A retrospective analysis of maternal factors, access of prevention of vertical transmission resources, and infant preterm delivery and mortality

Objective: – This study evaluated factors associated with adverse infant outcomes (preterm delivery, infant mortality) and described access of antiretroviral therapy (ART) by pregnant women living with HIV (WLWH) and their infants.Design: – The African Cohort Study (AFRICOS) enrolls individuals aged ≥ 15 years across 12 clinical sites in Kenya, Uganda, Tanzania, and Nigeria. These analyses included WLWH enrolled from 2013 to 2023. Data on sociodemographics, HIV-related factors, and pregnancy outcomes were collected by self-report and medical records. Methods: – Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for associations between maternal characteristics and infant outcomes, with clustered standard errors to account for multiple pregnancies by the same woman. Results: – Among 593 WLWH with 922 pregnancies, 753 (81.7%) resulted in singleton live births. Of these, 12.1% (91/753) were to WLWH who indicated they did not receive ART. In total, 5.2% (39/753) of live born infants were preterm; 5.6% (42/753) of infants died before 12 months of age. Odds of preterm birth were higher among WLWH under 20 years of age (aOR 3.39, 95% CI 1.12–10.31, versus 20–34 years). Increased odds of mortality were observed among infants born preterm (aOR 7.92, 95% CI 3.28–19.13, versus full term) and infants without ARV prophylaxis prescription (aOR 5.13, 95% CI 2.23–11.83, versus infants prescribed ARV prophylaxis). Conclusion: – Gaps in prevention of vertical transmission care persist. Expanding ART access to WLWH and adherence to WHO HIV treatment guidelines are critical to end vertical transmission of HIV and reduce infant mortality.