A comparative analysis of the medicine use and exposures in infants who are HIV exposed uninfected and HIV unexposed uninfected in the first year in Cape Town, South Africa
| dc.contributor.advisor | Mehta, Ushma | |
| dc.contributor.advisor | Honwana, Frissiano | |
| dc.contributor.advisor | Nyemba, Dorothy | |
| dc.contributor.author | Mlunga, Hilkka | |
| dc.date.accessioned | 2025-09-12T09:14:25Z | |
| dc.date.available | 2025-09-12T09:14:25Z | |
| dc.date.issued | 2025 | |
| dc.date.updated | 2025-09-12T08:07:59Z | |
| dc.description.abstract | Background: Despite several studies investigating medicine exposures in infants, the administration and monitoring of medications in infants who are HIV-exposed uninfected (HEU), a growing population, remains poorly studied. This study aimed to describe and compare medication consumption patterns, including immunization coverage, between infants who are HEU and HIV-unexposed uninfected (HUU) during their first year of life. Methods: This was a secondary analysis of a birth cohort study of pregnant women living with and without HIV and their infants between 2017 and 2019 in Cape Town, South Africa. Interviewer- administered questionnaires captured sociodemographic factors, self-reported medication use, infant feeding practices, and vaccine use over four postnatal visits (<7 days, 10 weeks, 6 and 12 months). Data was manually classified and coded by a clinical pharmacist and student. Logistic regression models were employed to compare patterns of use among infants who are HEU and HUU, as well as identify other maternal and infant factors associated with medication use and vaccine coverage. Findings: A total of 772 mother-infant pairs were analyzed. Compared to infants who are HUU, HEU infants were preterm (64/393 vs. 39/379; p = 0.02), less often breastfed (314/393 vs. 322/379; p <0.001), and weighed less (median, 3288g vs. 3405 g; p = 0.03). HEU infants were found to take at least one medication at a significantly higher rate 388/393 (98.7%) vs 345/379 (91.0%) than infants who are HUU (p <0.001). HEU infants reported lower use of over-the-counter (OTC) medicine (69.2% vs. 80.2%; p <0.01) and traditional, complementary, and alternative medicine (TCAM) (16.8% vs. 26.1%; p <0.001) compared to HUU infants. Mothers of HEU infants were less likely to forget a medicine's name (29.3% vs. 36.9%, p<0.001) than HUU mothers. Prescription medicine use, excluding antiretroviral (ARV) prophylaxis medicines routinely administered to infants who are HEU at birth, was significantly higher among infants who are HEU compared to HUU (65.4%. vs. 23.0%; p <0.01). Vaccine coverage showed no significant difference between infants who are HEU and HUU but steadily declined over the year (95.0% coverage with birth immunizations, vs 70.0% at 9 months) across the entire cohort. Only 293 infants (38.0%) had complete immunization coverage at 1 year. In the adjusted models, being a HEU infant was a protective factor against self-medication. (aOR 0.45; 95% CI 0.31 –0.65; p <0.001). Conversely, being breastfed (aOR 2.46; 95% CI 1.56 –3.83; p <0.001) was a significant risk factor for self-medication infants. Prescription medicine use (excluding ARV prophylaxis medicines) was significantly associated with increased maternal age (aOR 1.06; 95% CI 1.03 – 1.08; p <0.001) and infants who are HEU (aOR 6.52; 95% CI 4.66 – 9.21; p <0.001). No significant associations were found between maternal and infant characteristics and full vaccine coverage. Interpretation: The study revealed that infants who are HEU were more exposed to prescribed medicine (excluding ARV prophylaxis medicines) compared to their HUU counterparts, however, mothers of HUU infants, generally reported higher usage of both TCAM and OTC compared to HEU infants. The study also revealed drops in vaccine coverage rates among infants over the first year of life, indicating a gap in protection against vaccine-preventable diseases. Further research is needed to study medication patterns in different settings. Medication literacy efforts need to be prioritized in pregnant women and mothers of newborns to support rational and safe medicine (including vaccine) usage and subsequently improve the health outcomes for all infants, irrespective of HIV status. | |
| dc.identifier.apacitation | Mlunga, H. (2025). <i>A comparative analysis of the medicine use and exposures in infants who are HIV exposed uninfected and HIV unexposed uninfected in the first year in Cape Town, South Africa</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/41790 | en_ZA |
| dc.identifier.chicagocitation | Mlunga, Hilkka. <i>"A comparative analysis of the medicine use and exposures in infants who are HIV exposed uninfected and HIV unexposed uninfected in the first year in Cape Town, South Africa."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2025. http://hdl.handle.net/11427/41790 | en_ZA |
| dc.identifier.citation | Mlunga, H. 2025. A comparative analysis of the medicine use and exposures in infants who are HIV exposed uninfected and HIV unexposed uninfected in the first year in Cape Town, South Africa. . University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. http://hdl.handle.net/11427/41790 | en_ZA |
