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151. The Zambian Preterm Birth Prevention Study (ZAPPS): Cohort characteristics at enrollment

Author

Castillo, Marcela C., primary, Fuseini, Nurain M., additional, Rittenhouse, Katelyn, additional, Price, Joan T., additional, Freeman, Bethany L., additional, Mwape, Humphrey, additional, Winston, Jennifer, additional, Sindano, Ntazana, additional, Baruch-Gravett, Courtney, additional, Chi, Benjamin H., additional, Kasaro, Margaret P., additional, Litch, James A., additional, Stringer, Jeffrey S.A., additional, and Vwalika, Bellington, additional

Published
2018
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152. Burnout and use of HIV services among health care workers in Lusaka District, Zambia: a cross-sectional study

Author

Quiterio Nicole, Nkhoma Mavis, Ikeda Scott, Chapula Bushimbwa, Kruse Gina R, Pankratz Debra, Mataka Kaluba, Chi Benjamin H, Bond Virginia, and Reid Stewart E

Subjects
Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Well-documented shortages of health care workers in sub-Saharan Africa are exacerbated by the increased human resource demands of rapidly expanding HIV care and treatment programmes. The successful continuation of existing programmes is threatened by health care worker burnout and HIV-related illness. Methods From March to June 2007, we studied occupational burnout and utilization of HIV services among health providers in the Lusaka public health sector. Providers from 13 public clinics were given a 36-item, self-administered questionnaire and invited for focus group discussions and key-informant interviews. Results Some 483 active clinical staff completed the questionnaire (84% response rate), 50 staff participated in six focus groups, and four individuals gave interviews. Focus group participants described burnout as feeling overworked, stressed and tired. In the survey, 51% reported occupational burnout. Risk factors were having another job (RR 1.4 95% CI 1.2–1.6) and knowing a co-worker who left in the last year (RR 1.6 95% CI 1.3–2.2). Reasons for co-worker attrition included: better pay (40%), feeling overworked or stressed (21%), moving away (16%), death (8%) and illness (5%). When asked about HIV testing, 370 of 456 (81%) reported having tested; 240 (50%) tested in the last year. In contrast, discussion groups perceived low testing rates. Both discussion groups and survey respondents identified confidentiality as the prime reason for not undergoing HIV testing. Conclusion In Lusaka primary care clinics, overwork, illness and death were common reasons for attrition. Programmes to improve access, acceptability and confidentiality of health care services for clinical providers and to reduce workplace stress could substantially affect workforce stability.

Published
2009
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153. Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia

Author

Chi Harmony F, Mwango Albert, Chi Benjamin H, Chapula Bushimbwa, Morris Mary B, Mwanza Joyce, Manda Handson, Bolton Carolyn, Pankratz Debra S, Stringer Jeffrey SA, and Reid Stewart E

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth of literature describing task shifting in sub-Saharan Africa, where services for antiretroviral therapy (ART) have scaled up rapidly in the face of generalized human resource crises. As part of ART services expansion in Lusaka, Zambia, we implemented a comprehensive task-shifting program among existing health providers and community-based workers. Training begins with didactic sessions targeting specialized skill sets. This is followed by an intensive period of practical mentorship, where providers are paired with trainers before working independently. We provide on-going quality assessment using key indicators of clinical care quality at each site. Program performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. From 2005 to 2007, we trained 516 health providers in adult HIV treatment; 270 in pediatric HIV treatment; 341 in adherence counseling; 91 in a specialty nurse "triage" course, and 93 in an intensive clinical mentorship program. On-going quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. Our task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful, long-term solutions to the human resource crisis are also urgently needed to expand the number of providers and to slow staff migration out of the region.

Published
2009
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154. Trajectories of fertility intentions among women living with HIV in South Africa.

Author

Rucinski, Katherine B., Powers, Kimberly A., Pettifor, Audrey E., Black, Vivian, Pence, Brian W., Chi, Benjamin H., Rees, Helen, and Schwartz, Sheree R.

