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J Infect Dis. 2017 Dec 19;216(12):1541-1549. doi: 10.1093/infdis/jix533.

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

Author information

1
Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco.
2
Global Health Group, Malaria Elimination Initiative, San Francisco.
3
Infectious Diseases Research Collaboration, Makerere University College of Health Sciences, Kampala, Uganda.
4
Center for AIDS Prevention Studies, University of California, San Francisco.
5
Departments of Medicine, University of California, San Francisco.
6
Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda.
7
Departments of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco.
8
Department of Medicine, Stanford University, Palo Alto, California.
9
School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.

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.

KEYWORDS:

HIV; IRS; Uganda; malaria; preterm birth

PMID:
29029337
PMCID:
PMC5853907
[Available on 2018-12-19]
DOI:
10.1093/infdis/jix533

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