Protective Effect of Indoor Residual Spraying of Insecticide on Preterm Birth Among Pregnant Women With HIV Infection in Uganda: A Secondary Data Analysis - PubMed (original) (raw)

Randomized Controlled Trial

. 2017 Dec 19;216(12):1541-1549.

doi: 10.1093/infdis/jix533.

Stephen Shiboski 1, Paul Natureeba 3, Abel Kakuru 3, Mary Muhindo 3, Teddy Ochieng 3, Albert Plenty 4, Catherine A Koss 5, Tamara D Clark 5, Patricia Awori 3, Miriam Nakalambe 6, Deborah Cohan 7, Prasanna Jagannathan 8, Roly Gosling 1 2, Diane V Havlir 5, Moses R Kamya 9, Grant Dorsey 5

Affiliations

Randomized Controlled Trial

Protective Effect of Indoor Residual Spraying of Insecticide on Preterm Birth Among Pregnant Women With HIV Infection in Uganda: A Secondary Data Analysis

Michelle E Roh et al. J Infect Dis. 2017.

Abstract

Background: Recent evidence demonstrated improved birth outcomes among human immunodeficiency virus (HIV)-uninfected pregnant women protected by indoor residual spraying of insecticide (IRS). Evidence regarding its impact on HIV-infected pregnant women is lacking.

Methods: Data were pooled from 2 studies conducted before and after an IRS campaign in Tororo, Uganda, among HIV-infected pregnant women who received bed nets, daily trimethoprim-sulfamethoxazole, and combination antiretroviral therapy at enrollment. Exposure was the proportion of pregnancy protected by IRS. Adverse birth outcomes included preterm birth, low birth weight, and fetal or neonatal death. Multivariate Poisson regression with robust standard errors was used to estimate risk ratios.

Results: Of 565 women in our analysis, 380 (67%), 88 (16%), and 97 (17%) women were protected by IRS for 0%, >0% to 90%, and >90% of their pregnancy, respectively. Any IRS protection significantly reduced malaria incidence during pregnancy and placental malaria risk. Compared with no IRS protection, >90% IRS protection reduced preterm birth risk (risk ratio, 0.35; 95% confidence interval, .15-.84), with nonsignificant decreases in the risk of low birth weight (0.68; .29-1.57) and fetal or neonatal death (0.24; .04-1.52).

Discussion: Our exploratory analyses support the hypothesis that IRS may significantly reduce malaria and preterm birth risk among pregnant women with HIV receiving bed nets, daily trimethoprim-sulfamethoxazole, and combination antiretroviral therapy.

Keywords: HIV; IRS; Uganda; malaria; preterm birth.

© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

PubMed Disclaimer

Figures

Figure 1.

Figure 1.

Timeline of the PROMOTE–Protease Inhibitors (PROMOTE-PIs) and PROMOTE–Birth Cohort 2 (PROMOTE-BC2) trials relative to IRS exposure. IRS, indoor residual spraying.

Figure 2.

Figure 2.

Flow diagram representing the study’s inclusion criteria for human immunodeficiency virus (HIV)–infected pregnant women in the PROMOTE–Protease Inhibitors (PROMOTE-PIs) and PROMOTE–Birth Cohort 2 (PROMOTE-BC2) studies conducted in Tororo, Uganda. DP, dihydroartemisinin-piperaquine; EFV, efavirenz; IRS, indoor residual spraying; PI, protease inhibitor; TMP-SMX, trimethoprim-sulfamethoxazole.

References

    1. Eisele TP, Larsen DA, Anglewicz PA et al. Malaria prevention in pregnancy, birthweight, and neonatal mortality: a meta-analysis of 32 national cross-sectional datasets in Africa. Lancet Infect Dis 2012; 12:942–9. -PubMed
    1. Desai M, Gutman J, L’lanziva A et al. Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisinin–piperaquine versus intermittent preventive treatment with sulfadoxine–pyrimethamine for the control of malaria during pregnancy in western Kenya: an open-label, three-group, randomised controlled superiority trial. Lancet 2016; 386:2507–19. -PMC -PubMed
    1. Katz J, Lee AC, Kozuki N et al. ; CHERG Small-for-Gestational-Age-Preterm Birth Working Group Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet 2013; 382:417–25. -PMC -PubMed
    1. Bulterys PL, Kaplan JE, Gutman J. Preventing malaria in HIV-infected pregnant women. Clin Infect Dis 2014; 58:660–2. -PubMed
    1. World Health Organization. WHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP). Geneva, Switzerland: World Health Organization, 2013.

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources