• In Africa, at least one million pregnancies are co-infected with malaria and HIV annually.

    In Africa, at least one million pregnancies are co-infected with malaria and HIV annually.

  • Preg_multidrug

Preg_multidrug

Understanding the determinants of the effectiveness of HIV control strategies targeting HIV-infected pregnant women in Mozambique

This fellowship (ancillary to MAMAH project) was granted by the EDCTP (TMA2017CDF-1927- Career Development Fellowships) to Dr Tacilta Nhampossa. The project is coordinated by Fundação Manhiça, mentored by Dr Clara Menéndez (ISGlobal) and is planned to be conducted in Manhiça District, Southern Mozambique from early 2019 to 2022.

Introduction

Current treatment guidelines for HIV pregnant women in Mozambique recommend initiation of lifelong antiretroviral therapy (ART), administration of ferrous sulphate and folic acid for treatment or prevention of anaemia and prevention of fetal malformations, cotrimoxazole prophylaxis (CTXp) to prevent opportunistic infections all this imply self-administration of an average of five tablets from different medications daily at least during the pregnancy. Besides, pregnant women take mebendazole for deworming at first ante-natal care (ANC) visit, and may be recommended intermittent preventive treatment of tuberculosis with isoniazid (after ruling out active tuberculosis or with not taken previously) or any other medication according to the diagnosis of other diseases. However, maternal and neonatal mortality associated with preventable diseases in pregnancy is still high suggesting that compliance with the prescribed medication might be low while there is little understanding of the factors affecting their adherence. In turn, poor adherence to medication may lead to the development of advanced disease while there is scarce information on the frequency and clinical features of advanced HIV diseasein pregnancy and its effects on maternal and perinatal outcomes.

Objectives

MAMAH project and aims to identify and improve our understanding of the barriers and determinants that may affect the effectiveness of HIV control strategies in infected pregnant women exposed to malaria in rural southern Mozambique, in order to assist the Ministry of Health in the implementation of appropriate interventions in pregnant HIV-infected women, which is the most vulnerable group to the malaria infection. Firstly, we intend to assess the perceptions and attitudes related to administration of multiple medications by HIV-infected pregnant women (Objective 1); secondly we will assess the retention rate and its determinants regarding Option B+ to prevent MTCT among HIV-infected pregnant women (Objective 2). Finally, we propose to determine the prevalence and clinical presentation of AHD and to examine the effects of AHD on maternal and perinatal outcomes in women living in southern Mozambique (Objective 3).

Methods

All activities of this proposal have been conducted by the Manhiça Health Research Center (CISM) in the Manhiça District during a three-year period (2019-2021) and include one qualitative study and two descriptive retrospective and prospective quantitative analysis.

Results and conclusions

Furthermore, it is upsetting that no significant changes in the annual proportion of pregnant women enrolling ANC with AHD were observed during 2015-2020. Thus, prompt HIV diagnosis in women of childbearing age, effective linkage to HIV care and close monitoring after ART initiation may all contribute to reduce this burden and improve maternal and child survival. Furthermore, there is a high level of knowledge of the most common diseases in pregnancy and their prevention, however there is poor recognition of the drugs prescribed and their indication what may cause medications errors and affect adherence. Health communication and education strategies are needed to leverage their knowledge and enhance compliance to medication considering the high number of drugs prescribed.

Activities by objectives Methods Time period Progress
1. To assess perceptions, acceptability and behaviour of HIV-infected pregnant women regarding the administration of the recommended multiple medications Qualitative behavioural study nested to the randomized placebo-controlled trial – MAMAH January 2019 to
January 2022
  • Enrolment and follow up of all study participants completed.
  • Ongoing data analyis and manuscripts writing
  • Result dissemination (Jornadas d Saude de INSS and ASTMH annual meeting 2021)
2. To assess the retention rate and its determinants to Option B+ Retrospective and prospective quantitative analysis using two complementary data sources (IeDEA and HDSS).
  • Ongoing data analyis
3. To determine the proportion, characteristics and clinical presentation of pregnant women attending the antenatal care (ANC) clinic with HIV advanced disease.
  • Data analyis completed
  • Ongoing manuscripts writing
  • Result dissemination (Jornadas d Saude de INSS, EDCTP Forum and international workshop on hiv pediatrics 2021)