Browsing by Author "Brittain, Kirsty"

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    Antenatal health promotion via short message service at a Midwife Obstetrics Unit in South Africa: a mixed methods study
    (BioMed Central, 2014-08-21) Lau, Yan K; Cassidy, Tali; Hacking, Damian; Brittain, Kirsty; Haricharan, Hanne J; Heap, Marion
    Abstract Background Adequate antenatal care is important to both the health of a pregnant woman and her unborn baby. Given South Africa’s high rate of cellphone penetration, mobile health interventions have been touted as a potentially powerful means to disseminate health information. This study aimed to increase antenatal health knowledge and awareness by disseminating text messages about clinic procedures at antenatal visits, and how to be healthy during pregnancy. Methods Participants recruited were pregnant women attending a primary health care facility in Cape Town. A controlled clinical trial was carried out where the intervention group (n = 102) received text messages staggered according to the week of pregnancy at the time of recruitment. The control group (n = 104) received no text messages. These text messages contained antenatal health information, and were delivered in English, Xhosa or Afrikaans, according to the preference of each participant. A baseline knowledge questionnaire with nine questions was administered prior to the intervention. The same questionnaire was used with added health-related behaviour questions for the intervention group at exit. A modified intention-to-treat analysis was done. To compare the control and intervention group’s knowledge, Fisher’s exact tests and two-sample t-tests tests were carried out for binary and continuous outcomes, respectively. A focus group of seven participants from the intervention group was then conducted to gain more insight into how the text messages were perceived. Results There was substantial loss to follow-up during the study with only 57% of the participants retained at exit. No statistically significant difference was detected between the control and intervention group in any of the nine knowledge questions at exit (all p > 0.05). Responses from the focus group indicated that the text messages acted as a welcome reminder and a source of positive motivation, and were perceived as extended care from the health care provider. Conclusions While the intervention failed to improve antenatal health knowledge, evidence from self-reported behaviour and the focus group suggests that text messages have the potential to motivate change in health-seeking behaviour. One should be mindful of loss to follow-up when rolling out mobile health interventions in developing country settings. Trial registration Pan African Clinical Trials Registry PACTR201406000841188 . Registered 3 June 2014.
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    Examining the association between future pregnancy intentions, contraceptive use and repeat pregnancies among women living with HIV in Cape Town, South Africa
    (2020) Mubangizi, Lilian; Brittain, Kirsty; Myer, Landon
    Background: Given the rapid expansion of antiretroviral therapy (ART) services in South Africa, there is growing recognition of the importance of fertility intentions, contraceptive use and childbearing among women living with HIV (WLHIV). With the integration of family planning services in the prevention of mother-to-child transmission of HIV (PMTCT) services, understanding fertility intentions and contraceptive use is crucial in evaluating such programs. We investigated the relationship between future fertility intentions, contraceptive use and repeat pregnancies among WLHIV in Cape Town, South Africa. Methodology: We analyzed data from the MCH-ART study conducted at the Gugulethu Midwife Obstetric Unit (MOU) in Cape Town, South Africa, which followed women initiating ART during pregnancy through 36-60 months postpartum. Self-report data were collected using standardized questionnaires at repeated study visits. Data on repeat pregnancies were abstracted from the Western Cape Provincial Data Centre. Associations between maternal characteristics and repeat pregnancies were examined using Cox proportional hazards models. Results: Overall, 109 incident repeat pregnancies were recorded among the 471 women included in this analysis. The median time at risk per individual was 4.27 years. The rate of repeat pregnancies was 5.72 per 100 person-years (PY). This rate was significantly lower among women aged 35-45 years (2.11/100PY) compared to women aged 18-24 years [7.56/100 PY; adjusted hazard ratio (aHR), 0.26: 95% confidence interval [CI], 0.09, 0.81). A total of 333 women contributed data on future fertility intentions and contraceptive use at 12 months postpartum, with 9% reporting that they wanted another child in the future, and 82% reporting current contraceptive use; 16% (n=54) reported not wanting another child but no contraceptive use. The rate of repeat pregnancies was 3 folds higher among women who reported wanting a child in the future (12.59/100 PY) compared to women who did not want 5 a child in the future (4.31/100 PY; aHR, 3.46: 95% CI, 1.83, 6.50). Contraceptive use at 12 months postpartum was not associated with repeat pregnancies. Women who did not want a child and used contraceptives had a 45% decreased hazard of repeat pregnancies compared to women who did not want a child and did not use contraceptives (aHR 0.55: 95% CI [0.32, 0.94]. Conclusion: Among women initiating ART during pregnancy, a repeat pregnancy incidence rate of 5.72/100 PY was observed through 36-60 months postpartum, with the incidence lower among older women. At 12 months postpartum, a notable proportion of women reported not wanting another child but no contraceptive use. Wanting a child in the future was associated with a higher rate of repeat pregnancy, but contraceptive use at 12 months postpartum was not associated with repeat pregnancies. These results highlight the importance of understanding factors associated with the dissonance between fertility intentions and contraceptive use and childbearing to ensure delivery of quality integrated reproductive health services in the PMTCT framework.
