976 - A Descriptive Retrospective Data Analysis of Maternal Sociodemographic Factors and Access of Healthcare Resources within the African Cohort Study, an Integrated Multicountry Preventative Mother to Child Transmission Program

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Presenting Author(s)

Jeanette L. Traver

Active Duty Staff Pediatrician
Madigan Army Medical Center
JB LM, Washington
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

AE

Allahna L. Esber

Research Analyst
The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD and Walter Reed Army Institute of Research, Silver Spring, MD
Silver Spring, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
ND

Nicole Dear

Research Analyst
U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
Silver Spring, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EP

Elizabeth Polston

CPT
Madigan Army Medical Center
Joint Base Lewis McChord, Washington
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MI

Michael Iroezindu

Site Principal Investigator
Henry Jackson Foundation for the Advancement of Military Medicine
Abuja, Federal Capital Territory, Nigeria
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EB

Emmanuel Bahemana

Study Coordinator
Study Coordinator, Henry Jackson Foundation Medical Research International
Bethesda, MD
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
HK

Hannah Kibuuka

Executive Director, Makerere University Walter Reed Project
Makerere University Walter Reed Project
Kampala, Kampala, Uganda
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JO

John Owuoth

Site Principal Investigator
Henry M. Jackson Medical Research International
Kisumu, Western, Kenya
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JM

Jonah Maswai

Site Principal Investigator
Walter Reed Army Institute of Research, Silver Spring, MD
Silver Spring, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TC

Trevor A. Crowell

Dr
Henry M. Jackson Foundation for the Advancement of Military Medicine
Bethesda, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CP

Christina Polyak

Associate Director of Clinical Research
Henry Jackson Foundation for the Advancement of Military Medicine
Bethesda, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JA

Julie A. Ake

Deputy Director
Walter Reed Army Institute of Research
Silver Spring, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AK

Anjali Kunz

TY Program Director, Peds ID
Madigan Army Medical Center
Tacoma, WA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Global reduction in new infant HIV infections is largely due to the expansion of prevention
of mother-to-child transmission (PMTCT) programs. Identification of gaps in healthcare services is
paramount in targeting interventions that identify high-risk populations and healthcare barriers that
could lead to increased risk of mother to child transmission (MTCT) of HIV.

Methods: HIV infected women from 5 regions of Africa enrolled in the African Cohort Study (AFRICOS)
were followed prospectively with assessments performed every 6 months. Sociodemographic factors,
pregnancy outcomes, and access of PMTCT resources were reviewed for retrospectively reported
pregnancies and those followed prospectively from study enrollment. Statistical analysis compared the
impact of clinical factors on infant mortality and preterm delivery.

Results: The study reported 5591 pregnancies from January 2013 to June 2019 of which 5363 were retrospectively reported
prior to study enrollment and 228 occurred after enrollment. Pregnancies followed prospectively had
higher rates of linkage to PMTCT services prenatally (92.5% vs 6.8%, P< 0.001), intrapartum (64.5% vs
3.5%, P< 0.001), and post-partum (64.5% vs 2.9%, P< 0.001). This group had higher rates of delivery by a
skilled birth attendant (93.4% vs 66.7%, P< 0.001) and antiretroviral therapy (ART) prescribed
antepartum (96.1% vs 5.5%, P< 0.001) and post-partum (74.6% vs 3.6%, P< 0.001). Both groups had
similar rates of prescriptions for intrapartum ART (98.7% vs 97.9%). The majority of women reported
ART adherence (96.5%, P< 0.001) which was associated with a decrease in both preterm delivery and
infant mortality (adjusted OR 0.24, 95% CI 0.15-0.39). A significant proportion of women followed
prospectively reported their infants received ART with good adherence (51.8% vs 0.3% and 93.4% vs
6.3%, respectively P< 0.001).

Conclusion: Participation in AFRICOS increased linkage to PMTCT programs which resulted in increased
likelihood of skilled delivery and appropriate ART use for women and their infants. It highlights that
linkage to care continues to be a crucial factor in limiting MTCT of HIV especially in resource-limited
settings. Limitations in this study exist due to the low number of prospectively followed pregnancies.