Incident HIV among pregnant and breast-feeding women in sub-Saharan Africa: a systematic review and meta-analysis.
Lauren A. Graybill,Margaret P Kasaro,Kellie Freeborn,Jennifer S. Walker,Charles Poole,Kimberly A. Powers,Katie R. Mollan,Nora E. Rosenberg,Sten H. Vermund,Wilbroad Mutale,Benjamin H. Chi +10 more
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TLDR
Substantial HIV incidence among pregnant and breastfeeding women in SSA, even in the current era of combination HIV prevention and treatment, underscores the need for prevention tailored to high-risk pregnant and Breastfeeding women.Abstract:
Objectives A previous meta-analysis reported high HIV incidence among pregnant and breast-feeding women in sub-Saharan Africa (SSA), but limited evidence of elevated risk of HIV acquisition during pregnancy or breast-feeding when compared with nonpregnant periods. The rapidly evolving HIV prevention and treatment landscape since publication of this review may have important implications for maternal HIV incidence. Design Systematic review and meta-analysis. Methods We searched four databases and abstracts from relevant conferences through 1 December 2018, for literature on maternal HIV incidence in SSA. We used random-effects meta-analysis to summarize incidence rates and ratios, and to estimate 95% prediction intervals. We evaluated potential sources of heterogeneity with random-effects meta-regression. Results Thirty-seven publications contributed 100 758 person-years of follow-up. The estimated average HIV incidence rate among pregnant and breast-feeding women was 3.6 per 100 person-years (95% prediction interval: 1.2--11.1), while the estimated average associations between pregnancy and risk of HIV acquisition, and breast-feeding and risk of HIV acquisition, were close to the null. Wide 95% prediction intervals around summary estimates highlighted the variability of HIV incidence across populations of pregnant and breast-feeding women in SSA. Average HIV incidence appeared associated with age, partner HIV status, and calendar time. Average incidence was highest among studies conducted pre-2010 (4.1/100 person-years, 95% prediction interval: 1.1--12.2) and lowest among studies conducted post-2014 (2.1/100 person-years, 95% prediction interval: 0.7--6.5). Conclusion Substantial HIV incidence among pregnant and breast-feeding women in SSA, even in the current era of combination HIV prevention and treatment, underscores the need for prevention tailored to high-risk pregnant and breast-feeding women.read more
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PrEP uptake, persistence, adherence, and effect of retrospective drug level feedback on PrEP adherence among young women in southern Africa: Results from HPTN 082, a randomized controlled trial.
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TL;DR: In this article, the effect of drug level feedback on adherence and persistence of pre-exposure prophylaxis (PrEP) for African adolescent girls and young women (AGYW) was investigated.
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Dvora Joseph Davey,Linda-Gail Bekker,Nyiko Mashele,Pamina M. Gorbach,Thomas J. Coates,Landon Myer +5 more
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TL;DR: Facilitators of optimal PrEP use through pregnancy and postpartum included fear of HIV acquisition for self and infant, mostly due to partner sexual behaviors and unknown serostatus, along with PrEP disclosure, and encouragement from partners and family.
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Recent HIV infection among pregnant women in the 2017 antenatal sentinel cross-sectional survey, South Africa: Assay-based incidence measurement.
Selamawit A. Woldesenbet,Tendesayi Kufa-Chakezha,Carl Lombard,Samuel O. M. Manda,Mireille Cheyip,Kassahun Ayalew,Brian C. Chirombo,Peter Barron,Karidia Diallo,Bharat Parekh,Adrian Puren +10 more
TL;DR: In this article, the authors conducted a national cross-sectional survey among pregnant women aged 15-49 years old attending antenatal care at 1,595 public facilities and identified the characteristics of recently infected pregnant women at national level.
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