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Gannon, Hannah, Chappell, Elizabeth, Ford, Deborah, Gibb, Diana M, Chimwaza, Anesu, Manika, Ngoni, Wedderburn, Catherine J, Nenguke, Zivai Mupambireyi, Cowan, Frances 
ORCID: https://orcid.org/0000-0003-3087-4422, Gibb, Tom, Phillips, Andrew, Mushavi, Angela, Fitzgerald, Felicity, Heys, Michelle, Chimhuya, Simbarashe and Bwakura-Dangarembizi, Mutsa
(2024)
'Effects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience'. BMC Pediatrics, Vol 24, Issue 1, e16.
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12887_2023_Article_4473.pdf - Published Version Available under License Creative Commons Attribution. Download (1MB) | Preview |
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.
| Item Type: | Article |
|---|---|
| Subjects: | WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 506 COVID-19 WS Pediatrics > By Age Groups > WS 420 Newborn infants. Neonatology |
| Faculty: Department: | Clinical Sciences & International Health > International Public Health Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1186/s12887-023-04473-5 |
| SWORD Depositor: | JISC Pubrouter |
| Depositing User: | JISC Pubrouter |
| Date Deposited: | 25 Jan 2024 10:34 |
| Last Modified: | 25 Jan 2024 10:34 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/23794 |
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