Evidence map›Paper›PMID 31634186›Full record

ArticleAIDS (London, England)2020

Comparison of guidelines for HIV viral load monitoring among pregnant and breastfeeding women in sub-Saharan Africa.

Maia Lesosky, Janet M Raboud, Tracy Glass, Sean S Brummel, Andrea L Ciaranello, Judith S Currier, Shaffiq Essajee, Diane V Havlir, Catherine A Koss, Anthony Ogwu and 3 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in AIDS (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
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  5. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Maia LesoskyDivision of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
Janet M RaboudToronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
Tracy GlassDivision of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
Sean S BrummelThe Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston.
Andrea L CiaranelloMedical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Judith S CurrierUniversity of California Los Angeles, Los Angeles, California.
Shaffiq EssajeeUNICEF, New York, New York.
Diane V HavlirUniversity of California San Francisco, San Francisco, California, USA.
Catherine A KossUniversity of California San Francisco, San Francisco, California, USA.
Anthony OgwuBotswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
Roger L ShapiroHarvard Medical School and Harvard School of Public Health, Boston, Massachusetts.
Elaine J AbramsICAP at Columbia University, Mailman School of Public Health, and Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA.
Landon MyerDivision of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.

Funding

The Johns Hopkins University - Uganda Clinical Trials UnitUM1AI069530 · NIAID · JOHNS HOPKINS UNIVERSITY · PI MARY Glenn Fowler, Philippa Musoke · 2012 to 2026
$34.8M
The immunologic consequences of prenatal exposure to malariaP01HD059454 · NICHD · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI HAVLIR, DIANE V · 2008 to 2017
$22.6M
Innovation across the spectrum of pediatric HIV care: Clinical impact and cost-effectiveness of long-acting antiretroviral therapy for breastfeeding people with HIV and their infants in ZimbabweR01HD079214 · NICHD · MASSACHUSETTS GENERAL HOSPITAL · PI CIARANELLO, ANDREA LYNNE · 2014 to 2023
$8.0M
Optimizing Adherence to PrEP among Young African Women through a Community Adherence Club InterventionK23MH114760 · NIMH · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KOSS, CATHERINE ANNE STIMETS · 2018 to 2021
$796k
Optimizing routine HIV viral load monitoring in pregnant and postpartum womenR21HD093463 · NICHD · UNIVERSITY OF CAPE TOWN · PI LESOSKY, MAIA ROSE · 2018 to 2019
$287k
NIAID NIH HHS UM1 AI069530NICHD NIH HHS P01 HD059454NICHD NIH HHS R01 HD079214NICHD NIH HHS R21 HD093463NIMH NIH HHS K23 MH114760
6 · The paper itself

Abstract

backgroundIntensified viral load monitoring for pregnant and breastfeeding women has been proposed to help address concerns around antiretroviral therapy (ART) adherence, viraemia and transmission risk, but there have been no systematic evaluations of existing policies.

methodsWe used an individual Monte Carlo simulation to describe longitudinal ART adherence and viral load from conception until 2 years' postpartum. We applied national and international guidelines for viral load monitoring to the simulated data. We compared guidelines on the percentage of women receiving viral load monitoring and the percentage of women monitored at the time of elevated viral load.

resultsCoverage of viral load monitoring in pregnancy and breastfeeding varied markedly, with between 14% and 100% of women monitored antenatally and 38-98% monitored during breastfeeding. Specific recommendations for testing at either a fixed gestation or a short, fixed period after ART initiation achieved more than 95% testing in pregnancy but this was much lower (14-83%) among guidelines with no special stipulations. By the end of breastfeeding, only a small proportion of simulated episodes of elevated viral load more than 1000 copies/ml were successfully detected by monitoring (range, 20-50%). DISCUSSION: Although further research is needed to understand optimal viral load frequency and timing in this population, these results suggest that current policies yield suboptimal detection of elevated viral load in pregnant and breastfeeding women.

Indexed as

Practice Guidelines as TopicAfrica South of the SaharaAnti-HIV AgentsBreast FeedingFemaleFertilizationHIV InfectionsHumansInfectious Disease Transmission, VerticalMonte Carlo MethodPostpartum PeriodPregnancyPregnancy Complications, InfectiousSerologic TestsViral LoadAnti-HIV Agents

Identifiers

PMID31634186
PMCPMC7060505

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.