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    Impact of Unintended pregnancy on HIV viral load outcomes among postpartum women living with HIV in Cape Town, South Africa: clues from postpartum adherence clubs for antiretroviral therapy trial
    (2022) Mwalye, Pumulo Justine; Odayar, Jasantha; Brittain, Kirsty
    Introduction: Postpartum women living with HIV (WLWHIV) on antiretroviral therapy (ART) are at high risk of viraemia. We examined the association between unintended pregnancy and HIV viral load (VL) at 24 months postpartum in Cape Town, South Africa. Methods: Data are from a randomised trial that compared different ART delivery modalities for postpartum women aged at least 18 years who had initiated ART during their most recent pregnancy, had a VL<400 copies/ml in the previous three months, and had no comorbidities necessitating regular clinical follow-up. Pregnancy intentions regarding the most recent pregnancy were self-reported at enrolment into the study. VL was measured at 24 months postpartum, with elevated VL defined as VL≥1000 copies/ml. Chi-squared tests and logistic regression were used to examine predictors of unintended pregnancy. The impact of unintended pregnancy on elevated VL was examined using Poisson regression models. Results: Among 411 women included in the analysis (mean age: 28.7 years, 42% married/cohabiting, 75% with a parity≥2, and 86% with a VL<50 copies/ml), 57% reported that their most recent pregnancy was unintended. Compared to women aged 18-24 years, older women had a lower relative odds of unintended pregnancy [25-28 years, adjusted odds ratio (AOR): 0.34; 95% confidence interval (CI): 0.17-0.70; 29-34 years, AOR: 0.18; CI: 0.08-0.37; and ≥35 years, AOR: 0.35; CI: 0.14-0.89]. Additionally, unintended pregnancy was associated with being unmarried/not cohabiting (AOR: 4.44; CI: 2.78-7.09) and with higher parity (compared to parity=1: parity=2, AOR: 3.47; 95% CI: 1.86-6.50; and parity≥3, AOR: 6.38; 95% CI: 3.06-13.28). VL data at 24 months postpartum were available for 89% (366/411) of participants of whom 24% had elevated VL≥1000 copies/ml. Unintended pregnancy was associated with elevated VL in unadjusted analyses [risk ratio (RR): 1.54; CI: 1.03-2.28; p=0.032]. After adjustment for maternal factors and trial allocation, the association persisted despite not reaching statistical significance (adjusted risk ratio (aRR): 1.36; CI: 0.88-2.08; p=0.158). Conclusion: Among postpartum WLWHIV in South Africa, unintended pregnancy is prevalent and could be a risk factor for elevated VL. Reproductive health counselling and support during routine care visits may reduce unintended pregnancies and its effects.
