20 research outputs found
Three years of data on the impact of obstetrician/gynecologist coverage in rural Uganda
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135481/1/ijgo284.pd
Root causes and social consequences of birth injuries in Western Uganda
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138287/1/ijgo12257.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138287/2/ijgo12257_am.pd
Postpartum adherence to Option B+ until 18 months in Western Uganda
Since 2012, the WHO recommends Option B+ for the prevention of mother-to-child
transmission of HIV. This approach entails the initiation of lifelong
antiretroviral therapy in all HIV-positive pregnant women, also implying
protection during breastfeeding for 12 months or longer. Research on long-term
adherence to Option B+ throughout breastfeeding is scarce to date. Therefore,
we conducted a prospective observational cohort study in Fort Portal, Western
Uganda, to assess adherence to Option B+ until 18 months postpartum. In 2013,
we recruited 67 HIV-positive, Option B+ enrolled women six weeks after giving
birth and scheduled them for follow-up study visits after six, twelve and 18
months. Two adherence measures, self-reported drug intake and amount of drug
refill visits, were combined to define adherence, and were assessed together
with feeding information at all study visits. At six months postpartum, 51% of
the enrolled women were considered to be adherent. Until twelve and 18 months
postpartum, adherence for the respective follow-up interval decreased to 19%
and 20.5% respectively. No woman was completely adherent until 18 months. At
the same time, 76.5% of the women breastfed for ≥12 months. Drug adherence was
associated with younger age (p<0.01), lower travel costs (p = 0.02), and lower
number of previous deliveries (p = 0.04). Long-term adherence to Option B+
seems to be challenging. Considering that in our cohort, prolonged
breastfeeding until ≥12 months was widely applied while postpartum adherence
until the end of breastfeeding was poor, a potential risk of postpartum
vertical transmission needs to be taken seriously into account for Option B+
implementation
Lack of effect of intermittent preventive treatment for malaria in pregnancy and intense drug resistance in western Uganda
Background Intermittent preventive treatment in pregnancy (IPTp) with
sulfadoxine–pyrimethamine (SP) is widely implemented in sub-Saharan Africa for
the prevention of malaria in pregnancy and adverse birth outcomes. However, in
areas of intense SP resistance, the efficacy of IPTp may be compromised.
Methods A cross-sectional study among 915 delivering women (728 analysable
live singleton deliveries) was conducted in Fort Portal, western Uganda, to
assess associations of reported IPTp use, Plasmodium falciparum infection,
maternal anaemia, low birth weight, and preterm delivery, and to estimate the
degree of SP resistance as reflected by pfdhfr/pfdhps mutations. Results
Plasmodium falciparum infection was detected by PCR in 8.9 % and by microscopy
of placental blood samples in 4.0 %. Infection was significantly associated
with stillbirth, early neonatal death, anaemia, low birth weight, and pre-term
delivery. Eighty percent of the women had taken at least one dose of IPTp, and
more than half had taken two doses. As compared to women without
chemoprophylaxis against malaria, IPTp had no significant influence on the
presence of P. falciparum infection (13.8 vs. 9.6 %, P = 0.31). Nor was it
associated with reductions in anaemia, low birth weight or preterm delivery.
P. falciparum with intense SP resistance (pfdhfr/pfdhps quintuple or sextuple
mutations) were observed in 93 % (pfdhps 581G, 36 %), and the additional high
resistance allele pfhdr 164L in 36 %. Conclusions In Fort Portal, Uganda,
reported use of IPTp with SP does not provide an observable benefit. The
molecular markers of P. falciparum indicate high grade SP resistance reaching
the threshold set by WHO for the discontinuation of IPTp with SP. Alternative
approaches for the prevention of malaria in pregnancy are urgently needed
Prevention of mother-to-child transmission of HIV: Postpartum adherence to Option B+ until 18 months in Western Uganda.
