Pregnancy outcomes of women living with HIV in South Africa: prospective cohort study

external supervisor

Professor Shane Norris, NIHR Southampton Biomedical Research Centre

background

1.3 million HIV-positive pregnant women give birth every year, 91% of whom reside in sub-Saharan Africa, the region which also has the highest rates of neonatal and child morbidity and mortality. Antiretroviral therapy (ART)-naïve maternal HIV-infection is associated with an increased risk of preterm birth (less than 37 weeks), small-for-gestational-age (less than 10th centile), low birthweight (less than 2500g) and stillbirth. ART in pregnancy reduces maternal morbidity and mortality, and greatly reduces mother-to-child transmission of HIV, but may increase the risk of adverse perinatal outcomes.

In 2013-2016 we conducted a prospective pregnancy cohort study in Soweto, South Africa. Uniquely, for all 663 enrolled women, gestational age was estimated by first-trimester ultrasound and birthweight measured within 24 hours of birth. Detailed information on ~200 items was collected, including sociodemographic characteristics; smoking, alcohol and illicit drug use; nutritional supplements; drug history; medical and obstetric history, and detailed information on maternal HIV and ART. Enrolled women received ultrasound scans every 5 weeks to monitor fetal growth. Growth and neurodevelopmental status at 2 years of age were assessed in children.

Key references:

Wedi et al Hemelaar, Lancet HIV,3: e33-48 (2016)

Santosa et al Hemelaar, AIDS, 33:1623-33 (2019).

RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING

The project will encompass analysis of the data set of the extremely well-characterised pregnant South African women and their children. Analyses may include, but are not limited to:

1. Univariable and multivariable analyses to examine risk factors associated with specific perinatal outcomes, in both HIV-positive and HIV-negative women;
2. Univariable and multivariable analyses to examine risk factors associated with specific maternal outcomes, in both HIV-positive and HIV-negative women;
3. Examination of correlations and overlap between different perinatal outcomes, such as preterm birth and low birthweight, in both HIV-positive and HIV-negative women.

New data collection in South Africa may be possible in the future. This would allow analysis of perinatal outcomes in the context of dolutegravir-based ART, which has been introduced since our previous study concluded. This would allow comparison of outcomes among HIV-positive women receiving efavirenz-based ART and dolutegravir-based ART.

The exact research question and scope of the project will be determined through discussion with the student.

FIELD WORK, SECONDMENTS, INDUSTRY PLACEMENTS AND TRAINING

It is anticipated that the main work will be conducted in Oxford and all necessary facilities, equipment and training, including study design, analytic and statistical training, will be provided in Oxford. New data collection in South Africa may be possible in the future.

PROSPECTIVE  STUDENT

A student with a background in medicine, obstetrics and gynaecology, infectious diseases, statistics or global health might suit this project. The ideal candidate will have a Master's degree in a relevant area (e.g. statistics/epidemiology/public health). The project has a broad scope and candidates are encouraged to contact Dr Joris Hemelaar to work out a specific project proposal.