As per the National HIV Program in Peru, the designation of a patient-elected treatment supporter is a requisite for starting antiretroviral therapy (ART). These individuals are expected to aid the patient in medical and social support. This qualitative study examines the interaction between treatment supporters and people living with HIV/AIDS (PLWHA) to elucidate key dynamics contributing to care. Twenty individual interviews with treatment supporters were analyzed alongside 5 group interviews: 2 groups of treatment supporters, 2 groups of PLWHA, and 1 group of community health workers. Findings characterized formal means of treatment support and informal emotional and instrumental support. Gradual transfer of treatment responsibilities from supporters to PLWHA was found to foster a sense of self-efficacy among PLWHA, and when paired with open communication and committed emotional support, created an ideal reciprocal relationship. However, lack of HIV-related knowledge among treatment supporters was detrimental. More training and systemic support for treatment supporters may optimize their role as informed participants in the care of PLWHA.

Objective While administration of antenatal corticosteroids prior to term elective cesarean deliveries has been shown in international randomized controlled trials to decrease the rates of respiratory distress syndrome and transient tachypnea of the newborn, this is not a standard practice in the United States. We aim to determine if the administration of antenatal corticosteroids for fetal lung maturation within 1 week of scheduled early term cesarean delivery resulted in decreased composite respiratory morbidity. Study Design Historical cohort study including women who underwent scheduled early term cesarean delivery of a singleton, non-anomalous neonate at Mount Sinai Hospital between May 2015 and August 2019, comparing those who completed a course of antenatal corticosteroids within 1 week of delivery to those who did not. The primary outcome was composite respiratory morbidity defined as respiratory distress syndrome, transient tachypnea of the newborn, and neonatal intensive care unit admission for respiratory morbidity. Maternal and neonatal characteristics were compared between groups using t-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher's exact tests for categorical measures, as appropriate. The outcomes were assessed using logistic regression. Results History of preterm birth was significantly higher in those who received antenatal corticosteroids compared with those who did not (24.0 vs. 10.9%, p = 0.01). Neonates who were not exposed to antenatal corticosteroids were more likely to experience the composite respiratory morbidity compared with those who were exposed (RR 4.1, 95% CI 1.2–13.7; p = 0.02). Between 37 and 38 weeks, neonates who did not receive steroids were at increased risk of composite respiratory morbidity (RR 11.7, 95% CI 1.5–89.0, p < 0.01), however, there was no difference for those born between 38 and 39 weeks. Conclusion Betamethasone course administered prior to planned early term cesarean delivery was associated with a statistically significant reduction in the neonatal composite respiratory morbidity compared with routine management. Key Points

Hosmer-Lemeshow test was used to demonstrate goodness-of-fit. Model discrimination was evaluated via concordance index and displayed via area under the receiver operator curve (AUC). The developed model was internally validated using the remaining 30% of the cohort to further assess predictive ability. RESULTS: Of the 1,357 women meeting study criteria, 974 (71.8%) had a vaginal delivery following induction. The final model consisted of eight variables, which were significantly associated with mode of delivery following induction, including maternal age, BMI, gestational age, intrapartum magnesium sulfate, need for cervical ripening, prior cesarean delivery, cervical dilation and effacement. Model calibration and discrimination were satisfactory with Hosmer-Lemeshow test p¼0.35 and an AUC (95% CI) of 0.76 (0.73, 0.79). Internal validation demonstrated similar discriminatory ability. CONCLUSION: Using information available prior to labor induction, our model can predict vaginal delivery success for women with hypertensive disorders of pregnancy and may aid in clinical decisionmaking.