| dc.identifier.ris | TY - Thesis / Dissertation AU - Mlunga, Hilkka AB - Background: Despite several studies investigating medicine exposures in infants, the administration and monitoring of medications in infants who are HIV-exposed uninfected (HEU), a growing population, remains poorly studied. This study aimed to describe and compare medication consumption patterns, including immunization coverage, between infants who are HEU and HIV-unexposed uninfected (HUU) during their first year of life. Methods: This was a secondary analysis of a birth cohort study of pregnant women living with and without HIV and their infants between 2017 and 2019 in Cape Town, South Africa. Interviewer- administered questionnaires captured sociodemographic factors, self-reported medication use, infant feeding practices, and vaccine use over four postnatal visits (<7 days, 10 weeks, 6 and 12 months). Data was manually classified and coded by a clinical pharmacist and student. Logistic regression models were employed to compare patterns of use among infants who are HEU and HUU, as well as identify other maternal and infant factors associated with medication use and vaccine coverage. Findings: A total of 772 mother-infant pairs were analyzed. Compared to infants who are HUU, HEU infants were preterm (64/393 vs. 39/379; p = 0.02), less often breastfed (314/393 vs. 322/379; p <0.001), and weighed less (median, 3288g vs. 3405 g; p = 0.03). HEU infants were found to take at least one medication at a significantly higher rate 388/393 (98.7%) vs 345/379 (91.0%) than infants who are HUU (p <0.001). HEU infants reported lower use of over-the-counter (OTC) medicine (69.2% vs. 80.2%; p <0.01) and traditional, complementary, and alternative medicine (TCAM) (16.8% vs. 26.1%; p <0.001) compared to HUU infants. Mothers of HEU infants were less likely to forget a medicine's name (29.3% vs. 36.9%, p<0.001) than HUU mothers. Prescription medicine use, excluding antiretroviral (ARV) prophylaxis medicines routinely administered to infants who are HEU at birth, was significantly higher among infants who are HEU compared to HUU (65.4%. vs. 23.0%; p <0.01). Vaccine coverage showed no significant difference between infants who are HEU and HUU but steadily declined over the year (95.0% coverage with birth immunizations, vs 70.0% at 9 months) across the entire cohort. Only 293 infants (38.0%) had complete immunization coverage at 1 year. In the adjusted models, being a HEU infant was a protective factor against self-medication. (aOR 0.45; 95% CI 0.31 –0.65; p <0.001). Conversely, being breastfed (aOR 2.46; 95% CI 1.56 –3.83; p <0.001) was a significant risk factor for self-medication infants. Prescription medicine use (excluding ARV prophylaxis medicines) was significantly associated with increased maternal age (aOR 1.06; 95% CI 1.03 – 1.08; p <0.001) and infants who are HEU (aOR 6.52; 95% CI 4.66 – 9.21; p <0.001). No significant associations were found between maternal and infant characteristics and full vaccine coverage. Interpretation: The study revealed that infants who are HEU were more exposed to prescribed medicine (excluding ARV prophylaxis medicines) compared to their HUU counterparts, however, mothers of HUU infants, generally reported higher usage of both TCAM and OTC compared to HEU infants. The study also revealed drops in vaccine coverage rates among infants over the first year of life, indicating a gap in protection against vaccine-preventable diseases. Further research is needed to study medication patterns in different settings. Medication literacy efforts need to be prioritized in pregnant women and mothers of newborns to support rational and safe medicine (including vaccine) usage and subsequently improve the health outcomes for all infants, irrespective of HIV status. DA - 2025 DB - OpenUCT DP - University of Cape Town KW - HIV KW - Exposed Uninfected KW - Infant KW - Medicine pattern or exposure KW - Vaccine coverage KW - South Africa LK - https://open.uct.ac.za PB - University of Cape Town PY - 2025 T1 - A comparative analysis of the medicine use and exposures in infants who are HIV exposed uninfected and HIV unexposed uninfected in the first year in Cape Town, South Africa TI - A comparative analysis of the medicine use and exposures in infants who are HIV exposed uninfected and HIV unexposed uninfected in the first year in Cape Town, South Africa UR - http://hdl.handle.net/11427/41790 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/41790 | |
| dc.identifier.vancouvercitation | Mlunga H. A comparative analysis of the medicine use and exposures in infants who are HIV exposed uninfected and HIV unexposed uninfected in the first year in Cape Town, South Africa. []. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/41790 | en_ZA |
| dc.language.iso | en | |
| dc.language.rfc3066 | eng | |
| dc.publisher.department | Department of Public Health and Family Medicine | |
| dc.publisher.faculty | Faculty of Health Sciences | |
| dc.publisher.institution | University of Cape Town | |
| dc.subject | HIV | |
| dc.subject | Exposed Uninfected | |
| dc.subject | Infant | |
| dc.subject | Medicine pattern or exposure | |
| dc.subject | Vaccine coverage | |
| dc.subject | South Africa | |
| dc.title | A comparative analysis of the medicine use and exposures in infants who are HIV exposed uninfected and HIV unexposed uninfected in the first year in Cape Town, South Africa | |
| dc.type | Thesis / Dissertation | |
| dc.type.qualificationlevel | Masters | |
| dc.type.qualificationlevel | MPH |