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    Improving men's participation in preventing mother-to-child transmission of HIV as a maternal, neonatal, and child health priority in South Africa
    (Public Library of Science, 2015) van den Berg, Wessel; Brittain, Kirsty; Mercer, Gareth; Peacock, Dean; Stinson, Kathryn; Janson, Hanna; Dubula, Vuyiseka
    Wessel van den Berg and colleagues outline how increasing male partner involvement in efforts to reduce mother-to-child HIV transmission in South Africa may improve maternal and infant outcomes.
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    Investigating the intention of pregnancy among women living with HIV and its effect on the early development of their HIV exposed infants
    (2020) Moyo, Chido; Brittain, Kirsty
    Background: The increase in access and coverage of ART, including through prevention of mother-to-child transmission (PMTCT) programmes in Africa, has resulted in the reduction of vertical transmission, which has led to >95% of infants born to women living with HIV (WLHIV) in South Africa being born HIV uninfected. Concerns have however been raised regarding the health and development of HIV exposed and uninfected (HEU) infants. WLHIV in South Africa are more likely to have an unintended pregnancy compared HIV negative women. Unintended pregnancies continue to be a challenge towards the on-going strides and achievement of PMTCT goals. There is however a paucity of data on the investigations in research for the effect of unplanned pregnancy and early child development in South Africa. This research study focused on early infant development health outcomes of HIV exposed but uninfected (HEU).The aim of the study was to investigate the association between the intention of pregnancy among pregnant WLHIV, and the subsequent early child development of their HEU infants in Gugulethu, South Africa. Methods: This study used data from the “Long-term Adherence and Care Engagement” study (LACE; May 2017-Apr 2018), which provided long-term data from women who had initiated antiretroviral therapy (ART) during pregnancy. During pregnancy, the London Measure of Unplanned Pregnancy was used to assess pregnancy intentions. At 36-60 months postpartum, child development was assessed across six developmental domains using the Ages & Stages questionnaire (ASQ). Multivariate Linear regression models were used to examine the association between pregnancy intentions and subsequent child development, with results reported as regression coefficients (β) with 95% confidence intervals (CI). Results: A total of 250 mother-infant pairs completed assessments and were included in analysis. At enrolment, the median age for the women was 28.3 years, and 38% were married and/or cohabiting. Overall, based on the women's responses 58% of pregnancies were categorised as unplanned. Upon analysis, no associations were observed between pregnancy intention and all early child development domains p>0.05. Overall, infants with evidence of early developmental delay that scored below threshold (ASQ-3) were 8% for the gross motor domain, 19% for fine motor, 4% for communication, 15% for problem solving, and 7% for personal social domain. Whilst for the social emotional domain (ASQ: SE-2), two percent of infants scored above threshold and hence, had evidence of early developmental delay. Conclusions: Among women initiating ART during pregnancy, we observed no significant association between pregnancy intention and the early child development of their HEU infants. The findings of this research accentuate the need for targeted strategies towards psychosocial issues, and educational interventions for WLHIV and, for informed fertility decisions. Furthermore, the need for exploration of interventions to encourage infant-parent attachment and interaction for development, as well as the impact of pregnancy intentions on parenting behaviours.
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    Male partner involvement during pregnancy the missing component in PMTCT adherence in Khayelitsha
    (2014) Brittain, Kirsty; Stinson, Kathryn
    Includes abstract. Includes bibliographical references.