Subjects
CONCEPTION, FERTILITY, HIV-positive persons, LONGITUDINAL method, MEDICAL screening, QUESTIONNAIRES, WOMEN'S health, HIGHLY active antiretroviral therapy, FAMILY planning, DESCRIPTIVE statistics
Abstract

Fertility intentions are thought to be dynamic among women of reproductive age, yet few studies have assessed fertility intentions over time among women with HIV. We examine temporal patterns of fertility intentions in women with HIV to assess the extent to which fertility intentions – and the corresponding need for safer conception and judicious antiretroviral therapy (ART) regimen selection – vary over time. 850 non-pregnant HIV-positive women aged 18–35 on or being initiated onto ART in Johannesburg, South Africa were enrolled into a prospective cohort study (2009–2010). Fertility intentions were assessed at enrollment and at 30-day intervals via an interviewer-administered questionnaire. We used group-based trajectory modelling to identify longitudinal patterns of fertility intentions over 12 months. We identified four patterns of fertility intentions, which we labelled "consistently low" (representing ∼60% of the population), "low and increasing" (∼23%), "high and increasing" (∼12%), and "high and decreasing" (∼5%). Our findings suggest that a single family-planning assessment at one time point is insufficient to fully identify and meet the reproductive needs of women with HIV. As HIV testing and treatment evolve in South Africa, routine screening for fertility intentions can offer important opportunities to optimize HIV treatment, prevention, and maternal and child health. [ABSTRACT FROM AUTHOR]

Published
2021
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155. Maternal and newborn outcomes at a tertiary care hospital in Lusaka, Zambia, 2008-2012

Author

Somwe, Somwe W., Tshuma, Getrude G., Mwanahamuntu, Mulindi, Ahmed, Yusuf, Liu, K. Cherry, Stoner, Marie C.D., Chi, Benjamin H., Stringer, Jeffrey S.A., Stringer, Elizabeth M., Vwalika, Bellington, and Kaunda, Eugene

Subjects
parasitic diseases
Abstract

To measure key obstetric and neonatal outcomes recorded at a tertiary hospital in Zambia over a 5-year period.

Published
2017
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161. Maternal Decision-Making and Uptake of Health Services for the Prevention of Mother-to-Child HIV Transmission: A Secondary Analysis

Author

Ford, Catherine E., primary, Coetzee, David, additional, Winston, Jennifer, additional, Chibwesha, Carla J., additional, Ekouevi, Didier K., additional, Welty, Thomas K., additional, Tih, Pius M., additional, Maman, Suzanne, additional, Stringer, Elizabeth M., additional, Stringer, Jeffrey S. A., additional, and Chi, Benjamin H., additional

Published
2018
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163. Cohort Profile: The international epidemiological databases to evaluate AIDS (IeDEA) in sub-Saharan Africa

Author

Egger, Matthias, Ekouevi, Didier K., Williams, Carolyn, Lyamuya, Rita Elias, Mukumbi, Henri, Braitstein, Paula, Hartwell, Tyler, Graber, Claire, Chi, Benjamin H., Boulle, Andrew, Dabis, François, Wools-Kaloustian, Kara, Egger, Matthias, Ekouevi, Didier K., Williams, Carolyn, Lyamuya, Rita Elias, Mukumbi, Henri, Braitstein, Paula, Hartwell, Tyler, Graber, Claire, Chi, Benjamin H., Boulle, Andrew, Dabis, François, and Wools-Kaloustian, Kara

Published
2017

164. Effect of Baseline Renal Function on Tenofovir-Containing Antiretroviral Therapy Outcomes in Zambia

Author

Mulenga, Lloyd, Musonda, Patrick, Mwango, Albert, Vinikoor, Michael J., Davies, Mary-Ann, Mweemba, Aggrey, Calmy, Alexandra, Stringer, Jeffrey S., Keiser, Olivia, Chi, Benjamin H., Wandeler, Gilles, Mulenga, Lloyd, Musonda, Patrick, Mwango, Albert, Vinikoor, Michael J., Davies, Mary-Ann, Mweemba, Aggrey, Calmy, Alexandra, Stringer, Jeffrey S., Keiser, Olivia, Chi, Benjamin H., and Wandeler, Gilles

