30, 2015 to March 25, 2019). New-onset HDP included gestational hypertension, preeclampsia/eclampsia, or HELLP syndrome. We examined the associations of clinical risk factors and three exposures of interest, each in a separate model, with risk of new-onset HDP. Log-binomial regression models were fit using generalized estimating equations to account for correlations within people. Exposures included timing of ART initiation, antiretroviral class among those on therapy at conception, and antiretroviral class among those initiating treatment during pregnancy. Results: Of 1038 pregnancies in this cohort, 973 were singletons with complete data on HDP, with ART use in 948. Overall, 9% had a new-onset HDP, 10% had chronic hypertension, and 81% had no hypertension. Diabetes [adjusted relative risk (aRR) 2.44, 95% confidence interval (95% CI) 1.42–4.21] and first/second trimester CD4+ cell count less than 200 cells/μl (aRR 1.99, 95% CI 1.21–3.27) were associated with a greater risk of new-onset HDP. Risk of new-onset HDP was similar by antiretroviral class, but those initiating ART after 20 weeks’ gestation had a greater risk (aRR 1.93, 95% CI 1.12–3.30) compared with those receiving ART at conception. Conclusion: In this large, diverse cohort of pregnant PWH, worse early pregnancy immune status and later ART initiation were associated with an increased risk of HDP while ART class was not
Establishing and implementing a youth network for HIV prevention: A case study of meaningful youth engagement in Zimbabwe
Get PDFDifferences in quality of care of family planning services received by age and contraceptive continuation among young mothers in India
No full textPurpose: Youth face barriers that affect their use of family planning (FP) services, including low quality of care and provider bias. Although young women have the highest unmet need for FP in India, little is known about the effect of age on quality of care received. Additionally, although youth have higher contraceptive discontinuation than older women, the factors associated with continuation, including the effect of quality of care, are not well known. This study aims to assess differences in quality of care received by young mothers aged 15–24 and mothers aged 25–48, and to examine factors associated with modern contraceptive continuation 6 months after initiation among young mothers. Methods: Data come from a 12-month longitudinal study of married reversible contraceptive users in India. Multinomial logistic regression was conducted to examine adjusted associations of age and reported receipt of low, medium, or high quality of care. Logistic regression was used to assess factors associated with modern contraceptive continuation after 6 months. Results: Results showed that young mothers were less likely to receive high quality of care than older mothers, and that among young mothers, motivation to prevent pregnancy was significantly associated with continued use after 6 months. Discussion: As India aims to improve quality of care and increase access to services for youth, special attention should be paid to care received by young mothers, as well as options to support them in continuing to use contraceptive methods as long as they desire to prevent pregnancy
Global antibiotic use during the COVID-19 pandemic: Analysis of pharmaceutical sales data from 71 countries, 2020–2022
No full textBackground: Despite bacterial coinfection rates of less than 10%, antibiotics are prescribed to an estimated 75% of patients with COVID-19, potentially exacerbating antimicrobial resistance. We estimated the associations of COVID-19 cases and vaccinations with global antibiotic sales during the first two years of the COVID-19 pandemic. Methods: We obtained monthly data on broad-spectrum antibiotic sales volumes (cephalosporins, penicillins, macrolides, and tetracyclines) in 71 countries during March 2020–May 2022 from the IQVIA MIDAS® database. These data were combined with country-month-level COVID-19 case and vaccination data from Our World in Data. We used least squares (pooled) and fixed-effects panel data regression models, accounting for country characteristics, to estimate the associations between antibiotic sales volumes and COVID-19 cases and vaccinations per 1000 people. Findings: Sales of all four antibiotics fell sharply during April and May 2020, followed by a gradual rise to near pre-pandemic levels through May 2022. In fixed-effects regression models, a 10% increase in monthly COVID-19 cases was associated with 0.2%–0.3% higher sales of cephalosporins, 0.2%–0.3% higher sales of penicillins, 0.4%–0.6% higher sales of macrolides, and 0.3% higher sales of all four antibiotics combined per 1000 people. Across continents, a 10% increase in monthly COVID-19 cases was associated with 0.8%, 1.3%, and 1.5% higher macrolides sales in Europe, North America, and Africa respectively. Sales of other antibiotics across continent were also positively associated with COVID-19 cases, although the estimated associations were smaller in magnitude. No consistent associations were observed between antibiotic sales and COVID-19 vaccinations. Results from pooled regression analysis were similar to those from the fixed-effects models. Interpretation: Antibiotic sales were positively associated with COVID-19 cases globally during 2020–2022. Our findings underline that antibiotic stewardship in the context of COVID-19 remains essential. Funding: Bill & Melinda Gates Foundation
Adolescent education, health and wellbeing status in four counties in Kenya: Two years into the COVID-19 pandemic
