A5091467152- HIV/AIDS Research and Interventions
- Global Maternal and Child Health
- HIV Research and Treatment
- HIV-related health complications and treatments
- Pregnancy and preeclampsia studies
- Child Nutrition and Water Access
- Cytomegalovirus and herpesvirus research
- Adolescent Sexual and Reproductive Health
- Poverty, Education, and Child Welfare
- Maternal Mental Health During Pregnancy and Postpartum
- Gestational Diabetes Research and Management
- HIV, Drug Use, Sexual Risk
- Pregnancy and Medication Impact
- COVID-19 Impact on Reproduction
- HIV/AIDS drug development and treatment
- Iron Metabolism and Disorders
- Infant Nutrition and Health
- Reproductive tract infections research
- Birth, Development, and Health
- Preterm Birth and Chorioamnionitis
- Hepatitis B Virus Studies
- Advanced Causal Inference Techniques
- Assisted Reproductive Technology and Twin Pregnancy
- Parvovirus B19 Infection Studies
- Immune responses and vaccinations
Botswana Harvard AIDS Institute Partnership
2016-2025
University of Botswana
2019
A preliminary safety signal for neural-tube defects was previously reported in association with dolutegravir exposure from the time of conception, which has affected choices antiretroviral treatment (ART) human immunodeficiency virus (HIV)-infected women reproductive potential. The can now be evaluated data follow-up additional pregnancies.
<h3>Importance</h3> Maternal antiretroviral treatment (ART) started before conception may increase the risk for adverse birth outcomes among women with human immunodeficiency virus (HIV) infection, but whether differs by ART regimen is unknown. <h3>Objective</h3> To compare selected maternal regimen. <h3>Design, Setting, and Participants</h3> This observational surveillance study compared all live births stillbirths a gestational age of at least 24 weeks in 8 geographically dispersed...
BackgroundGlobal rollout of dolutegravir-based antiretroviral therapy (ART) has been hampered in part by insufficient safety data pregnancy. We compared birth outcomes among women initiating ART with those efavirenz-based pregnancy Botswana.MethodsIn this observational study, we captured outcome at eight government hospitals throughout Botswana (~45% all deliveries the country) an ongoing study that started on Aug 15, 2014. In 2016, changed first-line from efavirenz-tenofovir-emtricitabine...
BACKGROUND: We sought to determine if HIV-exposed uninfected (HEU) children had worse neurodevelopmental outcomes at 24 months compared with HIV-unexposed (HUU) in Botswana. METHODS: HIV-infected and mothers enrolled a prospective observational study (“Tshipidi”) Botswana from May 2010 July 2012. Child neurodevelopment was assessed the Bayley Scales of Infant Toddler Development, Third Edition (Bayley-III: cognitive, gross motor, fine expressive language, receptive language domains)...
Widespread lockdowns imposed during the coronavirus disease 2019 crisis may impact birth outcomes.This study aimed to evaluate association between COVID-19 lockdown and risk of adverse outcomes in Botswana.In response crisis, Botswana enforced a that restricted movement within country. We used data from an ongoing nationwide surveillance (stillbirth, preterm birth, small-for-gestational-age fetuses, neonatal death) severe very very-small-for-gestational-age recorded prelockdown (January 1,...
Antenatal multiple micronutrient supplementation (MMS) with iron, folic acid, and other micronutrients might improve birth outcomes, but it is not currently universally recommended by WHO.In this observational cohort study, we surveyed pregnancies for adverse outcomes at eight hospitals from July, 2014, to 2018, 18 August, December, 2020, in Botswana assess four routine strategies women presenting before 24 weeks' gestation: acid only, iron (IFAS), MMS. Women singleton pregnancies; a known...
Little is known about the impact of knowledge HIV serostatus on pregnancy intention and contraceptive use in high-HIV-burden southern African settings era widespread antiretroviral treatment availability. We analyzed interview data collected among 473 HIV-uninfected 468 HIV-infected pregnant recently postpartum women at two sites Botswana. Participants were interviewed their status prior to pregnancy, intendedness use, future childbearing desires. The median age 941 was 27 years, lifetime...
Background: Randomized trials in pregnancy are extremely challenging, and observational studies often the only option to evaluate medication safety during pregnancy. However, such susceptible immortal time bias if treatment initiation occurs after zero of follow-up. We describe how emulating a sequence target avoids apply approach estimate antibiotic between 24 37 weeks gestation on preterm delivery. Methods: The Tsepamo Study captured birth outcomes at hospitals throughout Botswana from...
Objective: To compare the effect of preconception initiation zidovudine, lamivudine, nevirapine (ZDV/3TC/NVP) versus tenofovir, emtricitabine, efavirenz (TDF/FTC/EFV) on adverse birth outcomes. Design: Emulation a hypothetical (target) trial using surveillance study in Botswana during an era CD4+-based antiretroviral therapy (ART) initiation. Methods: In women who initiated ART less than 3 years from HIV diagnosis, conceived 0.5–5 after initiation, and delivered at least 24-week gestation,...
Background: Minimal data exist related to neurodevelopment after in utero exposure Efavirenz (EFV). We sought compare neurodevelopmental outcomes HIV-exposed/uninfected (HEU) children with EFV-based triple antiretroviral treatment (ART) versus non-EFV-based ART, and examine whether timing of initial EFV is associated deficits. Methods: Women living HIV who had received ART during pregnancy whose HEU newborn participated a prior study were reconsented for their toddler undergo testing at 24...