Since 2012, the WHO recommends Option B+ for the prevention of mother-to-child transmission of HIV. This approach entails the initiation of lifelong antiretroviral therapy in all HIV-positive pregnant women, also implying protection during breastfeeding for 12 months or longer. Research on long-term adherence to Option B+ throughout breastfeeding is scarce to date. Therefore, we conducted a prospective observational cohort study in Fort Portal, Western Uganda, to assess adherence to Option B+ until 18 months postpartum. In 2013, we recruited 67 HIV-positive, Option B+ enrolled women six weeks after giving birth and scheduled them for follow-up study visits after six, twelve and 18 months. Two adherence measures, self-reported drug intake and amount of drug refill visits, were combined to define adherence, and were assessed together with feeding information at all study visits. At six months postpartum, 51% of the enrolled women were considered to be adherent. Until twelve and 18 months postpartum, adherence for the respective follow-up interval decreased to 19% and 20.5% respectively. No woman was completely adherent until 18 months. At the same time, 76.5% of the women breastfed for ≥12 months. Drug adherence was associated with younger age (p<0.01), lower travel costs (p = 0.02), and lower number of previous deliveries (p = 0.04). Long-term adherence to Option B+ seems to be challenging. Considering that in our cohort, prolonged breastfeeding until ≥12 months was widely applied while postpartum adherence until the end of breastfeeding was poor, a potential risk of postpartum vertical transmission needs to be taken seriously into account for Option B+ implementation
Option B+ for prevention of vertical HIV transmission has no influence on adverse birth outcomes in a cross-sectional cohort in Western Uganda
Background While most Sub-Saharan African countries are now implementing the
WHO-recommended Option B+ protocol for prevention of vertical HIV
transmission, there is a lack of knowledge regarding the influence of Option
B+ exposure on adverse birth outcomes (ABOs). Against this background, we
assessed ABOs among delivering women in Western Uganda. Methods A cross-
sectional, observational study was performed within a cohort of 412 mother-
newborn-pairs in Virika Hospital, Fort Portal in 2013. The occurrence of
stillbirth, pre-term delivery, and small size for gestational age (SGA) was
analysed, looking for influencing factors related to HIV-status,
antiretroviral drug exposure and duration, and other sociodemographic and
clinical parameters. Results Among 302 HIV-negative and 110 HIV-positive
women, ABOs occurred in 40.5%, with stillbirth in 6.3%, pre-term delivery in
28.6%, and SGA in 12.2% of deliveries. For Option B+ intake (n = 59), no
significant association was found with stillbirth (OR 0.48, p = 0.55), pre-
term delivery (OR 0.97, p = 0.92) and SGA (OR 1.5, p = 0.3) compared to
seronegative women. Women enrolled on antiretroviral therapy (ART) before
conception (n = 38) had no different risk for ABOs than women on Option B+ or
HIV-negative women. Identified risk factors for stillbirth included lack of
formal education, poor socio-economic status, long travel distance,
hypertension and anaemia. Pre-term delivery risk was increased with poor
socio-economic status, primiparity, Malaria and anaemia. The occurrence of SGA
was influenced by older age and Malaria. Conclusion In our study, women on
Option B+ showed no difference in ABOs compared to HIV-negative women and to
women on ART. We identified several non-HIV/ART-related influencing factors,
suggesting an urgent need for improving early risk assessment mechanisms in
antenatal care through better screening and triage systems. Our results are
encouraging with regard to continued universal scale-up of Option B+ and ART
programmes
Decreased emergence of HIV-1 drug resistance mutations in a cohort of Ugandan women initiating option B+ for PMTCT
Background: Since 2012, WHO guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings recommend the initiation of lifelong antiretroviral combination therapy (cART) for all pregnant HIV-1 positive women independent of CD4 count and WHO clinical stage (Option B+). However, long-term outcomes regarding development of drug resistance are lacking until now. Therefore, we analysed the emergence of drug resistance mutations (DRMs) in women initiating Option B+ in Fort Portal, Uganda, at 12 and 18 months postpartum (ppm). Methods and findings: 124 HIV-1 positive pregnant women were enrolled within antenatal care services in Fort Portal, Uganda. Blood samples were collected at the first visit prior starting Option B+ and postpartum at week six, month six, 12 and 18. Viral load was determined by real-time RT-PCR. An RT-PCR covering resistance associated positions in the protease and reverse transcriptase HIV-1 genomic region was performed. PCR-positive samples at 12/18 ppm and respective baseline samples were analysed by next generation sequencing regarding HIV-1 drug resistant variants including low-frequency variants. Furthermore, vertical transmission of HIV-1 was analysed. 49/124 (39.5%) women were included into the DRM analysis. Virological failure, defined as >1000 copies HIV-1 RNA/ml, was observed in three and seven women at 12 and 18 ppm, respectively. Sequences were obtained for three and six of these. In total, DRMs were detected in 3/49 (6.1%) women. Two women displayed dual-class resistance against all recommended first-line regimen drugs. Of 49 mother-infant-pairs no infant was HIV-1 positive at 12 or 18 ppm. Conclusion: Our findings suggest that the WHO-recommended Option B+ for PMTCT is effective in a cohort of Ugandan HIV-1 positive pregnant women with regard to the low selection rate of DRMs and vertical transmission. Therefore, these results are encouraging for other countries considering the implementation of lifelong cART for all pregnant HIV-1 positive women
Option B+ enrolled women attending postpartum study visits.
<p>Option B+ enrolled women attending postpartum study visits.</p