Get PDFThe COVID-19 pandemic resulted in widespread school closures globally, including in Kenya. This educational disruption had potential adverse consequences for adolescent school learners including school dropout, learning loss, opportunity losses, loss of previously acquired skills, and loss of socio-emotional benefits of time spent with peers and teachers. This study was undertaken in four counties in Kenya—two urban (Nairobi, Kisumu) and two rural (Kilifi and Wajir). Focusing on adolescent girls aged 10–19, the study increased understanding of the impact of the COVID-19 pandemic on girls’ education outcomes to enable implementation of policies and programs to address immediate harms caused, and to be better prepared for future pandemics or crises that could lead to prolonged school closures. The study utilized quantitative and qualitative techniques used for previously established research studies of cohorts in Kenya. Between March and May 2022, 2,784 adolescents participated in phone interviews and 66 adolescents, as well as 46 parents and other adult stakeholders, participated in in-depth interviews. In addition, literacy, comprehension, and numeracy testing was undertaken with 658 of the adolescent respondents
Policymakers\u27 and healthcare providers\u27 perspectives on the introduction of oral pre-exposure prophylaxis for key populations in Ghana
No full textBACKGROUND: Key populations (KPs) such as female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID), and their partners contribute more than a quarter (27.5%) of new HIV infection in Ghana. Oral pre-exposure prophylaxis (PrEP) can substantially reduce HIV acquisition among this group. While the available research indicates KPs willingness to take PrEP in Ghana, little is known about the position of policymakers and healthcare providers on the introduction of PrEP for KPs. METHODS: Qualitative data were collected from September to October 2017 in the Greater Accra (GA) and Brong-Ahafo (BA) regions of Ghana. Key informant interviews were conducted with 20 regional and national policymakers and supplemented with In-depth Interviews with 23 healthcare providers to explore their level of support for PrEP and their perspectives on challenges and issues to consider for oral PrEP implementation in Ghana. Thematic content analysis was used to unearth the issues emerging from the interviews. RESULTS: Policymakers and healthcare providers in both regions expressed strong support for introducing PrEP for KPs. Key concerns regarding oral PrEP introduction included potential for behavioral disinhibition, non-adherence and side effects of medication, cost and long-term financial implications, and stigma related to HIV and key populations. Participants stressed the need to integrate PrEP into existing services and the provision of PrEP should start with high risk groups like sero-discordant couples, FSWs and MSM. CONCLUSIONS: Policymakers and providers recognize the value of PrEP in cubing new HIV infections but have concerns about disinhibition, non-adherence, and cost. Therefore, the Ghana health service should roll-out a range of strategies to address their concerns including: sensitization with providers to mitigate underlying stigma towards KPs, particularly MSM, integration of PrEP into existing services, and innovative strategies to improve continued use of PrEP
Unique profile of inflammation and immune activation in pregnant people with HIV in the United States
No full textBackground: Little is known about inflammation/immune activation during pregnancy in people with HIV (PWH) and growth in their children who are HIV-exposed and uninfected (CHEU). Methods: Using data from the Pediatric HIV/AIDS Cohort Study and an HIV-seronegative comparison group, we assessed associations of (1) HIV status, mode of HIV acquisition (perinatally vs nonperinatally acquired), and type of antiretroviral therapy (ART) with inflammation/immune activation in pregnancy; and (2) inflammation/immune activation in pregnancy with growth of CHEU at 12 months. Interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), soluble(s) TNF-α receptor 1 and 2 (sTNFR1, sTNFR2), sCD14, and sCD163 were measured between 13 and 27 weeks’ gestation. Linear regression models were fit to estimate differences between groups for each log-transformed biomarker, adjusted for confounders. Results: Pregnant PWH (188 total, 39 perinatally acquired, 149 nonperinatally acquired) and 76 HIV-seronegative persons were included. PWH had higher IL-6, sTNFR1, sCD14, and sCD163 and lower sTNFR2 compared to HIV-seronegative persons in adjusted models. Among PWH, sCD163 was higher in those with perinatally versus nonperinatally acquired HIV and on PI-based versus INSTI-based ART. Higher maternal concentrations of IL-6, sTNFR2, and hs-CRP were associated with poorer growth at 12 months. Conclusions: Maternal HIV status is associated with a distinct profile of inflammation/immune activation during pregnancy, which may influence child growth
State of the Evidence: A reflection on the gaps identified in Breakthrough RESEARCH’s Research and Learning Agendas for Advancing Provider Behavior Change Programming and Advancing Integrated Social and Behavior Change Programming
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Using the Confidante method to measure new or recent cases of female genital mutilation: Insights from Narok County, Kenya
Get PDFThis report presents insights from a study conducted in Narok County of Kenya that used the Confidante method to identify new or recent cases of FGM. The study was a cross-sectional community-based survey conducted in November and December of 2022 among 703 women and girls aged 15-49 years in Narok East sub-county of Narok County. Participants were asked about the attitudes and experiences of FGM of up to three of their confidantes, defined as persons with whom they would share private information and who would also share such information with them. They provided information on a total of 1,684 confidantes. They were then asked about their own attitudes and experiences of FGM. Analysis entailed generation of descriptive statistics comparing prevalence and new or recent cases of FGM as well as FGM-related attitudes and beliefs among participants and their confidantes (as reported by the participants)