Clara Calvert1, Milly Marston1, Emma Slaymaker1, Amelia C Crampin1,2, Alison J Price1,2, Nigel Klein3,4, Kobus Herbst4, Denna Michael5, Mark Urassa5, Samuel J Clark6, Carine Ronsmans7, Georges Reniers1,8. 1. Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK. 2. Malawi Epidemiology and Intervention Research Unit, Lilongwe and Karonga, Malawi. 3. Institute of Child Health, University College London, London, UK. 4. African Health Research Institute, KwaZulu-Natal, South Africa. 5. National Institute for Medical Research, Mwanza, Tanzania. 6. Department of Sociology, The Ohio State University, Columbus, USA. 7. Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. 8. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
OBJECTIVE: To assess whether HIV is associated with an increased risk of mortality from direct maternal complications. DESIGN: Population-based cohort study using data from three demographic surveillance sites in Eastern and Southern Africa. METHODS: We use verbal autopsy data, with cause of death assigned using the InSilicoVA algorithm, to describe the association between HIV and direct maternal deaths amongst women aged 20-49 years. We report direct maternal mortality rates by HIV status, and crude and adjusted rate ratios comparing HIV-infected and uninfected women, by study site and by ART availability. We pool the study-specific rate ratios using random-effects meta-analysis. RESULTS: There was strong evidence that HIV increased the rate of direct maternal mortality across all the study sites in the period ART was widely available, with the rate ratios varying from 4.5 in Karonga, Malawi [95% confidence interval (CI) 1.6-12.6] to 5.2 in Kisesa, Tanzania (95% CI 1.7-16.1) and 5.9 in uMkhanyakude, South Africa (95% CI 2.3-15.2) after adjusting for sociodemographic confounders. Combining these adjusted results across the study sites, we estimated that HIV-infected women have 5.2 times the rate of direct maternal mortality compared with HIV-uninfected women (95% CI 2.9-9.5). CONCLUSION: HIV-infected women face higher rates of mortality from direct maternal causes, which suggests that we need to improve access to quality maternity care for these women. These findings also have implications for the surveillance of HIV/AIDS-related mortality, as not all excess mortality attributable to HIV will be explicitly attributed to HIV/AIDS on the basis of a verbal autopsy interview.
OBJECTIVE: To assess whether HIV is associated with an increased risk of mortality from direct maternal complications. DESIGN: Population-based cohort study using data from three demographic surveillance sites in Eastern and Southern Africa. METHODS: We use verbal autopsy data, with cause of death assigned using the InSilicoVA algorithm, to describe the association between HIV and direct maternal deaths amongst women aged 20-49 years. We report direct maternal mortality rates by HIV status, and crude and adjusted rate ratios comparing HIV-infected and uninfected women, by study site and by ART availability. We pool the study-specific rate ratios using random-effects meta-analysis. RESULTS: There was strong evidence that HIV increased the rate of direct maternal mortality across all the study sites in the period ART was widely available, with the rate ratios varying from 4.5 in Karonga, Malawi [95% confidence interval (CI) 1.6-12.6] to 5.2 in Kisesa, Tanzania (95% CI 1.7-16.1) and 5.9 in uMkhanyakude, South Africa (95% CI 2.3-15.2) after adjusting for sociodemographic confounders. Combining these adjusted results across the study sites, we estimated that HIV-infectedwomen have 5.2 times the rate of direct maternal mortality compared with HIV-uninfected women (95% CI 2.9-9.5). CONCLUSION:HIV-infectedwomen face higher rates of mortality from direct maternal causes, which suggests that we need to improve access to quality maternity care for these women. These findings also have implications for the surveillance of HIV/AIDS-related mortality, as not all excess mortality attributable to HIV will be explicitly attributed to HIV/AIDS on the basis of a verbal autopsy interview.
Authors: Florence M Momplaisir; Tanner Nassau; Kari Moore; Clara Grayhack; Wanjiku F M Njoroge; Ana V Diez Roux; Kathleen A Brady Journal: JAMA Netw Open Date: 2020-11-02