cART Initiation During Pregnancy Among HIV-Infected Women in Lusaka, Zambia: The Impact of Duration of cART on Pregnancy Outcomes and Predicting Postpartum Loss to Follow Up

Treatment guidelines for HIV-infected pregnant and breastfeeding women have shifted in recent years towards lifelong maternal cART. These changes have led to important reductions in MTCT and are expected to improve maternal HIV outcomes. However, the increasing use of cART during pregnancy has led to challenges. cART's role in causing adverse pregnancy outcomes has been of concern, as has improving postpartum retention in care. In Aim 1a, we evaluated duration of cART during pregnancy's association with LBW due to growth restriction. We found no evidence of an increased risk of LBW for women receiving cART for <8 weeks (RR 1.22, 95% CI: 0.77, 1.91), 9-20 weeks (RR 1.23, 95% CI: 0.82, 1.83), or 21-36 weeks (RR 0.87, 95% CI: 0.22, 3.46), compared to women who never initiated treatment. In Aim 1b, we examined the association between duration of cART during pregnancy through 32 weeks gestation with SGA and preterm birth. We used MO to address measurement error in gestational age. In the complete-case analysis, there was no evidence of an association between duration of cART and SGA or preterm birth. When MO was performed, RRs for SGA moved closer to and past the null, but remained imprecise. For preterm birth, RRs for 9-32 weeks of cART moved away from the null as the variance due to measurement error increased. In Aim 2, we developed a risk score to predict LTFU at 6 months postpartum among women who initiated cART during pregnancy. We observed that 25% of women were LTFU by 6 months postpartum. A risk score cut-point of 11, (42nd percentile) had 85% sensitivity (95% CI 0.82, 0.88) and 22% specificity (95% CI 0.20, 0.24) to detect women LTFU. A risk score cut-point of 18, (69th percentile) identified the 23% of women with the highest probability of LTFU and had sensitivity 32% (95% CI 28%, 36%) and specificity 80% (95% CI 78%, 82%). As lifelong cART increasingly becomes the standard of care, efforts to reduce postpartum LTFU and understand the mechanisms by which cART impacts pregnancy outcomes are essential to sustain improvements in PMTCT and maternal HIV outcomes.Doctor of Philosoph

Predictors of depression recovery in HIV-infected individuals managed through measurement-based care in infectious disease clinics

Treatment of comorbid chronic disease, such as depression, in people living with HIV/AIDS (PLWHA) increasingly falls to HIV treatment providers. Guidance in who will best respond to depression treatment and which patient-centered symptoms are best to target is limited

Identifying Patients With Vesicovaginal Fistula at High Risk of Urinary Incontinence After Surgery:

To develop a risk score to identify women with vesicovaginal fistula at high risk of residual urinary incontinence after surgical repair

Levels of alcohol use and history of HIV testing among female sex workers in Mombasa, Kenya

HIV testing is a critical first step to accessing HIV care and treatment, particularly for high-risk groups such as female sex workers (FSWs). Alcohol use may be a barrier to accessing HIV services, including HIV testing. We analyzed data from a cross-sectional survey of 818 FSWs in Mombasa, Kenya, and estimated the association between different levels of alcohol use and having never tested for HIV. In multivariable analyses, higher levels of alcohol consumption were associated with having never tested for HIV (PR 1.60; 95% CI: 1.07, 2.40). Future interventions should explore whether reducing harmful drinking improves HIV testing among FSWs

Improvement and retention of emergency obstetrics and neonatal care knowledge and skills in a hospital mentorship program in Lilongwe, Malawi

To evaluate whether a hospital-based mentoring program could significantly increase short- and longer-term emergency obstetrics and neonatal care (EmONC) knowledge and skills among health providers

Duration of cART Before Delivery and Low Infant Birthweight Among HIV-Infected Women in Lusaka, Zambia

To estimate the association between duration of combination antiretroviral therapy (cART) during pregnancy and low infant birthweight (LBW), among women ≥37 weeks gestation

Multiple Overimputation to Address Missing Data and Measurement Error: Application to HIV Treatment During Pregnancy and Pregnancy Outcomes

Investigations of the association of combination antiretroviral therapy (ART) with pregnancy outcomes often rely on routinely collected clinical data, which are prone to missing data and measurement error. Measurement error in gestational age may bias the relationship between combination ART and gestational age-based outcomes

Fertility outcomes following obstetric fistula repair: a prospective cohort study

Abstract Background Obstetric fistula (OF) is a maternal morbidity associated with high rates of stillbirth, amenorrhea, and sexual dysfunction. Limited data exists on the reproductive outcomes of women in the years following a fistula repair. The objective of this study is to describe the fertility outcomes and family planning practices in a population of Malawian women 1–4 years after fistula repair. Methods Women who had enrolled into a clinical database of OF patients and undergone OF repair between January 1, 2012 and July 31, 2014 were recruited and enrolled to complete a home-based survey of their demographic and reproductive health data 1–4 years after their repair. Pregnancy, amenorrhea, and sexual function were described using frequency analysis, and we compared antimüllerian hormone (AMH) concentrations between women with menses or pregnancy with women with amenorrhea or no pregnancy using Wilcoxon rank sum tests. Results Of 297 women with a prior OF repair, 148 had reproductive potential and were included in this analysis. Overall 30 women of these women (21%) became pregnant since their fistula repair, with most pregnancies ending with cesarean delivery. Of the 32 women who were amenorrheic at the time of repair, 25 (78.1%) had resumption of menses. Only 11 (8.6%) of sexually active women reported dyspareunia, and among women who were not trying to conceive, 53.1% were currently using a method of family planning. No significant differences were found in AMH concentrations between those who were pregnant or had menses versus those without pregnancy or menses, respectively. Conclusions In this long-term follow-up study of women after OF repair, many women were able to achieve a pregnancy with a live birth, have normal menses, be sexually active, and access contraception. These achievements will further assist a population of women whose reintegration and restoration of dignity is closely tied to their ability to achieve their reproductive goals. Trial registration ClinicalTrials.gov Identifier: NCT02685878

Somatic Symptoms Among US Adolescent Females: Associations with Sexual and Physical Violence Exposure

To examine the association between physical and sexual violence exposure and somatic symptoms among female adolescents