Disparities in Birth Outcomes Between HIV-Positive Women Undergoing Antiretroviral Therapy and HIV-Negative Women in Masvingo Province, 2023-2024.

Abstract

Maternal antiretroviral (ART) use has not been conclusively shown to lead to comparable birth outcomes with HIV negative women. Different studies have shown conflicting results with some studies in sub-Saharan Africa showing that adverse birth outcomes continue to occur more in HIV positive women despite ART use. The main objective of this study was to determine if there are disparities in the occurrence of low-birth-weight infants and stillbirths by HIV status in Masvingo Province and considered deliveries between January 2023 and December 2024. Delivery data for 603 women were collected from delivery registers from 18 randomly selected sites from Masvingo, Mwenezi and Chiredzi districts. Of these 304 were of HIV positive women virally suppressed on tenofovir-lamivudine-dolutegravir and 299 were of HIV negative women. The variables of interest were HIV status, place of residence, maternal age at delivery, gestational age at booking and the outcomes of interest were gestational age at delivery, fetal status at delivery and birth weight. A total of 9% of the deliveries had a low-birth-weight infant. HIV status was not associated with low-birth-weight deliveries (AOR 0.9, 95% CI 0.5-1.6, p=0.715). The stillbirth rate was 16 per 1000 deliveries and this did not differ by HIV status (AOR 0.2, 95% CI 0.1-1.12, p=0.079). Approximately 9% of the deliveries were premature deliveries. HIV status was not associated with preterm deliveries (AOR 0.8, 95% CI 0.4-1.4, p=0.444). Among HIV positive women low birth weight deliveries were associated with preterm delivery (AOR 8, 95% CI 2.5-25.7, p=0.001) and multiparity (AOR 0.2, 95% CI 0.1- 0.7, p=0.013) while among HIV negative women they were associated with low level of education (AOR 4.4, 95% CI 1.1-17.1, p=0.032), the presence of a maternal comorbidity (AOR 4.8, 95% CI 1.1-20.9, p=0.035), multiparity (AOR 0.2, 95% CI 0.1-0.7, p=0.008) and preterm delivery (AOR 3.4, 95% CI 1.2-9.4, p=0.021). None of the factors analysed for stillbirth deliveries were statistically significant. ART timing for HIV positive women was not associated with occurrence of adverse outcome. Preterm deliveries were associated with the presence of a maternal comorbidity among HIV negative women (AOR 3.7, 95% CI 1-13.4, p=0.047). Higher odds of preterm delivery in HIV positive women were seen in multiparous women (AOR 4.9, 95% CI 0.9-27, p=0.067) and starting ART after conceiving (AOR 5.2, 95% CI 0.9-29.7, p=0.063) but this did not reach statistical significance. The use of dolutegravir based first line ART with viral suppression may lead to birth outcomes that are comparable with those in HIV negative women and ART timing does not seem to affect this finding. Maternal comorbidities need to be well managed in all women to reduce the occurrence of adverse birth outcomes. The study recommends maintaining HIV positive women of childbearing age on the current first line regimen in the event that guidelines are changed until and unless evidence exists that other regimes have a beneficial effect on birth outcomes.