High HIV incidence in the postpartum period sustains vertical transmission in settings with generalized epidemics: a cohort study in Southern Mozambique

Schacht, Caroline De; Mabunda, Nédio; Ferreira, Orlando C.; Ismael, Nália; Calú, Nurbai; Santos, Iolanda; Hoffman, Heather J.; Alons, Catharina; Guay, Laura; Jani, Ilesh

doi:10.7448/ias.17.1.18808

Cited by 52 publications

(50 citation statements)

References 16 publications

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“…A large prospective study of postpartum women in southern Mozambique also found a substantial HIV incidence rate of 3.2 per 100 WY overall, highest in the youngest women of 18–19 years [5]. The incidence rate among participants in that study from Gaza Province, where Chókwè is located, was slightly higher at 3.6 per 100 WY.…”

Section: Discussionmentioning

confidence: 83%

HIV Prevalence and Incidence in a Cohort of Women at Higher Risk for HIV Acquisition in Chókwè, Southern Mozambique

et al. 2014

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BackgroundReliable HIV incidence estimates for Mozambique are limited. We conducted a prospective HIV incidence study as part of a clinical research site development initiative in Chókwè district, Gaza Province, southern Mozambique.MethodsBetween June 2010 and October 2012, we recruited women at sites where women at higher risk of HIV infection would likely be found. We enrolled and tested 1,429 sexually active women in the screening phase and 479 uninfected women in the prospective phase. Participants were scheduled for 12+ months follow-up, when they underwent face-to-face interviews, HIV counseling and testing, and pregnancy testing. We observed a total of 373.1 woman-years (WY) of follow-up, with mean (median) of 9.4 (9.7) women-months per participant.ResultsThe prevalence of HIV was 29.4% (95% confidence interval [CI]: 27.0–31.8%). In multivariable logistic regression analysis, factors that remained significantly associated with prevalent HIV were: older age (OR: 0.6; 95% CI: 0.4–0.7), lower educational level (OR: 0.4; 95% CI: 0.3–0.7), and using hormonal contraception (OR: 0.6; 95% CI: 0.4–0.7) or condoms (OR: 0.5; 95% CI: 0.3–0.7). We observed an HIV incidence rate of 4.6 per 100 WY (95% CI: 2.7, 7.3). The HIV incidence was 4.8 per 100 WY (95% CI: 2.5, 8.3) in women aged 18–24 years, 4.5 per 100 WY (95% CI: 1.2, 11.4) in women aged 25–29 years and 3.2 per 100 WY (95% CI: 0.1, 18.0) in the 30–35 years stratum. None of the demographic factors or time-varying behavioral factors examined was significantly associated with incident HIV infection in bivariable analysis at p≤0.10.ConclusionsWe found a high HIV incidence among sexually active young women in Chókwè, Mozambique. HIV prevention programs should be strengthened in the area, with more comprehensive reproductive health services, regular HIV testing, condom promotion, and messaging about multiple sexual partners.

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Section: Discussionmentioning

confidence: 83%

HIV Prevalence and Incidence in a Cohort of Women at Higher Risk for HIV Acquisition in Chókwè, Southern Mozambique

et al. 2014

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“…Longitudinal HIV incidence data is limited in Mozambique with approximately five reported studies across the country [13,17,20–22]. Incidence data among women has been reported in post-partum clinics at 2.9 per 100 person-years in Maputo Province and at 3.6 in Gaza Province, at 4.6 in a cohort study in Gaza, at 4.9 from cross-sectional surveys in Manhiça, at 6.5 in a cohort study in Sofala, and as high as 14.1 based on consecutive prevalence surveys in Manhiça [13,17,20–22].…”

Section: Discussionmentioning

confidence: 99%

“…Incidence data among women has been reported in post-partum clinics at 2.9 per 100 person-years in Maputo Province and at 3.6 in Gaza Province, at 4.6 in a cohort study in Gaza, at 4.9 from cross-sectional surveys in Manhiça, at 6.5 in a cohort study in Sofala, and as high as 14.1 based on consecutive prevalence surveys in Manhiça [13,17,20–22]. Participants were similar across the studies, as sexually active women of reproductive age, although with the exception of the latter referenced study in Manhiça, women in the other studies tended to be slightly younger than in our study with mean ages below the mid-20s, more comparable to the Mavalane than the Manhiça cohort.…”

Section: Discussionmentioning

confidence: 99%

High HIV prevalence and incidence among women in Southern Mozambique: Evidence from the MDP microbicide feasibility study

