Effects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience

dc.contributor.authorGannon, Hannah
dc.contributor.authorChappell, Elizabeth
dc.contributor.authorFord, Deborah
dc.contributor.authorGibb, Diana M.
dc.contributor.authorChimwaza, Anesu
dc.contributor.authorManika, Ngoni
dc.contributor.authorWedderburn, Catherine J.
dc.contributor.authorNenguke, Zivai M.
dc.contributor.authorCowan, Frances M.
dc.contributor.authorGibb, Tom
dc.contributor.authorPhillips, Andrew
dc.contributor.authorMushavi, Angela
dc.contributor.authorFitzgerald, Felicity
dc.contributor.authorHeys, Michelle
dc.contributor.authorChimhuya, Simbarashe
dc.contributor.authorBwakura-Dangarembizi, Mutsa
dc.date.accessioned2024-01-09T12:55:34Z
dc.date.available2024-01-09T12:55:34Z
dc.date.issued2024-01-05
dc.date.updated2024-01-07T04:12:53Z
dc.description.abstractAbstract Introduction The COVID-19 pandemic has globally impacted health service access, delivery and resources. There are limited data regarding the impact on the prevention of mother to child transmission (PMTCT) service delivery in low-resource settings. Neotree ( www.neotree.org ) combines data collection, clinical decision support and education to improve care for neonates. Here we evaluate impacts of COVID-19 on care for HIV-exposed neonates. Methods Data on HIV-exposed neonates admitted to the neonatal unit (NNU) at Sally Mugabe Central Hospital, Zimbabwe, between 01/06/2019 and 31/12/2021 were analysed, with pandemic start defined as 21/03/2020 and periods of industrial action (doctors (September 2019-January 2020) and nurses (June 2020-September 2020)) included, resulting in modelling during six time periods: pre-doctors’ strike (baseline); doctors’ strike; post-doctors’ strike and pre-COVID; COVID and pre-nurses’ strike; nurses’ strike; post nurses’ strike. Interrupted time series models were used to explore changes in indicators over time. Results Of 8,333 neonates admitted to the NNU, 904 (11%) were HIV-exposed. Mothers of 706/765 (92%) HIV-exposed neonates reported receipt of antiretroviral therapy (ART) during pregnancy. Compared to the baseline period when average admissions were 78 per week (95% confidence interval (CI) 70–87), significantly fewer neonates were admitted during all subsequent periods until after the nurses’ strike, with the lowest average number during the nurses’ strike (28, 95% CI 23–34, p < 0.001). Across all time periods excluding the nurses strike, average mortality was 20% (95% CI 18–21), but rose to 34% (95% CI 25, 46) during the nurses’ strike. There was no evidence for heterogeneity (p > 0.22) in numbers of admissions or mortality by HIV exposure status. Fewer HIV-exposed neonates received a PCR test during the pandemic (23%) compared to the pre-pandemic periods (40%) (RR 0.59, 95% CI 0.41–0.84, p < 0.001). The proportion of HIV-exposed neonates who received antiretroviral prophylaxis during admission was high throughout, averaging between 84% and 95% in each time-period. Conclusion While antiretroviral prophylaxis for HIV-exposed neonates remained high throughout, concerning data on low admissions and increased mortality, similar in HIV-exposed and unexposed neonates, and reduced HIV testing, suggest some aspects of care may have been compromised due to indirect effects of the pandemic.
