Cohort profile: the Hlabisa pregnancy cohort, KwaZulu-Natal, South Africa

• Published in: BMJ open Vol. 6; no. 10; p. e012088
• Main Authors: Chetty, Terusha, Thorne, Claire, Tanser, Frank, Bärnighausen, Till, Coutsoudis, Anna
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.10.2016; BMJ Publishing Group
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Breastfeeding & lactation; Clinics; Cohort Studies; Consent; Data collection; Disease transmission; Drug therapy; Female; Guideline Adherence; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV/AIDS; Households; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical - prevention & control; Medical tests; Medication Adherence - statistics & numerical data; Patient Acceptance of Health Care; Population; Postpartum Period; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - prevention & control; Rural Population; South Africa - epidemiology; Surveillance; Womens health; South Africa; antiretroviral therapy; pregnancy cohort
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-012088

PurposeThe Hlabisa pregnancy cohort was established to evaluate the effectiveness of prevention of mother-to-child transmission (PMTCT) guideline revisions. The objectives of the Hlabisa pregnancy cohort are to: (1) provide cohort-level information on maternal health up to 6 weeks postpartum in a high HIV prevalence setting; and to (2) evaluate aspects of PMTCT care that have policy relevance.ParticipantsThe pregnancy cohort is located in primary health clinics in the Hlabisa subdistrict of rural KwaZulu-Natal, South Africa. Baseline data collection between 2010 and 2014 has been completed with the enrolment of 25 608 pregnancies; age ranged from 15–49 years. Pregnant women were assessed during routine antenatal visits: first visit, follow-up 1 week later, 32 weeks (HIV test), infant delivery and 6 weeks postpartum. Demographic, pregnancy, clinical, laboratory and HIV data were collected through Department of Health interviews, laboratory tests and routine data linkage. Treatment data for HIV-infected pregnant women were linked to the Africa Centre Hlabisa HIV Treatment and Care Programme for detailed antiretroviral therapy (ART) history and laboratory tests.Findings to dateThe proportion of women initiated on ART post-2013 were higher (n=437; 100%) than pre-2013 (n=768; 84.2%). The proportion of women in care at 6 weeks (73.8%) was also higher post-2013 relative to earlier years (58.5%). The majority of HIV-infected pregnant women were either on lifelong ART or ART prophylaxis; pre-2013, ∼ 9.6% of women were not on any ART. Pregnancy viral load monitoring was inadequate.Future plansThis cohort will be used to: (1) determine HIV acquisition risk during pregnancy and postpartum; (2) determine the effect of HIV and ART on birth outcomes; (3) examine the effect of pregnancy on virological response to ART; and (4) characterise the effect of sequential pregnancies on access to clinical care, response to prolonged ART and birth outcomes.