Clinical and programmatic outcomes of HIV-exposed infants enrolled in care at geographically diverse clinics, 1997–2021: A cohort study
Year: 2022
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Although 1·3 million women with HIV give birth annually, care and outcomes for HIV-exposed infants remain incompletely understood. We analyzed programmatic and health indicators in a large, multidecade global dataset of linked mother-infant records from clinics and programs associated with the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS AND FINDINGS: HIV-exposed infants were eligible for this retrospective cohort analysis if enrolled at <18 months at 198 clinics in 10 countries across 5 IeDEA regions: East Africa (EA), Central Africa (CA), West Africa (WA), Southern Africa (SA), and the Caribbean, Central, and South America network (CCASAnet). We estimated cumulative incidences of DNA PCR testing, loss to follow-up (LTFU), HIV diagnosis, and death through 24 months of age using proportional subdistribution hazard models accounting for competing risks. Competing risks were transfer, care withdrawal, and confirmation of negative HIV status, along with LTFU and death, when not the outcome of interest. In CA and EA, we quantified associations between maternal/infant characteristics and each outcome. A total of 82,067 infants (47,300 EA, 10,699 CA, 6,503 WA, 15,770 SA, 1,795 CCASAnet) born from 1997 to 2021 were included. Maternal antiretroviral therapy (ART) use during pregnancy ranged from 65·6% (CCASAnet) to 89·5% (EA), with improvements in all regions over time. Twenty-four-month cumulative incidences varied widely across regions, ranging from 12·3% (95% confidence limit [CL], 11·2%,13·5%) in WA to 94·8% (95% CL, 94·6%,95·1%) in EA for DNA PCR testing; 56·2% (95% CL, 55·2%,57·1%) in EA to 98·5% (95% CL, 98·3%,98·7%) in WA for LTFU; 1·9% (95% CL, 1·6%,2·3%) in WA to 10·3% (95% CL, 9·7%,10·9%) in EA for HIV diagnosis; and 0·5% (95% CL, 0·2%,1·0%) in CCASAnet to 4·7% (95% CL, 4·4%,5·0%) in EA for death. Although infant retention did not improve, HIV diagnosis and death decreased over time, and in EA, the cumulative incidence of HIV diagnosis decreased substantially, declining to 2·9% (95% CL, 1·5%,5·4%) in 2020. Maternal ART was associated with decreased infant mortality (subdistribution hazard ratio [sdHR], 0·65; 95% CL, 0·47,0·91 in EA, and sdHR, 0·51; 95% CL, 0·36,0·74 in CA) and HIV diagnosis (sdHR, 0·40; 95% CL, 0·31,0·50 in EA, and sdHR, 0·41; 95% CL, 0·31,0·54 in CA). Study limitations include potential misclassification of outcomes in real-world service delivery data and possible nonrepresentativeness of IeDEA sites and the population of HIV-exposed infants they serve. CONCLUSIONS: While there was marked regional and temporal heterogeneity in clinical and programmatic outcomes, infant LTFU was high across all regions and time periods. Further efforts are needed to keep HIV-exposed infants in care to receive essential services to reduce HIV infection and mortality.
Source: PLoS Medicine
Institutions: University of North Carolina at Chapel Hill, City University of New York, Indiana University Indianapolis, Indiana University School of Medicine, Albert Einstein College of Medicine, University of Colorado Denver, University of Geneva, Universidade Federal de Minas Gerais, Université Toulouse III - Paul Sabatier, Inserm, Université de Toulouse, Centre d'Epidémiologie et de Recherche en santé des POPulations de Toulouse, University of Cape Town
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $5,887
Funders: National Science Foundation, United States Agency for International Development, Bill and Melinda Gates Foundation, Eli Lilly and Company, U.S. President’s Emergency Plan for AIDS Relief, ViiV Healthcare, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute of Allergy and Infectious Diseases, Fogarty International Center, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Child Health and Human Development, U.S. National Library of Medicine, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1002764156, Understanding the HIV epidemic in Malawi: integrating quantitative and qualitative data in a mathematical model, G1126150394, G1651421172, COOPERTIVE AGREEMENT, G6644291205, Long term outcomes of therapy in women initiated on lifelong ART because of pregnancy in DR Congo, University of Bern - to support Option B+ antiretroviral therapy for pregnant and breastfeeding women in Malawi, G7677445307, Central Africa International Epidemiology databases to Evaluate AIDS, Harmonist: A Scalable Toolkit for Standardizing and Coordinating Data Sharing Across International Research Networks, East Africa International Epidemiology Database to evaluate AIDS (IeDEA) Regional Consortium, Caribbean, Central, and South America network for HIV Epidemiology (CCASAnet), International Epidemiology Databases to EvaluateAIDS (IeDEA) Renewal 4, International epidemiology Databases to Evaluate AIDS (IeDEA) Southern Africa.
OpenAlex ID: W4295904087