Project Title

Effects of preterm birth on HIV acquisition risk and antiretroviral prophylaxis safety in HIV-exposed infants in Botswana (PERHAPS)

Project Objectives

The purpose of this project was to evaluate the relationship between preterm birth (PTB) and a) mother to child HIV transmission (MTCT); b) antiretroviral prophylaxis toxicity, in Botswana through the secondary analysis of data from a previously conducted randomized clinical trial. Specifically, the project aimed to - describe the prevalence and timing (in utero versus peripartum) of MTCT in HIV exposed infants delivered preterm vs those delivered at term - assess the hematologic safety of ARV prophylaxis among HIV-exposed infants born preterm in the first month of life, evaluating for anaemia and/or neutropenia

Results & Outcomes

Host Organisation

EDCTP Project Call

Career Development Fellowship (CDF)

Study Design

NA

Project Summary

Embedded in the planned clinical trial, the project also sorts to build local capacity specifically in data management processes through training and hands-on practice, expand knowledge of local researchers in infectious disease epidemiology through a post graduate study and lastly inform public policy relative to testing and prophylaxis strategies for preterm HIV-exposed infants. Achievements Capacity Building - quintessential and central to the effective execution and management of the project, activities within this component of the award was mainly directed at improving data management skills locally. Over an 18-month period, the study identified and trained 1 local staff member in data management processes, specifically building local data management skill in Dataset preparation and storage, Data analysis, Data sharing, Data security and Data repository management. All data used for the clinical research component of the project was generated, curated, stored analyzed and interpreted locally by locally based researchers and personnel in Botswana. Knowledge and Education: this fellowship grant facilitated training of the awardee in Infectious Disease Epidemiology at post-graduate level at the University of Cape Town (UCT). Enrolling in such a program helped to improve knowledge in the field of infectious disease epidemiology through mentorship at UCT and by interacting with peers and regional experts, particularly as it relates to regional trends and responses to HIV. Clinical Research: successfully carried out the planned secondary data analysis to meet set aims and objectives. Salient findings from the analysis includes - Low MTCT rate due to High ART coverage in pregnant WLHIV in Botswana. - High preterm delivery rate of 19% in WLHIV in a setting of high ART coverage - No difference in HIV acquisition rate in HIV exposed infants delivered preterm vs term overall (0.8% vs 0.6%), at birth (0.2% vs 0.3%) and at 14-34 days post-delivery (0.6% vs 0.3%) - Trend towards higher rates of peripartum HIV acquisition among infants delivered preterm as against no increase at all in those delivered term (0.2% - 0.6%) - Significant increase in odds of severe anemia and neutropenia in infants born preterm when compared with those born full term - No difference in proportions of infants with severe anemia and neutropenia amongst those who took AZT vs NVP for prophylaxis Challenges We have not been able to implement the result communication and dissemination plan as originally set out due to the COVID-19 pandemic, hence unable to measure report on the public policy impact of the project. The P.I and BHP as an institution are however committed to sharing the findings from this study with local and international stakeholders and the community and have started off by reporting on the study’s salient findings on the organization’s websites. All other results communication and dissemination activities will be regularly updated on the study website as they occur. Study action website https://bhp.org.bw/?page_id=518

Current Organisation

Botswana Harvard AIDS Institute

Current Job Title

Study Coordinator

Biography

Publications