Protective Effect of Indoor Residual Spraying of Insecticide on Preterm Birth Among Pregnant Women With HIV Infection in Uganda: A Secondary Data Analysis

• Published in: The Journal of infectious diseases 2017-12, Vol.216 (12), p.1541-1549
• Main Authors: Roh, Michelle E., Shiboski, Stephen, Natureeba, Paul, Kakuru, Abel, Muhindo, Mary, Ochieng, Teddy, Plenty, Albert, Koss, Catherine A., Clark, Tamara D., Awori, Patricia, Nakalambe, Miriam, Cohan, Deborah, Jagannathan, Prasanna, Gosling, Roly, Havlir, Diane V., Kamya, Moses R., Dorsey, Grant
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anti-Retroviral Agents - therapeutic use; Chemoprevention - methods; Drug Combinations; Female; HIV Infections - complications; HIV Infections - drug therapy; HIV/AIDS; Humans; Incidence; Infant, Newborn; Insecticide-Treated Bednets; Insecticides - administration & dosage; Major and Brief Reports; Malaria - prevention & control; Mosquito Control - methods; Pregnancy; Pregnancy Complications, Infectious - prevention & control; Premature Birth - prevention & control; Sulfadoxine - therapeutic use; Treatment Outcome; Trimethoprim - therapeutic use; Uganda - epidemiology; Young Adult
• ISSN: 0022-1899; 1537-6613; 1537-6613
• DOI: 10.1093/infdis/jix533

In high–malaria burden areas, early exposure to indoor residual spraying during the first trimester of pregnancy may reduce preterm birth risk by 65% among human immunodeficiency virus–infected pregnant women receiving insecticide-treated nets, daily trimethoprim-sulfamethoxazole, and combination antiretroviral therapy. Abstract Background Recent evidence demonstrated improved birth outcomes among human immunodeficiency virus (HIV)–uninfected pregnant women protected by indoor residual spraying of insecticide (IRS). Evidence regarding its impact on HIV-infected pregnant women is lacking. Methods Data were pooled from 2 studies conducted before and after an IRS campaign in Tororo, Uganda, among HIV-infected pregnant women who received bed nets, daily trimethoprim-sulfamethoxazole, and combination antiretroviral therapy at enrollment. Exposure was the proportion of pregnancy protected by IRS. Adverse birth outcomes included preterm birth, low birth weight, and fetal or neonatal death. Multivariate Poisson regression with robust standard errors was used to estimate risk ratios. Results Of 565 women in our analysis, 380 (67%), 88 (16%), and 97 (17%) women were protected by IRS for 0%, >0% to 90%, and >90% of their pregnancy, respectively. Any IRS protection significantly reduced malaria incidence during pregnancy and placental malaria risk. Compared with no IRS protection, >90% IRS protection reduced preterm birth risk (risk ratio, 0.35; 95% confidence interval, .15–.84), with nonsignificant decreases in the risk of low birth weight (0.68; .29–1.57) and fetal or neonatal death (0.24; .04–1.52). Discussion Our exploratory analyses support the hypothesis that IRS may significantly reduce malaria and preterm birth risk among pregnant women with HIV receiving bed nets, daily trimethoprim-sulfamethoxazole, and combination antiretroviral therapy.