dc.identifier.apacitationGannon, H., Chappell, E., Ford, D., Gibb, Diana M., Chimwaza, A., Manika, N., ... Bwakura-Dangarembizi, M. (2024). Effects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience. http://hdl.handle.net/11427/39125en_ZA
dc.identifier.chicagocitationGannon, Hannah, Elizabeth Chappell, Deborah Ford, Diana M. Gibb, Anesu Chimwaza, Ngoni Manika, Catherine J. Wedderburn, et al "Effects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience." (2024) http://hdl.handle.net/11427/39125en_ZA
dc.identifier.citationBMC Pediatrics. 2024 Jan 05;24(1):16
dc.identifier.ris TY - Journal Article AU - Gannon, Hannah AU - Chappell, Elizabeth AU - Ford, Deborah AU - Gibb, Diana M. AU - Chimwaza, Anesu AU - Manika, Ngoni AU - Wedderburn, Catherine J. AU - Nenguke, Zivai M. AU - Cowan, Frances M. AU - Gibb, Tom AU - Phillips, Andrew AU - Mushavi, Angela AU - Fitzgerald, Felicity AU - Heys, Michelle AU - Chimhuya, Simbarashe AU - Bwakura-Dangarembizi, Mutsa AB - Abstract Introduction The COVID-19 pandemic has globally impacted health service access, delivery and resources. There are limited data regarding the impact on the prevention of mother to child transmission (PMTCT) service delivery in low-resource settings. Neotree ( www.neotree.org ) combines data collection, clinical decision support and education to improve care for neonates. Here we evaluate impacts of COVID-19 on care for HIV-exposed neonates. Methods Data on HIV-exposed neonates admitted to the neonatal unit (NNU) at Sally Mugabe Central Hospital, Zimbabwe, between 01/06/2019 and 31/12/2021 were analysed, with pandemic start defined as 21/03/2020 and periods of industrial action (doctors (September 2019-January 2020) and nurses (June 2020-September 2020)) included, resulting in modelling during six time periods: pre-doctors’ strike (baseline); doctors’ strike; post-doctors’ strike and pre-COVID; COVID and pre-nurses’ strike; nurses’ strike; post nurses’ strike. Interrupted time series models were used to explore changes in indicators over time. Results Of 8,333 neonates admitted to the NNU, 904 (11%) were HIV-exposed. Mothers of 706/765 (92%) HIV-exposed neonates reported receipt of antiretroviral therapy (ART) during pregnancy. Compared to the baseline period when average admissions were 78 per week (95% confidence interval (CI) 70–87), significantly fewer neonates were admitted during all subsequent periods until after the nurses’ strike, with the lowest average number during the nurses’ strike (28, 95% CI 23–34, p < 0.001). Across all time periods excluding the nurses strike, average mortality was 20% (95% CI 18–21), but rose to 34% (95% CI 25, 46) during the nurses’ strike. There was no evidence for heterogeneity (p > 0.22) in numbers of admissions or mortality by HIV exposure status. Fewer HIV-exposed neonates received a PCR test during the pandemic (23%) compared to the pre-pandemic periods (40%) (RR 0.59, 95% CI 0.41–0.84, p < 0.001). The proportion of HIV-exposed neonates who received antiretroviral prophylaxis during admission was high throughout, averaging between 84% and 95% in each time-period. Conclusion While antiretroviral prophylaxis for HIV-exposed neonates remained high throughout, concerning data on low admissions and increased mortality, similar in HIV-exposed and unexposed neonates, and reduced HIV testing, suggest some aspects of care may have been compromised due to indirect effects of the pandemic. DA - 2024-01-05 DB - OpenUCT DP - University of Cape Town KW - COVID-19 KW - HIV KW - Neonates KW - Maternal health KW - Vertical transmission LK - https://open.uct.ac.za PY - 2024 T1 - Effects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience TI - Effects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience UR - http://hdl.handle.net/11427/39125 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12887-023-04473-5
dc.identifier.urihttp://hdl.handle.net/11427/39125
dc.identifier.vancouvercitationGannon H, Chappell E, Ford D, Gibb Diana M, Chimwaza A, Manika N, et al. Effects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience. 2024; http://hdl.handle.net/11427/39125.en_ZA
dc.language.rfc3066en
dc.publisherBioMed Central
dc.publisher.departmentPaediatrics and Child Health
dc.publisher.facultyHealth Sciences
dc.rights.holderThe Author(s)
dc.rights.licensehttp://creativecommons.org/licenses/by/4.0/
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceBio Med Central Pediatrics
dc.source.pagination9
dc.source.urihttps://bmcpediatr.biomedcentral.com/
dc.subjectCOVID-19
dc.subjectHIV
dc.subjectNeonates
dc.subjectMaternal health
dc.subjectVertical transmission
dc.titleEffects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience
dc.typeJournal Article
publicationissue.issueNumber16
publicationvolume.volumeNumber24
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