Abstract

In this large cohort of human immunodeficiency virus-infected patients receiving first-line antiretroviral therapy in Zambia, individuals who started a tenofovir-containing regimen despite baseline renal dysfunction showed comparable mortality and renal function improvement to those not receiving tenofovir

Published
2017

165. Chronic Hepatitis B Virus Coinfection Is Associated With Renal Impairment Among Zambian HIV-Infected Adults

Author

Mweemba, Aggrey, Zanolini, Arianna, Mulenga, Lloyd, Emge, Drew, Chi, Benjamin H., Wandeler, Gilles, Vinikoor, Michael J., Mweemba, Aggrey, Zanolini, Arianna, Mulenga, Lloyd, Emge, Drew, Chi, Benjamin H., Wandeler, Gilles, and Vinikoor, Michael J.

Abstract

Among 6789 HIV-infected Zambian adults screened for hepatitis B virus (HBV) coinfection, estimated glomerular filtration rate (eGFR) was 50-90 mL/minute/1.73 m2 in 17.6% and <50 mL/minute/1.73 m2 in 2.5%. Human immunodeficiency virus/HBV coinfection was associated with eGFR <50 mL/minute/1.73 m2 (adjusted odds ratio, 1.96 [95% confidence interval, 1.34-2.86]), adjusted for age, sex, CD4+ count, and World Health Organization disease stage

Published
2017

166. Liver fibrosis in treatment-naïve HIV-infected and HIV/HBV co-infected patients: Zambia and Switzerland compared

Author

Wandeler, Gilles, Mulenga, Lloyd, Vinikoor, Michael J, Kovari, Helen, Battegay, Manuel, Calmy, Alexandra, Cavassini, Matthias, Bernasconi, Enos, Schmid, Patrick, Bolton-Moore, Carolyn, Sinkala, Edford, Chi, Benjamin H, Egger, Matthias, Rauch, Andri, IeDEA-Southern Africa, Swiss HIV Cohort Study, University of Zurich, and Wandeler, Gilles

Subjects
10234 Clinic for Infectious Diseases, 610 Medicine & health, 2725 Infectious Diseases, 2726 Microbiology (medical)
Published
2016

167. Malaria in HIV-Infected Children Receiving HIV Protease-Inhibitor- Compared with Non-Nucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy, IMPAACT P1068s, Substudy to P1060

Author

Nonde, Thikazi, Phakati, Severiano, Kafulafula, George, Simbeye, Darius, Mbewe, Felistas, Balamusani, David, Tegha, Gerald, Mwale, John, Chen, Jingyang, Neal, Jillian, Parikh, Sunil, Kafufu, Bosco, Duffy, Patrick E., Chintu, Namwinga, Nunkwe, Esnart Mwaba, Kamthunzi, Portia, Elbireer, Ali, Ilmet, Tiina, Shingalili, Ellen, Palumbo, Paul, Kirmse, Brian, Gabriel, Erin E., Philippe, Patrick Jean, Mofenson, Lynne, Musoke, Philippa, Barlow-Mosha, Linda, Borkowsky, William, Tauzie, Jean, Sambo, Pauline, Chi, Benjamin H., Prescott, William, Hobbs, Charlotte V., Deygoo, Nagamah, Li, Yonghua, Petzold, Elizabeth, and Kabugho, Enid

Subjects
parasitic diseases, virus diseases
Abstract

HIV and malaria geographically overlap. HIV protease inhibitors kill malaria parasites in vitro and in vivo, but further evaluation in clinical studies is needed.

