Understanding the Impact of Maternal HIV Infection on the Health and Well-Being of Mothers and Infants in South Africa: Siyakhula Collaborative Workshop Report

Abstract

The Siyakhula study is an ongoing, observational cohort study in Pretoria, South Africa, that aims to understand how maternal HIV infection and perinatal environmental factors shape development and health in infants who are HIV-exposed (in utero and during breastfeeding) but remain uninfected themselves (HEU). The Siyakhula Collaborative Workshop, which took place at the Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies at Kalafong Hospital in Pretoria, South Africa on November 15-16, 2018, brought together a group of international health scientists, clinicians, and stakeholders, including women with lived experience, to build capacity for research and training on the impact of HIV infection on women's and infants' health across geographical and disciplinary boundaries. The workshop sought to summarise the state of knowledge on the effects of being HEU on infant development and health in the first two years of life, identify gaps in existing research on modifiable exposures that may be associated with poor infant development, and develop ideas for novel research and interventions to lessen or prevent adverse health outcomes in pregnant or breastfeeding people living with HIV. These proceedings summarise the pre-workshop consensus process that was used to identify priority areas to discuss during small-group breakout sessions, as well as the themes and key challenges that emerged from these discussions during the workshop.

Metabolic Alterations in Mothers Living with HIV and Their HIV-Exposed, Uninfected Infants

“…This study formed part of a larger study, the Siyakhula study [ 14 ], for which ethics approval by the Research Ethics Committee of the Faculty of Health Sciences of the University of Pretoria had been obtained (protocol number 294/2017). The larger study recruited 315 women, 152 PWLWH and 163 HIV-uninfected pregnant women, from antenatal clinics in Southwest Tshwane, South Africa.…”

Comparison of Feeding Practices and Growth of Urbanized African Infants Aged 6–12 Months Old by Maternal HIV Status in Gauteng Province, South Africa

“…This study is a sub-study of the longitudinal Siyakhula cohort study [ 37 ], which aims to better understand how the in-utero and early postnatal environments, altered by maternal HIV infection and the treatment thereof, influence infants’ growth trajectories and cognitive development and alter their immune development and function, irrespective of the infants’ own HIV status. For this study, mother-infant dyads who attended the 6 ( n = 181), 9 ( n = 166), and 12 ( n = 155) month follow-up visits were included, with declining numbers due to loss to follow-up and relocation.…”

“…All study-related information was collected at the central study site at Kalafong Provincial Tertiary Hospital, Gauteng Province, South Africa [ 37 ]. After obtaining informed consent, questionnaires were administered in the participants’ preferred local languages by trained fieldworkers.…”

“…In addition, HEU infants are also smaller at birth in terms of the mean weight and length [ 28 , 29 ], which may contribute to their poor growth observed as early as three months of age, as documented in multiple African countries (Zambia: lower mean weight 2.9 kg vs. 3.0 kg between 1–16 weeks, lower length in HEU infants at 6 months (64.3 cm ± 1.1) [ 30 ]; Zimbabwe: the likelihood of stunting (25%), underweight (55%), and wasting (58%) high in HEU infants [ 31 ]; Ethiopia: risk of stunting of 51.9 per 100 person-years infants HIV exposed from conception [ 32 ]; and South Africa:10% HEU stunted [ 33 ]). Limited research is available on HEU infants that focuses on the complementary feeding introduction phase, especially in terms of having an appropriate HIV-unexposed-uninfected (HUU) comparison group [ 11 , 28 , 34 , 35 , 36 , 37 ]. Therefore, this study aimed to compare the feeding practices and growth of HEU and HUU infants between 6–12 months of age in Tshwane District, Gauteng Province, South Africa.…”

Early life programming of neurodevelopment and growth: understanding nutritional, inflammatory, and placental contributions in complex pregnancies

“…The potential benefits of exclusive breastfeeding are also important to understand for infants who are HEU and could provide a target for early nutrition-related interventions. Mothers living with HIV who are on ARTs report mixed messaging around the safety and benefits of breastfeeding, and social pressures to not breastfeed 521 , and increased duration of exclusive breastfeeding has shown to be protective against adverse outcomes for infants who are HEU in some cohorts 339,386 , but not others 522 . There is also a lack of understanding of how maternal HIV infection and ARTs, alone or in combination with suboptimal maternal dietary intakes, may influence the nutritional composition breastmilk.…”