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    Maternal participant experience in a South African birth cohort study enrolling healthy pregnant women and their infants
    (BioMed Central, 2016-07-19) Barnett, Whitney; Brittain, Kirsty; Sorsdahl, Katherine; Zar, Heather J; Stein, Dan J
    Background: Critical to conducting high quality research is the ability to attract and retain participants, especially for longitudinal studies. Understanding participant experiences and motivators or barriers to participating in clinical research is crucial. There are limited data on healthy participant experiences in longitudinal research, particularly in low- and middle-income countries. This study aims to investigate quantitatively participant experiences in a South African birth cohort study. Methods: Maternal participant experience was evaluated by a self-administered survey in the Drakenstein Child Health Study, a longitudinal birth cohort study investigating the early life determinants of child health. Pregnant mothers, enrolled during the second trimester, were followed through childbirth and the early childhood years. Satisfaction scores were derived from the participant experience survey and quantitatively analyzed; associations between satisfaction scores and sociodemographic variables were then investigated using a linear regression model. Results: Data were included from 585 pregnant mothers (median age 26.6 years), who had participated in the study for a median time of 16 months. Overall participant satisfaction was high (median score 51/60) and associated with increased attendance of study visits. Reasons for participating were a belief that involvement would improve their health, their child’s health or the health of family and friends. Potential reasons for leaving the study were inconvenience, not receiving clinical or study results, and unexpected changes in study visits or procedures. Variables associated with higher overall satisfaction scores were no prior participation in research, higher socioeconomic status, less intensive follow-up schedules and having experienced stressful life events in the past year. Conclusions: Satisfaction scores were high and associated with increased visit attendance. Participants’ perceived benefits of study participation, most notably the potential for an improvement in the health of their child, were a significant motivator to enroll and remain in the study. The consistent theme of perceived health benefits as a motivator to join and remain in the study raises the question of whether participation in research results in actual improvements in health.
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    Psychosocial predictors of HIV treatment outcomes among young pregnant and postpartum women living with HIV
    (2022) Noholoza, Sandisiwe; Brittain, Kirsty
    Introduction: Young pregnant and postpartum women's suboptimum antiretroviral therapy (ART) adherence and engagement in HIV care remains a global concern despite improvements in prevention of mother-to-child transmission (PMTCT) and general ART services. Various psychosocial risk factors have been individually shown to be associated with HIV infection. However, longitudinal, and quantitative research on the impact of these psychosocial risk factors on HIV treatment outcomes is limited, particularly among young pregnant and postpartum women living with HIV (WLHIV) in low-income countries like South Africa. Furthermore, knowledge on the cumulative impact of these often-co-occurring psychosocial risk factors on HIV treatment outcomes is limited. This analysis examined the prevalence and co-occurrence of four key psychosocial risk factors [unintended pregnancy, depression, hazardous alcohol use and intimate partner violence (IPV)]. Furthermore, the analysis quantitatively examined the cumulative impact (defined as psychosocial burden) of these psychosocial risk factors on HIV treatment outcomes among young pregnant and postpartum WLHIV. Methods: This was a secondary data analysis of a pilot study (“Masibambisane Girls”) that designed and evaluated the role of a peer support intervention to mitigate the negative impact of stigma among young (16 – 24 years old) pregnant and postpartum WLHIV attending antenatal care (ANC) at the Gugulethu midwife obstetric unit (MOU), in Cape Town, South Africa. Participants were followed up to 6 months post enrolment. This analysis includes data collected from 114 of these pregnant (n=55) and postpartum (n=59) women. Psychosocial burden (primary exposure variable) was calculated as a sum score of the four key psychosocial risk factors. Each psychosocial risk factor threshold met scored the participant one point on psychosocial burden such that the minimum score was zero and the maximum was four. The prevalence of each exposure variable was analyzed using descriptive statistics and associations between them and with the outcome variables (engagement in care and HIV viral load <50 copies/mL) were examined using Chi2 tests and Fischer exact tests for sparse data. Poisson regression models were built to examine the association between psychosocial burden and HIV treatment outcomes before and after adjusting for sociodemographic and clinical confounding variables. Results: Overall, data from 114 women who were followed up for 6 months was analyzed (median age: 23 years, median gestation 25 weeks, median days postpartum: 6 days). There was an 88%, 14%, 19% and 32% prevalence of unintended pregnancy, probable depression, hazardous alcohol use and IPV respectively. Furthermore, probable depression and hazardous alcohol use were more prevalent among pregnant versus postpartum women. No statistically significant associations were found among these psychosocial risk factors. However, there was some indication of an association between depression and unintended pregnancy (P=0.095), depression and IPV (p=0.087) and hazardous alcohol use and IPV (p=0.119). The risk factors that most commonly co-occurred were unintended pregnancy and IPV (in 16% of women). Overall, pregnant women had significantly higher psychosocial burden scores than postpartum women. Analysis of HIV treatment outcomes revealed that 60% of women were engaged in care and among the 58 women who had an available viral load result within the window of follow up, 78% were virally suppressed. There was some indication of depression being a potential predictor of engagement in care (p=0.151). However, no statistically significant associations were found between any of the other psychosocial risk factors nor psychosocial burden scores and either HIV treatment outcome, before and after adjusting for potential confounders. Conclusions: This analysis mostly supports the existing body of literature on the prevalence of psychosocial risk factors and HIV treatment outcomes. However, more extensive research is needed to confirm associations among psychosocial risk factors and rigorously assess the cumulative impact of psychosocial risk factors (psychosocial burden) on HIV treatment outcomes.
