Sylvia M LaCourse1, Anjuli D Wagner2, Lisa M Cranmer3,4, Audrey Copeland5,6, Elizabeth Maleche-Obimbo7, Barbra A Richardson2,8, Daniel Matemo9, John Kinuthia9,10, Grace John-Stewart1,2,11. 1. Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA. 2. Global Health, University of Washington, Seattle, WA. 3. Department of Pediatrics, Division of Infectious Diseases, Emory University, Atlanta, GA. 4. Children's Healthcare of Atlanta, Atlanta, GA. 5. Schools of Nursing, Emory University, Atlanta, GA. 6. Public Health, Emory University, Atlanta, GA. 7. Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya. 8. Department of Biostatistics, University of Washington, Seattle, WA. 9. Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. 10. Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya. 11. Pediatrics, University of Washington, Seattle, WA.
Abstract
BACKGROUND: The World Health Organization recommends isoniazid preventive therapy (IPT) for people living with HIV (PLHIV) to prevent tuberculosis (TB), including pregnant women. Recent trial results suggest increased adverse pregnancy outcomes associated with IPT during pregnancy. Data are limited regarding programmatic IPT use in pregnant PLHIV. METHODS: We assessed previous programmatic IPT during pregnancy among HIV-infected mothers on enrollment to an infant TB prevention trial in Kenya. Pregnancy IPT use was assessed by the estimated conception date assuming 38 weeks of gestation. Correlates of initiation and completion were analyzed by relative risk regression, using generalized linear models with log link and Poisson family adjusted for IPT initiation year. RESULTS: Between August 15, 2016, to June 6, 2018, 300 HIV-infected women enrolled at 6 weeks postpartum. Two hundred twenty-four (74.7%) women reported previous IPT, of whom 155/224 (69.2%) had any pregnancy IPT use. Forty-five (29.0%) initiated preconception extending into early pregnancy, 41 (26.5%) initiated and completed during pregnancy, and 69 (44.5%) initiated in pregnancy and extended into early postpartum. The median gestational age at IPT pregnancy initiation was 15.1 weeks (interquartile range 8.3-28.4). Pregnancy/early postpartum IPT initiation was associated with new pregnancy HIV diagnosis [adjusted relative risk 1.9 95% confidence interval (CI): 1.6 to 2.2, P < 0.001]. Six-month IPT completion rates were high [147/160 (91.9%)] among women with sufficient time to complete before trial enrollment and similar among preconception or during pregnancy initiators [adjusted relative risk 0.93 (95% confidence interval: 0.83 to 1.04, P = 0.19)]. CONCLUSIONS: Programmatic IPT use was high in pregnant PLHIV, with frequent periconception and early pregnancy initiation. Programmatic surveillance could provide further insights on pregnancy IPT implementation and maternal and infant safety outcomes.
BACKGROUND: The World Health Organization recommends isoniazid preventive therapy (IPT) for people living with HIV (PLHIV) to prevent tuberculosis (TB), including pregnant women. Recent trial results suggest increased adverse pregnancy outcomes associated with IPT during pregnancy. Data are limited regarding programmatic IPT use in pregnant PLHIV. METHODS: We assessed previous programmatic IPT during pregnancy among HIV-infected mothers on enrollment to an infant TB prevention trial in Kenya. Pregnancy IPT use was assessed by the estimated conception date assuming 38 weeks of gestation. Correlates of initiation and completion were analyzed by relative risk regression, using generalized linear models with log link and Poisson family adjusted for IPT initiation year. RESULTS: Between August 15, 2016, to June 6, 2018, 300 HIV-infectedwomen enrolled at 6 weeks postpartum. Two hundred twenty-four (74.7%) women reported previous IPT, of whom 155/224 (69.2%) had any pregnancy IPT use. Forty-five (29.0%) initiated preconception extending into early pregnancy, 41 (26.5%) initiated and completed during pregnancy, and 69 (44.5%) initiated in pregnancy and extended into early postpartum. The median gestational age at IPT pregnancy initiation was 15.1 weeks (interquartile range 8.3-28.4). Pregnancy/early postpartum IPT initiation was associated with new pregnancy HIV diagnosis [adjusted relative risk 1.9 95% confidence interval (CI): 1.6 to 2.2, P < 0.001]. Six-month IPT completion rates were high [147/160 (91.9%)] among women with sufficient time to complete before trial enrollment and similar among preconception or during pregnancy initiators [adjusted relative risk 0.93 (95% confidence interval: 0.83 to 1.04, P = 0.19)]. CONCLUSIONS: Programmatic IPT use was high in pregnant PLHIV, with frequent periconception and early pregnancy initiation. Programmatic surveillance could provide further insights on pregnancy IPT implementation and maternal and infant safety outcomes.
