PMID- 38183019 OWN - NLM STAT- MEDLINE DCOM- 20240108 LR - 20240210 IS - 1471-2431 (Electronic) IS - 1471-2431 (Linking) VI - 24 IP - 1 DP - 2024 Jan 5 TI - Effects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience. PG - 16 LID - 10.1186/s12887-023-04473-5 [doi] LID - 16 AB - 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. CI - (c) 2023. The Author(s). FAU - Gannon, Hannah AU - Gannon H AD - UCL Great Ormond Street Institute of Child Health, University College London, London, UK. h.gannon@ucl.ac.uk. FAU - Chappell, Elizabeth AU - Chappell E AD - MRC Clinical Trials Unit at UCL, London, UK. FAU - Ford, Deborah AU - Ford D AD - MRC Clinical Trials Unit at UCL, London, UK. FAU - Gibb, Diana M AU - Gibb DM AD - MRC Clinical Trials Unit at UCL, London, UK. FAU - Chimwaza, Anesu AU - Chimwaza A AD - Ministry of Health and Child Care, Harare, Zimbabwe. FAU - Manika, Ngoni AU - Manika N AD - Ministry of Health and Child Care, Harare, Zimbabwe. FAU - Wedderburn, Catherine J AU - Wedderburn CJ AD - MRC Clinical Trials Unit at UCL, London, UK. AD - Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa. FAU - Nenguke, Zivai Mupambireyi AU - Nenguke ZM AD - Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe. FAU - Cowan, Frances M AU - Cowan FM AD - Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe. AD - Liverpool School of Tropical Medicine, Liverpool, UK. FAU - Gibb, Tom AU - Gibb T AD - Picturing Health, London, UK. FAU - Phillips, Andrew AU - Phillips A AD - Institute for Global Health, UCL, London, UK. FAU - Mushavi, Angela AU - Mushavi A AD - Ministry of Health and Child Care, Harare, Zimbabwe. FAU - Fitzgerald, Felicity AU - Fitzgerald F AD - Department of Infectious Disease, Imperial College London, London, UK. FAU - Heys, Michelle AU - Heys M AD - UCL Great Ormond Street Institute of Child Health, University College London, London, UK. FAU - Chimhuya, Simbarashe AU - Chimhuya S AD - Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe. FAU - Bwakura-Dangarembizi, Mutsa AU - Bwakura-Dangarembizi M AD - Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe. LA - eng GR - WT_/Wellcome Trust/United Kingdom GR - 215742/Z/19/Z: PI: Heys/WT_/Wellcome Trust/United Kingdom GR - MC_UU_00004/03/MRC_/Medical Research Council/United Kingdom GR - MR/V029126/1/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20240105 PL - England TA - BMC Pediatr JT - BMC pediatrics JID - 100967804 SB - IM MH - Child MH - Infant, Newborn MH - Pregnancy MH - Humans MH - Female MH - *COVID-19/epidemiology MH - Tertiary Care Centers MH - Infectious Disease Transmission, Vertical/prevention & control MH - Pandemics MH - Zimbabwe/epidemiology MH - *HIV Infections/drug therapy/epidemiology PMC - PMC10768266 OTO - NOTNLM OT - COVID-19 OT - HIV OT - Maternal health OT - Neonates OT - Vertical transmission COIS- The authors declare no competing interests. EDAT- 2024/01/06 10:42 MHDA- 2024/01/08 06:41 PMCR- 2024/01/05 CRDT- 2024/01/05 23:44 PHST- 2023/03/08 00:00 [received] PHST- 2023/12/07 00:00 [accepted] PHST- 2024/01/08 06:41 [medline] PHST- 2024/01/06 10:42 [pubmed] PHST- 2024/01/05 23:44 [entrez] PHST- 2024/01/05 00:00 [pmc-release] AID - 10.1186/s12887-023-04473-5 [pii] AID - 4473 [pii] AID - 10.1186/s12887-023-04473-5 [doi] PST - epublish SO - BMC Pediatr. 2024 Jan 5;24(1):16. doi: 10.1186/s12887-023-04473-5.