Cohort profile: the Hlabisa pregnancy cohort, KwaZulu-Natal, South Africa
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 hi...
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Published in | BMJ open Vol. 6; no. 10; p. e012088 |
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Language | English |
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01.10.2016
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Abstract | 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. |
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AbstractList | 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. The 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. The 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. The 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. This 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. |
Author | Chetty, Terusha Bärnighausen, Till Thorne, Claire Coutsoudis, Anna Tanser, Frank |
AuthorAffiliation | 2 Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal , KwaZulu-Natal , South Africa 4 Department of Global Health and Population , Harvard School of Public Health , Boston, Massachusetts , USA 6 Department of Paediatrics and Child Health , Nelson R. Mandela School of Medicine, University of KwaZulu-Natal , KwaZulu-Natal , South Africa 1 Wellcome Trust Africa Health Research Institute , KwaZulu-Natal , South Africa 3 UCL Institute of Child Health, University College London , London , UK 5 Institute of Public Health, Medical School, University of Heidelberg , Heidelberg , Germany |
AuthorAffiliation_xml | – name: 4 Department of Global Health and Population , Harvard School of Public Health , Boston, Massachusetts , USA – name: 3 UCL Institute of Child Health, University College London , London , UK – name: 1 Wellcome Trust Africa Health Research Institute , KwaZulu-Natal , South Africa – name: 2 Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal , KwaZulu-Natal , South Africa – name: 6 Department of Paediatrics and Child Health , Nelson R. Mandela School of Medicine, University of KwaZulu-Natal , KwaZulu-Natal , South Africa – name: 5 Institute of Public Health, Medical School, University of Heidelberg , Heidelberg , Germany |
Author_xml | – sequence: 1 givenname: Terusha surname: Chetty fullname: Chetty, Terusha email: tchetty@africacentre.ac.za organization: Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa – sequence: 2 givenname: Claire surname: Thorne fullname: Thorne, Claire email: tchetty@africacentre.ac.za organization: UCL Institute of Child Health, University College London, London, UK – sequence: 3 givenname: Frank surname: Tanser fullname: Tanser, Frank email: tchetty@africacentre.ac.za organization: Wellcome Trust Africa Health Research Institute, KwaZulu-Natal, South Africa – sequence: 4 givenname: Till surname: Bärnighausen fullname: Bärnighausen, Till email: tchetty@africacentre.ac.za organization: Institute of Public Health, Medical School, University of Heidelberg, Heidelberg, Germany – sequence: 5 givenname: Anna surname: Coutsoudis fullname: Coutsoudis, Anna email: tchetty@africacentre.ac.za organization: Department of Paediatrics and Child Health, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa |
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CitedBy_id | crossref_primary_10_1371_journal_pone_0192805 crossref_primary_10_1371_journal_pone_0229874 crossref_primary_10_1097_QAD_0000000000002799 crossref_primary_10_1371_journal_pone_0203193 crossref_primary_10_1111_tmi_13001 crossref_primary_10_1177_09564624211046995 |
Cites_doi | 10.2174/1874613601105010051 10.1093/ije/dym211 10.2105/AJPH.2009.177469 10.1093/database/bat082 10.1186/1472-6963-14-116 10.1111/tmi.12637 10.11604/pamj.2016.23.72.7958 10.1080/09540121.2010.516341 10.1097/QAD.0b013e328359590f 10.1371/journal.pmed.1000229 10.1097/QAI.0b013e3181fdbf20 10.1371/journal.pone.0022778 10.1093/ije/dyp402 10.1016/S2352-3018(15)00045-4 10.1097/QAI.0b013e318227fc34 10.1126/science.1228160 10.1097/QAI.0000000000000373 10.1186/1471-2458-14-993 10.1097/MOP.0b013e32831ec353 10.2174/157016212803306014 10.1097/01.qai.0000148529.58963.83 10.7448/IAS.19.1.20679 10.7448/IAS.17.1.19242 |
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Snippet | PurposeThe Hlabisa pregnancy cohort was established to evaluate the effectiveness of prevention of mother-to-child transmission (PMTCT) guideline revisions.... The Hlabisa pregnancy cohort was established to evaluate the effectiveness of prevention of mother-to-child transmission (PMTCT) guideline revisions. The... PURPOSEThe Hlabisa pregnancy cohort was established to evaluate the effectiveness of prevention of mother-to-child transmission (PMTCT) guideline revisions.... |
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SubjectTerms | 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 |
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Title | Cohort profile: the Hlabisa pregnancy cohort, KwaZulu-Natal, South Africa |
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