HIV-exposed and HIV-uninfected (HEU) infants may be at increased risk of poor health and growth outcomes. We characterized infant growth trajectories in a cohort of HEU infants to identify factors associated with healthy growth. HIV-positive women participating in prevention of mother-to-child HIV transmission programmes in Kigali, Rwanda, were followed until their infants were 2 years old. Infant anthropometrics were regularly collected. Latent class analysis was used to categorize infant growth trajectories. Multiple logistic regression was used to estimate the odds of infants belonging to each growth trajectory class. On average, this population of HEU infants had moderate linear growth faltering, but only modest faltering in weight, resulting in mean weight-for-length z-score (WLZ) above the World Health Organization (WHO) median. Mean WLZ was 0.53, and mean length-for-age z-score (LAZ) was −1.14 over the first 2 years of life. We identified four unique WLZ trajectories and seven trajectories in LAZ. Low neonatal weight-for-age and a high rate of illness increased the likelihood that infants were in the lightest WLZ class. Shorter mothers were more likely to have infants with linear growth faltering. Female infants who were older at the end of exclusive breastfeeding were more likely to be in the second tallest LAZ class. In conclusion, the current WHO recommendations of Option B+ and extended breastfeeding may induce higher WLZ and lower LAZ early in infancy. However, there is considerable heterogeneity in growth patterns that is obscured by simply analysing average growth trends, necessitating the analysis of growth in subpopulations.

Immunisation is one of the most cost-effective interventions to prevent and control life-threatening infectious diseases. Nonetheless, rates of routine vaccination of children in low-and middle-income countries (LMICs) are strikingly low or stagnant.In 2019, an estimated 19.7 million infants did not receive routine immunisations.Community engagement interventions are increasingly being emphasised in international and national policy frameworks as a means to improve immunisation coverage and reach marginalised communities. This systematic review examines the

Introduction Human leukocyte antigen (HLA) ‐B*5701 screening identifies patients at increased risk for abacavir ( ABC ) hypersensitivity reaction ( HSR ). Screening was adopted in GlaxoSmithKline and ViiV Healthcare clinical trials in 2007 and human immunodeficiency virus treatment guidelines in 2008. Company meta‐analyses of trials pre– HLA ‐B*5701 screening reported HSR rates of 4–8%. We analyzed the effectiveness of HLA ‐B*5701 screening on reducing HSR rates using clinical trial, Observational Pharmaco‐Epidemiology Research & Analysis ( OPERA ) cohort, and spontaneous reporting data. Methods A meta‐analysis examined 12 trials in 3063 HLA ‐B*5701–negative patients receiving an ABC ‐containing regimen from April 9, 2007, to September 22, 2015. Potential cases were identified using prespecified Medical Dictionary for Regulatory Activities (Med DRA ) preferred terms ( drug hypersensitivity, hypersensitivity, anaphylactic reaction, anaphylaxis ) and adjudicated against a Company ABC HSR case definition. Investigator‐diagnosed cases were identified and rates were calculated. In the OPERA cohort, 9619 patients initiating their first ABC ‐containing regimen from January 1, 1999, to January 1, 2016, were identified. Patients were observed from regimen start until the earliest‐following censoring event: ABC discontinuation, loss to follow‐up, death, or study end (July 31, 2016). OPERA physicians evaluated events against OPERA definitions for definite/probable cases of ABC HSR ; rates were calculated pre‐ and post‐2008. The Company case definition was used to identify spontaneously reported cases for four marketed ABC ‐containing products; reporting rates were calculated using estimated exposure from sales data, through December 31, 2016. Results Suspected ABC HSR rates were 1.3% or less in the meta‐analysis. In the OPERA cohort, the rate was 0.4% among patients initiating ABC post‐2008 versus 1.3% pre‐2008 (p<0.0001). Spontaneous reporting rates were low post‐2008 (54 to 22 cases per 100,000 patient‐years exposure [ PYE ]) versus pre‐2008 (618 to 55 cases per 100,000 PYE ). Conclusions Clinically suspected ABC HSR rates were 1.3% or less in HLA ‐B*5701–negative patients. Recognizing their limitations, data from t...

Background: HIV-uninfected infants of HIV-positive women may experience worse growth and health outcomes than infants of HIV-negative women, but this has not been thoroughly investigated under the WHO's most recent recommendations to reduce vertical transmission.Objective: To determine if HIV-exposed and -uninfected (HEU) infants whose mothers received Option B+ have higher odds of experiencing suboptimal growth trajectories than HIV-unexposed,uninfected infants and if this relationship is affected by food insecurity.Design: Repeated anthropometric measures were taken on 238 infants (HEU=86) at 1 week and 1,3,6,9, and 12 months after delivery in Gulu, Uganda. Latent class growth mixture modeling was used to develop trajectories for length-for-age z-scores (LAZ), weight-for-length z-scores, midupper arm circumference (MUAC), sum of skinfolds, and arm fat area. Multinomial logistic models were built to predict odds of trajectory class membership, controlling for socioeconomic factors.Results: HEU infants had greater odds of being in the shortest two LAZ trajectory classes (OR=3. 80[1.22,11.82], OR=8.72 [1.80,42.09]) and higher odds of being in smallest sum of skinfolds trajectory class (OR=3. 85[1.39,10.59]) vs. unexposed infants. Among HEU infants, increasing food insecurity was associated with lower odds of being in the lowest sum of skinfolds class (OR=0. 86[0.76,0.98 ]).Conclusions: There continues to be differences in growth patterns by HIV-exposure under the new set of WHO guidelines for the prevention of mother-to-child transmission of HIV and the feeding of HEU infants in low-resource settings that are not readily identified through traditional

ObjectiveTo support evidence informed decision-making, we systematically examine the effectiveness and cost-effectiveness of community engagement interventions on routine childhood immunisation outcomes in low-income and middle-income countries (LMICs) and identify contextual, design and implementation features associated with effectiveness.DesignMixed-methods systematic review and meta-analysis.Data sources21 databases of academic and grey literature and 12 additional websites were searched in May 2019 and May 2020.Eligibility criteria for selecting studiesWe included experimental and quasi-experimental impact evaluations of community engagement interventions considering outcomes related to routine child immunisation in LMICs. No language, publication type, or date restrictions were imposed.Data extraction and synthesisTwo independent researchers extracted summary data from published reports and appraised quantitative risk of bias using adapted Cochrane tools. Random effects meta-analysis was used to examine effects on the primary outcome, full immunisation coverage.ResultsOur search identified over 43 000 studies and 61 were eligible for analysis. The average pooled effect of community engagement interventions on full immunisation coverage was standardised mean difference 0.14 (95% CI 0.06 to 0.23, I2=94.46). The most common source of risk to the quality of evidence (risk of bias) was outcome reporting bias: most studies used caregiver-reported measures of vaccinations received by a child in the absence or incompleteness of immunisation cards. Reasons consistently cited for intervention success include appropriate intervention design, including building in community engagement features; addressing common contextual barriers of immunisation and leveraging facilitators; and accounting for existing implementation constraints. The median intervention cost per treated child per vaccine dose (excluding the cost of vaccines) to increase absolute immunisation coverage by one percent was US$3.68.ConclusionCommunity engagement interventions are successful in improving outcomes related to routine child immunisation. The findings are robust to exclusion of studies assessed as high risk of bias.