et al. 2017

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BackgroundThe study aimed to assess the feasibility of conducting large scale HIV prevention clinical trials in Mozambique by measuring HIV prevalence and incidence among women of reproductive age. This paper describes the baseline socio-demographic characteristics of the Mozambique Microbicides Development Programme (MDP) feasibility cohort, baseline prevalence of HIV and other STIs, and HIV incidence.MethodsThe Mozambique MDP feasibility study was conducted from September 2007 to August 2009 in urban Mavalane and rural Manhiça, in Southern Mozambique. Sexually active, HIV negative women aged 18 years and above were recruited to attend the study clinic every 4 weeks for a total of 40 weeks. At baseline, we collected demographic and sexual behaviour data, samples to test for sexually transmitted infections (STI) and conducted HIV rapid testing. STI and HIV testing were repeated at clinical follow-up visits. We describe HIV prevalence of women at screening, the demographic, behavioural and clinical characteristics of women at enrolment, and HIV incidence during follow-up.ResultsWe screened 793 women (369 at Mavalane and 424 at Manhiça) and enrolled 505 eligible women (254 at Mavalane and 251 at Manhiça). Overall HIV prevalence at screening was 17%; 10% at Mavalane and 22% at Manhiça. Women screened at Manhiça were twice as likely as women screened at Mavalane to be HIV positive and HIV positive status was associated with younger age (18–34), lower educational level, not using a reliable method of contraception and being Zionist compared to other Christian religions. At enrolment contraceptive use was low in both clinics at 19% in Mavalane and 21% in Manhiça, as was reported condom use at last sex act at 48% in Mavalane and 25% in Manhiça. At enrolment, 8% of women tested positive for Trichomonas vaginalis, 2% for Neisseria gonorrhoeae, 4% for Chlamydia trachomatis and 46% for bacterial vaginosis. In Manhiça, 8% of women had active syphilis at screening. HIV incidence was 4.3 per 100 person years at Mavalane and 9.2 per 100 person years at Manhiça.ConclusionsWe demonstrated the ability to recruit a cohort of women at risk of HIV who were willing to participate in clinical research. The high HIV incidence necessitates additional action around HIV prevention for women and offers opportunities to evaluate the impact of available prevention options, such as treatment as prevention and oral PrEP. The high HIV incidence and STI prevalence also offers opportunities to evaluate the added benefit of potential prevention options such as new formulations of oral PrEP, vaginal microbicides (also called topical PrEP), vaccines, and multi-purpose technologies for HIV, STIs and contraception.

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“…Service integration of HEI screening into immunization clinics has previously been shown to be associated with increased uptake, younger age at screening, increased receipt of test results, and increased enrollment in HIV care. 38 Further, the high HIV incidence among postpartum women in Mozambique 39 and the higher risk of viral rebound in the first 3 40 to 6 41 months postpartum highlights the importance of engaging postpartum women in ongoing care to preserve the mother’s health and to prevent vertical transmission, including counseling on appropriate feeding, HEI screening, and prevention of future unplanned pregnancies.…”

Section: Discussionmentioning

confidence: 99%

Implementation and Operational Research: Impact of a Systems Engineering Intervention on PMTCT Service Delivery in Côte d'Ivoire, Kenya, Mozambique: A Cluster Randomized Trial

Rustagi

Gimbel

Nduati

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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BACKGROUND Efficacious interventions to prevent mother-to-child HIV transmission (PMTCT) have not translated well into effective programs. Prior studies of systems engineering applications to PMTCT lacked comparison groups or randomization. METHODS Thirty-six health facilities in Côte d’Ivoire, Kenya, and Mozambique were randomized to usual care or a systems engineering intervention, stratified by country and volume. The intervention guided facility staff to iteratively identify and then rectify barriers to PMTCT implementation. Registry data quantified coverage of HIV testing during first antenatal care visit, antiretrovirals (ARVs) for HIV-positive pregnant women, and screening HIV-exposed infants (HEI) for HIV by 6–8 weeks. We compared the change between baseline (January 2013–January 2014) and post-intervention (January–March 2015) periods using t-tests. All analyses were intent-to-treat. RESULTS ARV coverage increased 3-fold (+13.3 percentage points [95% CI: 0.5, 26.0] in intervention vs. +4.1 [−12.6, 20.7] in control facilities) and HEI screening increased 17-fold (+11.6 [−2.6, 25.7] in intervention vs. +0.7 [−12.9, 14.4] in control facilities). In pre-specified sub-group analyses, ARV coverage increased significantly in Kenya (+20.9 [−3.1, 44.9] in intervention vs. −21.2 [−52.7, 10.4] in controls; p=0.02). HEI screening increased significantly in Mozambique (+23.1 [10.3, 35.8] in intervention vs. +3.7 [−13.1, 20.6] in controls; p=0.04). HIV testing did not differ significantly between arms. CONCLUSIONS In this first randomized trial of systems engineering to improve PMTCT, we saw substantially larger improvements in ARV coverage and HEI screening in intervention facilities compared to controls, which were significant in pre-specified sub-groups. Systems engineering could strengthen PMTCT service delivery and protect infants from HIV.

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High HIV incidence in the postpartum period sustains vertical transmission in settings with generalized epidemics: a cohort study in Southern Mozambique

Cited by 52 publications

References 16 publications

HIV Prevalence and Incidence in a Cohort of Women at Higher Risk for HIV Acquisition in Chókwè, Southern Mozambique

HIV Prevalence and Incidence in a Cohort of Women at Higher Risk for HIV Acquisition in Chókwè, Southern Mozambique

High HIV prevalence and incidence among women in Southern Mozambique: Evidence from the MDP microbicide feasibility study

Implementation and Operational Research: Impact of a Systems Engineering Intervention on PMTCT Service Delivery in Côte d'Ivoire, Kenya, Mozambique: A Cluster Randomized Trial

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