HIVST acceptance and PrEP initiation among pregnant women at high risk of HIV in Homa Bay and Siaya counties, Kenya

Thesis (Master's)--University of Washington, 2021Background: Sub-Saharan Africa has the highest incidence of HIV worldwide with women having a higher incidence than men. Pregnancy increases risk for HIV acquisition which can increase the risk of vertical HIV transmission. Low rates of HIV testing in male partners is an important driver of incident HIV infection among pregnant women. Distribution of HIV self-tests (HIVST) for male partners can facilitate male partner HIV testing and help women make informed decisions about PrEP. This study aims to understand how acceptance of HIVST for male partner testing influences PrEP acceptance among pregnant women, identify cofactors of HIVST, PrEP, and of combined HIVST and PrEP, and influence of HIVST on knowledge of partner HIV status. Methods: This study utilized longitudinal data from the targeted arm of the PrEP Implementation of Mothers in Antenatal care study, a cluster-randomized clinical trial evaluating two models of PrEP delivery in pregnant women conducted in Homa Bay and Siaya counties. Within the targeted arm, pregnant women were assessed using an objective HIV risk assessment tool. Women at high risk of HIV acquisition were systematically offered PrEP and were included in this analysis. Additionally, women in this arm were offered HIVST for their male partners and were asked to report on the HIVST results of their partners at their next visit. Data including HIVST acceptance, PrEP acceptance, PrEP discontinuation, male partner HIVST acceptance and HIVST reported by the participants was captured. Presence of intimate partner violence (IPV) was assessed using the Hurt-Insult-Threaten-Scream (HITS) screening tool. Depression was assessed using the Patient Health Questionnaire-2 (PHQ2) while social support was evaluated using the 18-item Medical Outcomes Study Social Support Survey (MOS-SSS). Chi-squared tests were utilized to compare the association between HIVST acceptance for male partner and PrEP acceptance. Univariate logistic regression was used to compare participant demographics, pregnancy characteristics and male partner characteristics between women who accepted either intervention or accepted both interventions compared to those who declined both HIVST and PrEP (reference group). Results: Of 2,197 women in the targeted arm, 1,008 (46%) women were determine to be at high risk of HIV acquisition and were included in the analysis. Median age of women was 25 years and 88.4% were married. Approximately 46.7% perceived themselves to be at high risk of HIV acquisition, 51.1% reported high social support, 12.8% reported experiencing IPV and 16.9% reported signs of depression. Male partners had a median age of 31 years, with 16.4% being >10 years older. Overall, 86.1% of women reported that they did not know their partner’s HIV status. Of 1,008 high-risk pregnant women, 50% accepted HIVST only, 13.9% accepted both HIVST and PrEP and 10.2% accepted PrEP only. Overall, 63.9% accepted HIVST, of whom 80.9% offered them to their male partners; 69.1% used the HIVST kits and 67.2% of the women tested together with their male partners. Overall, 68.7% of women became newly aware of their partners HIV status by 9 months postpartum with 1.9% of these partners having a positive HIVST. Cofactors for accepting either PrEP or HIVST included HIV risk perception, social support, parity, male partner HIV status and marital status/type of partnership. Cofactors for accepting PrEP alone included the woman’s age, the male partner’s age and presence of IPV. Cofactors for accepting HIVST alone included the woman’s level of education. Cofactors for accepting both HIVST and PrEP included social support, presence of IPV, depression and suspicion of male partners’ having other sexual partners. Unawareness of male partner HIV status and high HIV risk perception were the facilitators of uptake of PrEP. The major barrier of accepting both HIVST and PrEP was need to consult the male partner. Other barriers of accepting PrEP included their need for more time to think, pill burden and low HIV risk perception Conclusion: Distribution of HIVST for male partner testing was acceptable and useful to help high risk pregnant women navigate decisions about PrEP. Understanding the factors that foster high risk pregnant women to accept HIVST only, PrEP only or accept both HIVST and PrEP is key in informing and scaling up HIVST programming and PrEP counselling for pregnant women

Perspective piece effect of SARS-CoV-2 infection in pregnancy on maternal and neonatal outcomes in Africa: An AFREhealth call for evidence through multicountry research collaboration

© 2021 by The American Society of Tropical Medicine and Hygiene In the African context, there is a paucity of data on SARS-CoV-2 infection and associated COVID-19 in pregnancy. Given the endemicity of infections such as malaria, HIV, and tuberculosis (TB) in sub-Saharan Africa (SSA), it is important to evaluate coinfections with SARS-CoV-2 and their impact on maternal/infant outcomes. Robust research is critically needed to evaluate the effects of the added burden of COVID-19 in pregnancy, to help develop evidence-based policies toward improving maternal and infant outcomes. In this perspective, we briefly review current knowledge on the clinical features of COVID-19 in pregnancy; the risks of preterm birth and cesarean delivery secondary to comorbid severity; the effects of maternal SARS-CoV-2 infection on the fetus/neonate; and in utero mother-to-child SARS-CoV-2 transmission. We further highlight the need to conduct multicountry surveillance as well as retrospective and prospective cohort studies across SSA. This will enable assessments of SARS-CoV-2 burden among pregnant African women and improve the understanding of the spectrum of COVID-19 manifestations in this population, which may be living with or without HIV, TB, and/or other coinfections/comorbidities. In addition, multicountry studies will allow a better understanding of risk factors and outcomes to be compared across countries and subregions. Such an approach will encourage and strengthen much-needed intra-African, south-to-south multidisciplinary and interprofessional research collaborations. The African Forum for Research and Education in Health\u27s COVID-19 Research Working Group has embarked upon such a collaboration across Western, Central, Eastern and Southern Africa

Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis

BACKGROUND: Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. METHODS: We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. RESULTS: Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). CONCLUSIONS: Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women

Effect of SARS-CoV-2 Infection in Pregnancy on Maternal and Neonatal Outcomes in Africa: An AFREhealth Call for Evidence through Multicountry Research Collaboration.

In the African context, there is a paucity of data on SARS-CoV-2 infection and associated COVID-19 in pregnancy. Given the endemicity of infections such as malaria, HIV, and tuberculosis (TB) in sub-Saharan Africa (SSA), it is important to evaluate coinfections with SARS-CoV-2 and their impact on maternal/infant outcomes. Robust research is critically needed to evaluate the effects of the added burden of COVID-19 in pregnancy, to help develop evidence-based policies toward improving maternal and infant outcomes. In this perspective, we briefly review current knowledge on the clinical features of COVID-19 in pregnancy; the risks of preterm birth and cesarean delivery secondary to comorbid severity; the effects of maternal SARS-CoV-2 infection on the fetus/neonate; and in utero mother-to-child SARS-CoV-2 transmission. We further highlight the need to conduct multicountry surveillance as well as retrospective and prospective cohort studies across SSA. This will enable assessments of SARS-CoV-2 burden among pregnant African women and improve the understanding of the spectrum of COVID-19 manifestations in this population, which may be living with or without HIV, TB, and/or other coinfections/comorbidities. In addition, multicountry studies will allow a better understanding of risk factors and outcomes to be compared across countries and subregions. Such an approach will encourage and strengthen much-needed intra-African, south-to-south multidisciplinary and interprofessional research collaborations. The African Forum for Research and Education in Health’s COVID-19 Research Working Group has embarked upon such a collaboration across Western, Central, Eastern and Southern Africa.http://www.ajtmh.org2022-02-01pm2021Obstetrics and Gynaecolog

Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis.

Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women