AEGiS-13IAC: Randomized trial of STD control for maternal-infant health

AEGiS-13IAC: Randomized trial of STD control for maternal-infant health - Rakai, Uganda.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Randomized trial of STD control for maternal-infant health - Rakai, Uganda.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrC242)

Wabwire-Mangen F, Gray RH, Wawer M, Kigozi G, Sewankambo MK, Serwadda D, Lutalo T, Meehan M, Chuanjun L
F. Wabwire-Mangen, PO Box 7072, Kampala, Uganda, Tel.: +256 41 532 207, Fax: +256 41 531 807, E-mail: fwabwire@imul.com

BACKGROUND: A randomized trial of STD control for HIV prevention, was designed to assess the effects of STD control during pregnancy on maternal-infant STDs, MTCT, maternal HIV acquisition and birth outcomes.

METHODS: Ten community clusters were randomized, 5 to an STD intervention (STD mass treatment), and 5 to a control regimen (iron/folate supplements). Women were enrolled and treated at varying durations of pregnancy and followed postpartum. Data on maternal behaviors, pregnancy and STDs/HIV were obtained, and infant anthropometry, gestational age, ocular gonorrhea/chlamydia were determined. Infant HIV infection was determined by HIV RT-PCR. Analysis used multivariate cluster-adjusted rate ratios (RR) and 95% CI.

RESULTS: The trial enrolled 2,070 pregnant women in the intervention arm and 1,963 in the control, with a 94.6% and a 92.7% follow up rate in intervention and control arms respectively. There were no significant differences between arms in rates of spontaneous abortion, stillbirth or maternal deaths. However, early neonatal deaths were lower in the intervention than control arm (RR = 0.80, 95%CI 0.69-0.94). Maternal STDs were significantly reduced in the intervention arm: T vaginalis RR = 0.28 (95%CI 0.17-0.46), Bacterial vaginosis RR = 0.74 (95%CI 0.66-0.84), N. gonorrhoeae/C. trachomatis RR = 0.42 (95%CI 0.25-0.70), and infant gonorrhea/chlamydia ophthalmia RR = 0.38 (0.21-0.68). There was no reduction in maternal HIV acquisition during pregnancy or post delivery (RR = 1.41, 95%CI 0.65-3.07), or in MTCT (RR = 1.08, 95%CI 0.51-2.31). The prevalence of chest circumference > 30.0 centimeters (a proxy for low birth weight) was significantly reduced (RR = 0.70, 955CI 0.51-0.96) as was preterm delivery (RR = 0.73, 95%CI 0.54-0.99).

CONCLUSIONS: Mass treatment of maternal STDs during pregnancy reduces the rates of maternal and infant STDs, but does not decrease maternal HIV acquisition or MTCT. Mass STD treatment reduces the frequency of low birth weight, preterm delivery and early neonatal death.

Keywords: AEGIS, Infant Welfare, Maternal Welfare, Prevalence, HIV Infections, Mothers, Acquired Immunodeficiency Syndrome, Pregnancy Complications, Infectious, Labor, Premature, Fetal Death, Pregnancy Outcome, Infant Mortality, Gestational Age, Uganda, Abortion, Spontaneous, Infant, Pregnancy, Human, Female, prevention & control
000709
MoOrC242