Authors: Neil A Martinson; Grace L Barnes; Lawrence H Moulton; Reginah Msandiwa; Harry Hausler; Malathi Ram; James A McIntyre; Glenda E Gray; Richard E Chaisson Journal: N Engl J Med Date: 2011-07-07 Impact factor: 91.245
Authors: Appolinaire Tiam; Rhoderick Machekano; Celine R Gounder; Llang B M Maama-Maime; Keletso Ntene-Sealiete; Maitreyi Sahu; Anthony Isavwa; Oyebola Oyebanji; Allan Ahimbisibwe; Majoalane Mokone; Grace L Barnes; Richard E Chaisson; Laura Guay; Seble Kassaye Journal: J Acquir Immune Defic Syndr Date: 2014-09-01 Impact factor: 3.731
Authors: Victor F Gomes; Andreas Andersen; Christian Wejse; Ines Oliveira; Fina J Vieira; Luis Carlos Joaquim; Cesaltina S Vieira; Peter Aaby; Per Gustafson Journal: Thorax Date: 2010-12-08 Impact factor: 9.139
Authors: Amita Gupta; Jyoti S Mathad; Susan M Abdel-Rahman; Jessica D Albano; Radu Botgros; Vikki Brown; Renee S Browning; Liza Dawson; Kelly E Dooley; Devasena Gnanashanmugam; Beatriz Grinsztejn; Sonia Hernandez-Diaz; Patrick Jean-Philippe; Peter Kim; Anne D Lyerly; Mark Mirochnick; Lynne M Mofenson; Grace Montepiedra; Jeanna Piper; Leyla Sahin; Radojka Savic; Betsy Smith; Hans Spiegel; Soumya Swaminathan; D Heather Watts; Amina White Journal: Clin Infect Dis Date: 2015-12-09 Impact factor: 9.079
Authors: Jean B Nachega; Olalekan A Uthman; Jean Anderson; Karl Peltzer; Sarah Wampold; Mark F Cotton; Edward J Mills; Yuh-Shan Ho; Jeffrey S A Stringer; James A McIntyre; Lynne M Mofenson Journal: AIDS Date: 2012-10-23 Impact factor: 4.177
Authors: Sylvia M LaCourse; Barbra A Richardson; John Kinuthia; A J Warr; Elizabeth Maleche-Obimbo; Daniel Matemo; Lisa M Cranmer; Jerphason Mecha; Jaclyn N Escudero; Thomas R Hawn; Grace John-Stewart Journal: Clin Infect Dis Date: 2021-07-15 Impact factor: 9.079
Authors: Samantha R Kaplan; Jaclyn N Escudero; Jerphason Mecha; Barbra A Richardson; Elizabeth Maleche-Obimbo; Daniel Matemo; John Kinuthia; Grace C John-Stewart; Sylvia M LaCourse Journal: J Acquir Immune Defic Syndr Date: 2022-01-01 Impact factor: 3.771
Authors: Sylvia M LaCourse; Barbra A Richardson; John Kinuthia; A J Warr; Elizabeth Maleche-Obimbo; Daniel Matemo; Lisa M Cranmer; Jaclyn N Escudero; Thomas R Hawn; Grace C John-Stewart Journal: BMJ Open Date: 2020-01-21 Impact factor: 2.692