Browsing by Subject "Vertical infectious disease transmission"

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    Implementing WHO Differentiated Service Delivery Model for Pregnant and Breastfeeding Women and Infants Living with HIV: Insights from Kenyan Healthcare Providers
    (Global Health and Education Projects, 2025-01-22) Humphrey, John; Carlucci, James G.; Wanjama, Esther Karen; Naanyu, Violet; Muli, Lindah; Alera, Joy Marsha; Were, Edwin; McGuire, Alan; Nyandiko, Winstone; Zimet, Gregory; Jerono Songok, Julia; Wools-Kaloustian, Kara; Medicine, School of Medicine
    Background and Objective:: Differentiated service delivery (DSD) is a strategy endorsed by the World Health Organization that simplifies and adapts human immunodeficiency (HIV) services to meet the needs of people living with HIV (PLHIV) while reducing unnecessary health system burdens. DSD for PLHIV has been widely adopted in sub-Saharan Africa, but DSD for women and infants enrolled in prevention of mother-to-child HIV transmission (PMTCT) services is lacking. Methods:: We conducted in-depth interviews with healthcare providers (i.e., clinicians, nurses, and mentor mothers) in antenatal and postnatal clinics at two facilities affiliated with the Academic Model Providing Access to Healthcare (AMPATH) in Kenya to explore perspectives on the adaptation of DSD for PMTCT. Providers were recruited in person at each facility. Interview guides focused on their views on DSD implementation for PMTCT, characteristics of stable and unstable PMTCT clients, and strategies to improve PMTCT services. We used inductive coding with illustrative quotes to highlight emerging themes. Results:: 12 PMTCT providers (6 antenatal, 6 postnatal; 4 clinicians, 4 nurses, and 4 mentor mothers) were enrolled; 10 (83%) were female, with a median age of 40 years, and a median of 7 years of PMTCT experience. Providers held positive views about the potential benefits of DSD for PMTCT but expressed concern about reducing service intensity during pregnancy/breastfeeding. Providers also suggested specific criteria defining stable PMTCT clients beyond those used for non-pregnant PLHIV, such as having no pregnancy complications, psychosocial or socioeconomic barriers, or breastfed infants. Conclusion and Global Health Implications:: Filling the gap in DSD guidance for this population will require adaptations to the DSD model that are responsive to providers’ concerns and the unique aspects of the pregnancy-postpartum service continuum, which may vary across settings based on contextual and client-level factors. Such nuanced guidance will need to remain clear and simple to implement to ensure implementation fidelity at scale.
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    Neurocognitive outcomes in Malawian children exposed to malaria during pregnancy: An observational birth cohort study
    (PLOS, 2021-09-28) Weckman, Andrea M.; Conroy, Andrea L.; Madanitsa, Mwayiwawo; Gnaneswaran, Bruno; McDonald, Chloe R.; Kalilani-Phiri, Linda; Chandna, Jaya; Ali, Doreen; Mwapasa, Victor; Khairallah, Carole; Thwai, Kyaw Lay; Meshnick, Steven R.; Taylor, Steve M.; ter Kuile, Feiko O.; Kain, Kevin C.; Gladstone, Melissa; Pediatrics, School of Medicine
    Background: Annually 125 million pregnancies are at risk of malaria infection. However, the impact of exposure to malaria in pregnancy on neurodevelopment in children is not well understood. We hypothesized that malaria in pregnancy and associated maternal immune activation result in neurodevelopmental delay in exposed offspring. Methods and findings: Between April 2014 and April 2015, we followed 421 Malawian mother-baby dyads (median [IQR] maternal age: 21 [19, 28] years) who were previously enrolled (median [IQR] gestational age at enrollment: 19.7 [17.9, 22.1] weeks) in a randomized controlled malaria prevention trial with 5 or 6 scheduled assessments of antenatal malaria infection by PCR. Children were evaluated at 12, 18, and/or 24 months of age with cognitive tests previously validated in Malawi: the Malawi Developmental Assessment Tool (MDAT) and the MacArthur-Bates Communicative Development Inventories (MCAB-CDI). We assessed the impact of antenatal malaria (n [%] positive: 240 [57.3]), placental malaria (n [%] positive: 112 [29.6]), and maternal immune activation on neurocognitive development in children. Linear mixed-effects analysis showed that children exposed to antenatal malaria between 33 and 37 weeks gestation had delayed language development across the 2-year follow-up, as measured by MCAB-CDI (adjusted beta estimate [95% CI], -7.53 [-13.04, -2.02], p = 0.008). Maternal immune activation, characterized by increased maternal sTNFRII concentration, between 33 and 37 weeks was associated with lower MCAB-CDI language score (adjusted beta estimate [95% CI], -8.57 [-13.09, -4.06], p < 0.001). Main limitations of this study include a relatively short length of follow-up and a potential for residual confounding that is characteristic of observational studies. Conclusions: This mother-baby cohort presents evidence of a relationship between malaria in pregnancy and neurodevelopmental delay in offspring. Malaria in pregnancy may be a modifiable risk factor for neurodevelopmental injury independent of birth weight or prematurity. Successful interventions to prevent malaria during pregnancy may reduce the risk of neurocognitive delay in children.