Published
2016
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168. Association between hepatitis B co-infection and elevated liver stiffness among HIV-infected adults in Lusaka, Zambia

Author

Wandeler, Gilles, Vinikoor, Michael J., Chilengi, Roma, Moore, Carolyn Bolton, Musukuma, Kalo, Egger, Matthias, Siyunda, Alice, Chi, Benjamin H., Mulenga, Lloyd, and Davies, Mary-Ann

Subjects
parasitic diseases
Abstract

In sub-Saharan Africa, liver disease epidemiology among HIV-infected individuals is not well described, in part due to limited access to diagnostic tests for liver fibrosis.

Published
2016
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169. Liver fibrosis in treatment-naïve HIV-infected and HIV/HBV co-infected patients: Zambia and Switzerland compared

Author

Wandeler Gilles, Mulenga Lloyd, Vinikoor Michael J, Kovari Helen, Battegay Manuel, Calmy Alexandra, Cavassini Matthias, Bernasconi Enos, Schmid Patrick, Bolton-Moore Carolyn, Sinkala Edford, Chi Benjamin H, Egger Matthias, Rauch Andri, for IeDEA-Southern Africa and the Swiss HIV Cohort Study, and for IeDEA-Southern, Africa

Subjects
Microbiology (medical), Adult, Blood Platelets, Liver Cirrhosis, Male, Hepatitis B virus, Adolescent, Liver fibrosis, Zambia, HIV Infections, 610 Medicine & health, Article, lcsh:Infectious and parasitic diseases, Cohort Studies, Young Adult, Risk Factors, 360 Social problems & social services, parasitic diseases, Humans, lcsh:RC109-216, Aspartate Aminotransferases, ddc:616, Hepatitis B Surface Antigens, Coinfection, Aspartate Aminotransferases/metabolism, Blood Platelets/metabolism, Cross-Sectional Studies, Female, HIV Infections/complications, HIV Infections/epidemiology, HIV Infections/virology, Hepatitis B/complications, Hepatitis B/epidemiology, Hepatitis B/virology, Hepatitis B Surface Antigens/analysis, Hepatitis B virus/genetics, Hepatitis B virus/immunology, Hepatitis B virus/physiology, Liver Cirrhosis/complications, Liver Cirrhosis/epidemiology, Liver Cirrhosis/virology, Middle Aged, Switzerland/epidemiology, Viral Load, Zambia/epidemiology, HIV, Hepatitis B infection, Switzerland, virus diseases, Hepatitis B, digestive system diseases, Infectious Diseases
Abstract

OBJECTIVE To examine the association between hepatitis B virus (HBV) infection and liver fibrosis in HIV-infected patients in Zambia and Switzerland. METHODS HIV-infected adults starting antiretroviral therapy in two clinics in Zambia and Switzerland were included. Liver fibrosis was evaluated using the aspartate aminotransferase-to-platelet-ratio index (APRI), with a ratio >1.5 defining significant fibrosis and a ratio >2.0 indicating cirrhosis. The association between hepatitis B surface antigen (HBsAg) positivity, HBV replication, and liver fibrosis was examined using logistic regression. RESULTS In Zambia, 96 (13.0%) of 739 patients were HBsAg-positive compared to 93 (4.5%) of 2058 in Switzerland. HBsAg-positive patients were more likely to have significant liver fibrosis than HBsAg-negative ones: the adjusted odds ratio (aOR) was 3.25 (95% confidence interval (CI) 1.44-7.33) in Zambia and 2.50 (95% CI 1.19-5.25) in Switzerland. Patients with a high HBV viral load (≥20000 IU/ml) were more likely to have significant liver fibrosis compared to HBsAg-negative patients or patients with an undetectable viral load: aOR 3.85 (95% CI 1.29-11.44) in Zambia and 4.20 (95% CI 1.64-10.76) in Switzerland. In both settings, male sex was a strong risk factor for significant liver fibrosis. CONCLUSIONS Despite the differences in HBV natural history between Sub-Saharan Africa and Europe, the degree of liver fibrosis and the association with important risk factors were similar.