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    Re-recruiting postpartum women living with HIV into a follow-up study in Cape Town, South Africa
    (2019-07-26) Mogoba, Phepo; Gomba, Yolanda; Brittain, Kirsty; Phillips, Tamsin K; Zerbe, Allison; Myer, Landon; Abrams, Elaine J
    Abstract Objective Recruitment and retention present major challenges to longitudinal research in maternal and child health, yet there are few insights into optimal strategies that can be employed in low-resource settings. Following prior participation in a longitudinal study following women living with HIV through pregnancy and breastfeeding in Cape Town, women were re-contacted at least 18 months after the last study contact and were invited to attend an additional follow-up visit. We describe lessons learnt and offer recommendations for a multiphase recruitment approach. Results Using telephone calls, home visits, clinic tracing and Facebook/WhatsApp messages, we located 387 of the 463 eligible women and successfully enrolled 353 (91% of those contacted). Phone calls were the most successful strategy, yielding 67% of enrolments. Over half of the women had changed their contact information since participation in the previous study. We recommend that researchers collect multiple contact details and use several recruitment strategies in parallel from the start of a study. Participants in longitudinal studies may require frequent contact to update contact information, particularly in settings where mobility is common.
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    Spatial Patterns and Correlates of Lower Respiratory Tract Illnesses in Children from Drakenstein, Western Cape
    (2022) Bhenxa, Namhla; Brittain, Kirsty; Ncayiyana, Jabulani; Zar, Heather J
    Background: Lower respiratory tract infections (LRTIs) in children under 5 years of age are a major public health concern globally with high proportions of cases occurring in low- and middle-income countries. However, little is known about the spatial variation of LRTIs especially in developing countries such as South Africa. This study aimed to explore and map the spatial dependence and clustering of childhood pneumonia and wheeze and to identify factors associated with these diseases in two communities of the Western Cape province in South Africa. Methods: This analysis used case-control data from the Drakenstein Child Health Study. Cases were children who developed pneumonia or wheeze, and controls were incidence density matched on date of birth, age, and enrolment site. Smooth maps were created using Kernel density estimation and cluster analysis was performed using Ripley's K function and Kullddorf spatial scan statistics. Finally, generalized additive models were used to identify socio-demographic factors associated with pneumonia and wheeze. Results: A total of 947 children were included in analysis, with 406 cases of wheeze and 466 cases of pneumonia. Overall, cases and controls had a similar spatial concentration, although there was some variation in the density of wheezing cases in comparison to controls. In particular, there was evidence of a non-random difference in the distribution between cases and controls, and cases of wheeze were significantly more concentrated the TC Newman area than expected. Those who developed pneumonia and wheeze were more likely to be males as compared to females (both p<0.05). There were no statistically significant association between socioeconomic status, ethnicity, education, breastfeeding practices and maternal smoking (all p>0.05). Conclusions: This study revealed a significant clustering of wheeze in TC Newman, which may be attributable to socio-demographic differences between communities, while pneumonia was spatially dispersed across the study areas. These findings suggest that focused public health interventions are needed to reduce the incidence of LRTIs in the area of TC Newman specifically.