2 research outputs found
Low HIV incidence in pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa
BACKGROUND:
Young Southern African women have the highest HIV incidence globally. Pregnancy doubles
the risk of HIV acquisition further, and maternal HIV acquisition contributes significantly
to the paediatric HIV burden. Little data on combination HIV prevention interventions during
pregnancy and lactation are available. We measured HIV incidence amongst pregnant and
postpartum women receiving a community-based combination HIV prevention intervention
in a high HIV incidence setting in South Africa.
METHODS:
A cohort study that included HIV-uninfected pregnant women was performed. Lay community-
based workers provided individualized HIV prevention counselling and performed
three-monthly home and clinic-based individual and couples HIV testing. Male partners
were referred for circumcision, sexually transmitted infections or HIV treatment as appropriate.
Kaplan-Meier analyses and Cox's regression were used to estimate HIV incidence and
factors associated with HIV acquisition. RESULTS
The 1356 women included (median age 22.5 years) received 5289 HIV tests. Eleven new
HIV infections were detected over 828.3 person-years (PY) of follow-up, with an HIV incidence
rate of 1.33 infections/100 PY (95% CI: 0.74±2.40). Antenatally, the HIV incidence
rate was 1.49 infections/100 PY (95% CI: 0.64±2.93) and postnatally the HIV incidence rate
was 1.03 infections/100 PY (95% CI: 0.33±3.19). 53% of male partners received HIV testing
and 66% of eligible partners received referral for circumcision. Women within known serodiscordant
couples, and women with newly diagnosed HIV-infected partners, adjusted hazard
ratio (aHR) = 32.7 (95% CI: 3.8±282.2) and aHR = 126.4 (95% CI: 33.8±472.2) had
substantially increased HIV acquisition, respectively. Women with circumcised partners had
a reduced risk of incident HIV infection, aHR = 0.22 (95% CI: 0.03±1.86).
CONCLUSIONS:
Maternal HIV incidence was substantially lower than previous regional studies. Community-based
combination HIV prevention interventions may reduce high maternal HIV incidence in
resource-poor settings. Expanded roll-out of home-based couples HIV testing and initiating
pre-exposure prophylaxis for pregnant women within serodiscordant couples is needed in
Southern Africa
Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.
BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa