Direct maternal deaths attributable to HIV in the era of antiretroviral therapy: evidence from three population-based HIV cohorts with verbal autopsy

Calvert, C. et al. (2020) Direct maternal deaths attributable to HIV in the era of antiretroviral therapy: evidence from three population-based HIV cohorts with verbal autopsy. AIDS, 34(9), pp. 1397-1405. (doi: 10.1097/QAD.0000000000002552) (PMID:32590436)

Abstract

Objective: To assess whether HIV is associated with an increased risk of mortality from direct maternal complications. Design: Population-based cohort study using data from three demographic surveillance sites in Eastern and Southern Africa. Methods: We use verbal autopsy data, with cause of death assigned using the InSilicoVA algorithm, to describe the association between HIV and direct maternal deaths amongst women aged 20–49 years. We report direct maternal mortality rates by HIV status, and crude and adjusted rate ratios comparing HIV-infected and uninfected women, by study site and by ART availability. We pool the study-specific rate ratios using random-effects meta-analysis. Results: There was strong evidence that HIV increased the rate of direct maternal mortality across all the study sites in the period ART was widely available, with the rate ratios varying from 4.5 in Karonga, Malawi [95% confidence interval (CI) 1.6–12.6] to 5.2 in Kisesa, Tanzania (95% CI 1.7–16.1) and 5.9 in uMkhanyakude, South Africa (95% CI 2.3–15.2) after adjusting for sociodemographic confounders. Combining these adjusted results across the study sites, we estimated that HIV-infected women have 5.2 times the rate of direct maternal mortality compared with HIV-uninfected women (95% CI 2.9–9.5). Conclusion: HIV-infected women face higher rates of mortality from direct maternal causes, which suggests that we need to improve access to quality maternity care for these women. These findings also have implications for the surveillance of HIV/AIDS-related mortality, as not all excess mortality attributable to HIV will be explicitly attributed to HIV/AIDS on the basis of a verbal autopsy interview.

• Item Type: Articles
• Additional Information: This study was supported by a grant from Economic and Social Research Council (ES/P00959X/1) and from grants from the Bill & Melinda Gates Foundation to the ALPHA Network (BMGF-OPP1082114) and the MeSH Consortium (BMGF-OPP1120138).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Crampin, Professor Mia
• Authors: Calvert, C., Marston, M., Slaymaker, E., Crampin, A. C., Price, A. J., Klein, N., Herbst, K., Michael, D., Urassa, M., Clark, S. J., Ronsmans, C., and Reniers, G.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: AIDS
• Publisher: Lippincott, Williams & Wilkins
• ISSN: 0269-9370
• ISSN (Online): 1473-5571
• Published Online: 08 May 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in AIDS 34(9): 1397-1405
• Publisher Policy: Reproduced under a Creative Commons License