HIV has been transformed into a chronic, manageable disease for most people living with HIV in the United States, where mother-to-child transmission of HIV is now a rare occurrence. But in sub-Saharan Africa, new HIV infections in children, and maternal deaths due to HIV, are still major problems. Two new studies from the University of Alabama at Birmingham aim to change that.
It is estimated that more pregnant women in Eastern and Southern Africa are HIV-positive than any other place in the world. Additionally, the children in this region make up nearly 50 percent of children living with HIV globally; more than 90 percent are infected through vertical transmission from mother to child during pregnancy, delivery or breastfeeding, according to UNICEF.
Starting this summer, Janet Turan, Ph.D., associate professor in the Department of Health Care Organization and Policy at the UAB School of Public Health, will continue her work in reducing the adverse effects of HIV-related stigma among pregnant women in Kenya. Turan will be principal investigator of a new project that is being conducted in collaboration with investigators at the Kenya Medical Research Institute and the University of California, San Francisco.
Turan has been awarded more than $600,000 from the National Institute of Mental Health for the new study, A Home-Based Couples Intervention to Enhance PMTCT and Family Health in Kenya, which will last three years. The goal is to develop and pilot a home-based couple's intervention that includes safe HIV testing and disclosure for couples, alongside information and counseling for family health during the perinatal period.
"Antiretroviral therapy has the potential to ensure maternal health and reduce vertical HIV transmission to as low as 1 percent," Turan said. "But because many women refuse HIV testing, do not disclose their HIV status and avoid treatment because they fear negative consequences from their partner, HIV-related deaths and HIV infection among infants remain unacceptably high."
Engaging both partners of a couple during pregnancy has the potential to enhance health decisions, increase health care utilization, and ultimately improve maternal, paternal and infant health, Turan says.
"As men rarely attend antenatal clinics in Kenya, a home-based strategy can reach the couple in a safe and convenient space and give them unprecedented access to family health information, couples HIV counseling and testing services, and linkage to HIV care and treatment," Turan said.
Additionally, Turan is co-principal investigator on another new R01 grant in the amount of $1,721,830, funded by the National Institute of Child Health and Development for the next five years that will also focus on eliminating new pediatric HIV infections and saving maternal lives, as well as simplifying antiretroviral therapy implementation. This study is being conducted in collaboration with KEMRI and the University of Colorado, Denver.
Maximizing adherence and retention in the context of Option B+ in Kenya will support the recent rollout in Kenya of the current World Health Organization recommendation that all pregnant and breastfeeding women receive lifelong triple antiretroviral therapy, regardless of stage of HIV disease, known as Option B+. The investigators will work to identify effective methods to ensure long-term ART adherence and retention in HIV care for mother-baby pairs.
"We will rigorously test two interventions — community-based mentor mothers and mobile phone text messaging — that are highly likely to maximize ART adherence and retention in care among HIV-infected pregnant women and HIV-exposed infants in rural Kenya," Turan said.
Specific barriers in the context of Option B+ are not well understood despite efforts to scale up Option B+ in the region, Turan says.
"The goal of this study is to inform the scale-up by identifying effective interventions and combinations of interventions that can reduce barriers and increase facilitators of optimal ART adherence and retention in care with the aims of reaching the elimination of mother-to-child transmission of HIV and significantly improving maternal health," Turan said.
UAB School of Public Health