Published
2016

174. Distance from household to clinic and its association with the uptake of prevention of mother-to-child HIV transmission regimens in rural Zambia

Author

Escamilla, Veronica, Chibwesha, Carla J., Gartland, Matthew, Chintu, Namwinga, Mubiana-Mbewe, Mwangelwa, Musokotwane, Kebby, Musonda, Patrick, Miller, William C., Stringer, Jeffrey S. A., and Chi, Benjamin H.

Subjects
Adult, Rural Population, Adolescent, Anti-HIV Agents, Maternal-Child Health Centers, Infant, Newborn, Zambia, HIV Infections, Pilot Projects, Prenatal Care, Transportation, Article, Infectious Disease Transmission, Vertical, Young Adult, Cross-Sectional Studies, Pregnancy, Risk Factors, Odds Ratio, Humans, Female, Pregnancy Complications, Infectious
Abstract

In rural settings, HIV-infected pregnant women often live significant distances from facilities that provide prevention of mother-to-child transmission (PMTCT) services.We offered universal maternal combination antiretroviral regimens in 4 pilot sites in rural Zambia. To evaluate the impact of services, we conducted a household survey in communities surrounding each facility. We collected information about HIV status and antenatal service utilization from women who delivered in the past 2 years. Using household Global Positioning System coordinates collected in the survey, we measured Euclidean (i.e., straight line) distance between individual households and clinics. Multivariable logistic regression and predicted probabilities were used to determine associations between distance and uptake of PMTCT regimens.From March to December 2011, 390 HIV-infected mothers were surveyed across four communities. Of these, 254 (65%) had household geographical coordinates documented. One hundred sixty-eight women reported use of a PMTCT regimen during pregnancy including 102 who initiated a combination antiretroviral regimen. The probability of PMTCT regimen initiation was the highest within 1.9 km of the facility and gradually declined. Overall, 103 of 145 (71%) who lived within 1.9 km of the facility initiated PMTCT versus 65 of 109 (60%) who lived farther away. For every kilometer increase, the association with PMTCT regimen uptake (adjusted odds ratio: 0.90, 95% confidence interval: 0.82 to 0.99) and combination antiretroviral regimen uptake (adjusted odds ratio: 0.88, 95% confidence interval: 0.80 to 0.97) decreased.In this rural African setting, uptake of PMTCT regimens was influenced by distance to health facility. Program models that further decentralize care into remote communities are urgently needed.

Published
2015

175. Implementation and Operational Research: Distance From Household to Clinic and Its Association With the Uptake of Prevention of Mother-to-Child HIV Transmission Regimens in Rural Zambia

Author

Mubiana-Mbewe, Mwangelwa, Miller, William C., Chi, Benjamin H., Musokotwane, Kebby, Stringer, Jeffrey S. A., Chibwesha, Carla J., Musonda, Patrick, Chintu, Namwinga, Escamilla, Veronica, and Gartland, Matthew

Subjects
virus diseases, reproductive and urinary physiology
Abstract

In rural settings, HIV-infected pregnant women often live significant distances from facilities that provide prevention of mother-to-child transmission (PMTCT) services.

Published
2015
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176. Response to LIVint-15-00100

Author

Wandeler, Gilles, Sinkala, Edford, Vinikoor, Michael J, and Chi, Benjamin H

Subjects
virus diseases, 610 Medicine & health, digestive system diseases, 360 Social problems & social services
Abstract

Although AST-to-platelet ratio index (APRI) and FIB-4 have been compared with liver biopsy in patients with hepatitis C virus (HCV), hepatitis B virus (HBV), HIV/HCV co-infection, and HIV/HBV co-infection, Johannessen and Lemoine stress that they have not been validated in HIV mono-infected populations in SSA. However, this is unlikely to occur because liver biopsy does not play a role in HIV management and the procedure carries its own risks for complication. Clinicians using APRI and FIB-4 in this setting should be aware of this limitation and should interpret test results in the context of each patient's clinical scenario. This article is protected by copyright. All rights reserved.

Published
2015
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179. Maternal Decision-Making and Uptake of Health Services for the Prevention of Mother-to-Child HIV Transmission: A Secondary Analysis.

Author

Ford, Catherine E., Coetzee, David, Winston, Jennifer, Chibwesha, Carla J., Ekouevi, Didier K., Welty, Thomas K., Tih, Pius M., Maman, Suzanne, Stringer, Elizabeth M., Stringer, Jeffrey S. A., and Chi, Benjamin H.

Subjects
DIAGNOSIS of HIV infections, VERTICAL transmission (Communicable diseases), CHI-squared test, STATISTICAL correlation, DECISION making, HEALTH services accessibility, HELP-seeking behavior, HIV-positive persons, MOTHER-infant relationship, MOTHERHOOD, MOTHERS, WOMEN'S health, LOGISTIC regression analysis, ANTIRETROVIRAL agents, SECONDARY analysis, DATA analysis software, ODDS ratio, CHILDREN, PREVENTION
Abstract

Objectives We investigated whether a woman's role in household decision-making was associated with receipt of services to prevent mother-to-child HIV transmission (PMTCT). Methods We conducted a secondary analysis of the PEARL study, an evaluation of PMTCT effectiveness in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Our exposure of interest was the women's role (active vs. not active) in decision-making about her healthcare, large household purchases, children's schooling, and children's healthcare (i.e., four domains). Our primary outcomes were self-reported engagement at three steps in PMTCT: maternal antiretroviral use, infant antiretroviral prophylaxis, and infant HIV testing. Associations found to be significant in univariable logistic regression were included in separate multivariable models. Results From 2008 to 2009, 613 HIV-infected women were surveyed and provided information about their decision-making roles. Of these, 272 (44.4%) women reported antiretroviral use; 281 (45.9%) reported infant antiretroviral prophylaxis; and 194 (31.7%) reported infant HIV testing. Women who reported an active role were more likely to utilize infant HIV testing services, across all four measured domains of decision-making (adjusted odds ratios [AORs] 2.00-2.89 all p < .05). However, associations between decision-making and antiretroviral use—for both mother and infant—were generally not significant. An exception was active decision-making in a woman's own healthcare and reported maternal antiretroviral use (AOR 1.69, p < 0.05). Conclusions for Practice Associations between decision-making and PMTCT engagement were inconsistent and may be related to specific characteristics of individual health-seeking behaviors. Interventions seeking to improve PMTCT uptake should consider the type of health-seeking behavior to better optimize health services. [ABSTRACT FROM AUTHOR]

Published
2019
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180. The National Institutes of Health Fogarty International Center Global Health Scholars and Fellows Program: Collaborating Across Five Consortia to Strengthen Research Training.

Author

Zunt, Joseph R, Zunt, Joseph R, Chi, Benjamin H, Heimburger, Douglas C, Cohen, Craig R, Strathdee, Steffanie, Hobbs, Nicole, Thomas, Yolanda, Bale, Kimberly, Salisbury, Kathryn, Hernandez, Maria T, Riley, Lee W, Vermund, Sten H, van der Horst, Charles, Zunt, Joseph R, Zunt, Joseph R, Chi, Benjamin H, Heimburger, Douglas C, Cohen, Craig R, Strathdee, Steffanie, Hobbs, Nicole, Thomas, Yolanda, Bale, Kimberly, Salisbury, Kathryn, Hernandez, Maria T, Riley, Lee W, Vermund, Sten H, and van der Horst, Charles

Abstract

As demand for global health research training continues to grow, many universities are striving to meet the needs of trainees in a manner complementary to research priorities of the institutions hosting trainees, while also increasing capacity for conducting research. We provide an overview of the first 4 years of the Global Health Program for Fellows and Scholars, a collaboration of 20 U.S. universities and institutions spread across 36 low- and middle-income countries funded through the National Institutes of Health Fogarty International Center. We highlight many aspects of our program development that may be of interest to other multinational consortia developing global health research training programs.

