Birth Outcomes in Hiv Positive Women Receiving Antiretroviral Therapy at The Tamale Teaching Hospital: A Retrospective Study

Abstract

Introduction: There are several conflicting reports on the effect of antiretroviral drugs (ARVs) on birth outcomes in HIV positive women. Studies also suggest that different geographic locations present with varying birth outcomes with respect to specific antiretroviral drugs. Objective: This sought to examine birth outcomes in HIV positive women who received antiretroviral therapy (ART) at the Tamale Teaching Hospital (TTH) from 2010 to 2015. Methods: As a result of sparse data on this issue, this Ghanaian retrospective study sought to identify birth outcomes in HIV positive women who received ART in a Ghanaian sentinel clinic between 2010 and 2015. A purposive sampling technique was employed to collect data on birth outcomes from the registry of the ART clinic of the TTH as well as the database of the National AIDS/STI Control Program, Ghana. The Stata software (StataSE 13.0) was used to analyse data. Descriptive data included maternal demographic characteristics and obstetric history as well as ART regimen used. Birth outcomes considered were: newborn`s HIV status, low birth weight (<2,500 g), preterm delivery (gestational age <37 weeks) and still births. The Fisher`s exact test was used to test for associations between birth outcomes (newborn`s HIV seropositivity, low birth weight, preterm delivery and still birth) and ARV regimens as well as maternal risk factors (smoking, alcohol abuse, HIV type, coinfections, education, religion and mode of delivery). The one sample t-test was used to test mean differences of age and birth weight. A p-value below 0.05 was considered statistically significant. Results: With a mean age of 31.3±5.2 years (CI, 30.21-32.26), the 101 clients` data provided prevalence rates of 4.2%, 18.8%, 7.3% and 5.0% for HIV seropositivity, low birth weight, preterm delivery and still birth respectively. About 85.2% of clients received any one of the following alternative antiretroviral regimens: TDF+3TC+NVP; TDF+FTC+EFV; d4T+3TC+NVP; AZT+3TC+EFV; AZT+3TC+NVP and AZT+3TC. The mean birth weight was 2.9±0.5 (CI, 2.78-2.99). No significant associations were observed between birth outcomes (newborn`s HIV seropositivity, low birth weight, preterm delivery and still birth) and respective ARV regimens (p>0.05). Additionally, a-priori confounding maternal risk factors (smoking, alcohol abuse, HIV type, coinfections, education, religion and mode of delivery) assessed in this study were found to have no significant associations with the observed birth outcomes (p >0.05). Conclusions and recommendations: Birth outcomes were not significantly associated with antiretroviral drug combinations and maternal risk factors. Due to shortages, the sentinel clinic lacked the WHO`s recommended ARV regimens for ART. It is critical for key stakeholders to support Ghanaian sentinel clinics obtain preferred antiretroviral regimens (eg. TDF+3TC/FTC+EFV) so as to reduce potential adverse birth outcomes. Also, high priority strategies are required from stakeholders to help reduce mother to child transmission of HIV in order to meet the target of the WHO`s Global Plan for eliminating MTCT of HIV while keeping respective mothers alive.