BackgroundRecent data suggests clinically significant weight gain among non-pregnant HIV-positive adults after starting dolutegravir-based ART (DTG). Excess or insufficient in pregnancy could adversely impact outcomes, but for pregnant women receiving DTG are limited.MethodsThe Tsepamo Study captured at delivery sites Botswana from 2014 to 2019. HIV testing, treatment information, and measurements during antenatal care were abstracted the maternity obstetric record delivery. initiating...
The hepatitis B virus (HBV) is a global problem; however, the burden of HBV infection in pregnant women Botswana unknown. We sought to determine prevalence chronic and occult human immunodeficiency (HIV)-infected -uninfected Botswana. Samples from 752 were tested for surface antigen (HBsAg), HBsAg-positive samples e (HBeAg) DNA load. that HBsAg negative screened by determining genotypes determined based on 415-base-pair fragment gene. Among during pregnancy or early postpartum, 16 (2.1%)...
Objective: To examine the impact of in utero exposure to dolutegravir (DTG)- or efavirenz (EFV)-based antiretroviral treatment (ART) on child neurodevelopmental (ND) outcomes. Design: Prospective cohort design, enrolling 3 cohorts 2-year-olds: children HIV-negative born mothers with HIV (CHEU) receiving either DTG-based EFV-based 3-drug ART during pregnancy, and without (CHUU). Methods: Primary ND outcomes were assessed using Bayley Scales Infant Toddler Development, Third Edition (BSID-III)...
Antiretrovirals such as dolutegravir (DTG) and tenofovir alafenamide (TAF) have been associated with excessive weight gain. The objective of this study was to understand the potential impact ART-associated gain on pregnancy outcomes among women living HIV.
Objective: Conflicting data exist regarding the impact of in-utero exposure to maternal combination antiretrovirals. We compared neurodevelopmental outcomes between HIV-exposed-uninfected (HEU) children exposed in utero three-drug antiretroviral therapy (ART) vs. zidovudine (ZDV) monotherapy. Design: Prospective study child neurodevelopment, nested within two cohorts HIV-infected mothers and their Botswana (one observational, one interventional). Methods: The Tshipidi Mma Bana studies...
Background: Little is known about the combined impact of HIV/syphilis coinfection on birth outcomes. Methods: Antenatal HIV and syphilis test results, obstetric history, infant outcomes were collected from records in maternity wards Botswana between 2008 2011 (5 sites) 2014 2016 (8 sites). We used logistic regression to compare adverse by status. Outcomes included stillbirth, preterm delivery, low weight, in-hospital neonatal death. Results: Of 76,466 women, 75,770 (99.1%) had 20,520 (27.1%)...
Abstract Introduction Young women in sub‐Saharan Africa are at particularly high risk of HIV acquisition. Recent shifts towards “test and treat” strategies have potential to reduce transmission this age group but not been widely studied outside clinical trials. Using data from nationwide surveillance among pregnant Botswana, where a program was implemented 2016, we describe trends prevalence over time highlight opportunities for targeted prevention. Methods The Tsepamo study abstracted...
Distance to care is a common exposure and proposed instrumental variable in health research, but it vulnerable violations of fundamental identifiability conditions for causal inference. We used data collected from the Botswana Birth Outcomes Surveillance study between 2014 2016 outline 4 challenges potential biases when using distance as an instrument: selection bias, unmeasured confounding, lack sufficiently well-defined interventions, measurement error. describe how these issues can arise,...
Human immunodeficiency virus (HIV)-exposed, uninfected (HEU) infants experience high rates of infectious morbidity. We hypothesized that early cytomegalovirus (CMV) infection was associated with increased hospitalization and decreased vaccine responses in HEU compared HIV-unexposed (HUU) infants.
OBJECTIVE: To evaluate the combined association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV) infection on adverse birth outcomes in an HIV-endemic region. METHODS: The Tsepamo Study abstracts data from antenatal obstetric records government maternity wards across Botswana. We assessed maternal mortality for all singleton pregnancies September 2020 to mid-November 2021 at 13 sites among individuals with documented SARS-CoV-2 screening...
In Botswana, where almost all pregnant women known to have HIV receive antiretroviral therapy, a large proportion of vertical transmission may occur among with incident undiagnosed infection during pregnancy. Botswana guidelines recommend repeat testing every 3 months in pregnancy, at least one test the third trimester. We evaluated rate testing, calculated incidence pregnancy and estimated missed seroconversions.
Among human immunodeficiency virus-positive women in Botswana on the recommended first-line antiretroviral therapy regimen, tenofovir-emtricitabine-efavirenz, initiated within first or early second trimester, we found no increased risk of stillbirth, neonatal death, preterm/very preterm delivery, infant being born small very for gestational age. Treatment with tenofovir-emtricitabine-efavirenz <1 year before conception delivery slightly over late-second-trimester treatment initiation...
Background: In utero exposure to nucleoside reverse transcriptase inhibitor (NRTI)-containing antiretroviral treatment (ART) regimens may be associated with poor neurodevelopmental functioning in children of HIV-infected mothers. We investigated outcomes HIV-exposed uninfected (HEU) women enrolled a randomized trial abacavir/zidovudine/lamivudine (triple-NRTI regimen) vs. lopinavir/ritonavir/zidovudine/lamivudine [dual-NRTI + protease (PI) regimen]. Setting: The Mma Bana was conducted urban...