Published
2016

181. Benefits and Risks of Antiretroviral Therapy for Perinatal HIV Prevention.

Author

Fowler, Mary G, Fowler, Mary G, Qin, Min, Fiscus, Susan A, Currier, Judith S, Flynn, Patricia M, Chipato, Tsungai, McIntyre, James, Gnanashanmugam, Devasena, Siberry, George K, Coletti, Anne S, Taha, Taha E, Klingman, Karin L, Martinson, Francis E, Owor, Maxensia, Violari, Avy, Moodley, Dhayendre, Theron, Gerhard B, Bhosale, Ramesh, Bobat, Raziya, Chi, Benjamin H, Strehlau, Renate, Mlay, Pendo, Loftis, Amy J, Browning, Renee, Fenton, Terence, Purdue, Lynette, Basar, Michael, Shapiro, David E, Mofenson, Lynne M, IMPAACT 1077BF/1077FF PROMISE Study Team, Fowler, Mary G, Fowler, Mary G, Qin, Min, Fiscus, Susan A, Currier, Judith S, Flynn, Patricia M, Chipato, Tsungai, McIntyre, James, Gnanashanmugam, Devasena, Siberry, George K, Coletti, Anne S, Taha, Taha E, Klingman, Karin L, Martinson, Francis E, Owor, Maxensia, Violari, Avy, Moodley, Dhayendre, Theron, Gerhard B, Bhosale, Ramesh, Bobat, Raziya, Chi, Benjamin H, Strehlau, Renate, Mlay, Pendo, Loftis, Amy J, Browning, Renee, Fenton, Terence, Purdue, Lynette, Basar, Michael, Shapiro, David E, Mofenson, Lynne M, and IMPAACT 1077BF/1077FF PROMISE Study Team

Abstract

BackgroundRandomized-trial data on the risks and benefits of antiretroviral therapy (ART) as compared with zidovudine and single-dose nevirapine to prevent transmission of the human immunodeficiency virus (HIV) in HIV-infected pregnant women with high CD4 counts are lacking.MethodsWe randomly assigned HIV-infected women at 14 or more weeks of gestation with CD4 counts of at least 350 cells per cubic millimeter to zidovudine and single-dose nevirapine plus a 1-to-2-week postpartum "tail" of tenofovir and emtricitabine (zidovudine alone); zidovudine, lamivudine, and lopinavir-ritonavir (zidovudine-based ART); or tenofovir, emtricitabine, and lopinavir-ritonavir (tenofovir-based ART). The primary outcomes were HIV transmission at 1 week of age in the infant and maternal and infant safety.ResultsThe median CD4 count was 530 cells per cubic millimeter among 3490 primarily black African HIV-infected women enrolled at a median of 26 weeks of gestation (interquartile range, 21 to 30). The rate of transmission was significantly lower with ART than with zidovudine alone (0.5% in the combined ART groups vs. 1.8%; difference, -1.3 percentage points; repeated confidence interval, -2.1 to -0.4). However, the rate of maternal grade 2 to 4 adverse events was significantly higher with zidovudine-based ART than with zidovudine alone (21.1% vs. 17.3%, P=0.008), and the rate of grade 2 to 4 abnormal blood chemical values was higher with tenofovir-based ART than with zidovudine alone (2.9% vs. 0.8%, P=0.03). Adverse events did not differ significantly between the ART groups (P>0.99). A birth weight of less than 2500 g was more frequent with zidovudine-based ART than with zidovudine alone (23.0% vs. 12.0%, P<0.001) and was more frequent with tenofovir-based ART than with zidovudine alone (16.9% vs. 8.9%, P=0.004); preterm delivery before 37 weeks was more frequent with zidovudine-based ART than with zidovudine alone (20.5% vs. 13.1%, P<0.001). Tenofovir-based ART was associated

Published
2016

183. Benefits and Risks of Antiretroviral Therapy for Perinatal HIV Prevention

Author

Fowler, Mary G., primary, Qin, Min, additional, Fiscus, Susan A., additional, Currier, Judith S., additional, Flynn, Patricia M., additional, Chipato, Tsungai, additional, McIntyre, James, additional, Gnanashanmugam, Devasena, additional, Siberry, George K., additional, Coletti, Anne S., additional, Taha, Taha E., additional, Klingman, Karin L., additional, Martinson, Francis E., additional, Owor, Maxensia, additional, Violari, Avy, additional, Moodley, Dhayendre, additional, Theron, Gerhard B., additional, Bhosale, Ramesh, additional, Bobat, Raziya, additional, Chi, Benjamin H., additional, Strehlau, Renate, additional, Mlay, Pendo, additional, Loftis, Amy J., additional, Browning, Renee, additional, Fenton, Terence, additional, Purdue, Lynette, additional, Basar, Michael, additional, Shapiro, David E., additional, and Mofenson, Lynne M., additional

Published
2016
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185. The National Institutes of Health Fogarty International Center Global Health Scholars and Fellows Program: Collaborating Across Five Consortia to Strengthen Research Training

Author

Zunt, Joseph R., primary, Heimburger, Douglas C., additional, Riley, Lee W., additional, Thomas, Yolanda, additional, Cohen, Craig R., additional, Vermund, Sten H., additional, Bale, Kimberly, additional, Chi, Benjamin H., additional, Hernandez, Maria T., additional, Hobbs, Nicole, additional, Strathdee, Steffanie, additional, van der Horst, Charles, additional, and Salisbury, Kathryn, additional

Published
2016
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186. Multiple Overimputation to Address Missing Data and Measurement Error

Author

Bengtson, Angela M., primary, Westreich, Daniel, additional, Musonda, Patrick, additional, Pettifor, Audrey, additional, Chibwesha, Carla, additional, Chi, Benjamin H., additional, Vwalika, Bellington, additional, Pence, Brian W., additional, Stringer, Jeffrey S. A., additional, and Miller, William C., additional

Published
2016
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190. Nevirapine- Versus Lopinavir/Ritonavir-Based Antiretroviral Therapy in HIV-Infected Infants and Young Children: Long-term Follow-up of the IMPAACT P1060 Randomized Trial

Author

Barlow-Mosha, Linda, primary, Angelidou, Konstantia, additional, Lindsey, Jane, additional, Archary, Moherndran, additional, Cotton, Mark, additional, Dittmer, Sylvia, additional, Fairlie, Lee, additional, Kabugho, Enid, additional, Kamthunzi, Portia, additional, Kinikar, Arti, additional, Mbengeranwa, Tapiwa, additional, Msuya, Levina, additional, Sambo, Pauline, additional, Patel, Kunjal, additional, Barr, Emily, additional, Jean-Phillipe, Patrick, additional, Violari, Avy, additional, Mofenson, Lynne, additional, Palumbo, Paul, additional, and Chi, Benjamin H., additional

Published
2016
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191. Impact of targeted counseling on reported vaginal hygiene practices and bacterial vaginosis: the HIV Prevention Trials Network 035 study

Author

Kasaro, Margaret P, primary, Husnik, Marla J, additional, Chi, Benjamin H, additional, Reid, Cheri, additional, Magure, Tsitsi, additional, Makanani, Bonus, additional, Tembo, Tchangani, additional, Ramjee, Gita, additional, Maslankowski, Lisa, additional, Rabe, Lorna, additional, and Brad Guffey, M, additional

Published
2016
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196. A risk score to identify HIV-infected women most likely to become lost to follow-up in the postpartum period

Author

Bengtson, Angela M., primary, Chibwesha, Carla J., additional, Westreich, Daniel, additional, Mubiana-Mbewe, Mwangelwa, additional, Chi, Benjamin H., additional, Miller, William C., additional, Mapani, Muntanga, additional, Pence, Brian W, additional, Musonda, Patrick, additional, Stringer, Jeffrey SA, additional, and Pettifor, Audrey, additional

Published
2016
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