Submission ID 130392
| Issue/Objective | Despite widespread use of antiretroviral therapy (ART) to prevent mother-to-child HIV transmission, adverse birth outcomes, low birth weight (LBW), preterm delivery (PTD), and stillbirth remain common in resource-limited settings. In Ghana, delayed HIV diagnosis and late ART initiation reduce treatment exposure during pregnancy. ART exposure duration is a modifiable factor with potential to improve outcomes, yet it is not routinely used in program monitoring. This study assesses the association between ART exposure duration and adverse birth outcomes and identifies actionable risk factors to inform implementation and accountability in maternal HIV care. |
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| Methodology/Approach | A facility-based retrospective analytical cross-sectional study was conducted among 340 HIV-positive women who delivered in four health facilities in the Volta Region of Ghana between 2013 and 2018. Data were extracted from antenatal and delivery records. Adverse outcomes included LBW (<2500 g), PTD (<37 weeks), and stillbirth. ART exposure duration was calculated as gestational age at delivery minus gestational age at ART initiation. Multivariable logistic regression models identified independent predictors. |
| Results | The prevalence of LBW, PTD, and stillbirth was 16.5%, 20.6%, and 3.5%, respectively. Each additional week of ART exposure reduced the odds of LBW by 7% (aOR=0.93, 95% CI: 0.88-0.98) and PTD by 9.6% (aOR=0.90, 95% CI: 0.86-0.95). Women with adverse outcomes had shorter ART exposure durations. Primigravidity (aOR=6.67, 95% CI: 2.11-12.42) and maternal anaemia (aOR=3.67, 95% CI: 1.02-12.94) increased the risk of LBW, while hypertension at delivery (aOR=2.65, 95% CI: 1.28-5.49) increased PTD risk. Despite 66.8% initiating ART in the second trimester, women had a mean ART exposure of 21.0 weeks, which was strongly associated with reduced adverse outcomes. |
| Discussion/Conclusion | ART exposure duration is a critical, actionable determinant of birth outcomes. Integrating ART exposure tracking into antenatal care systems provides a practical tool for translating evidence into action. Strengthening early HIV testing, rapid ART initiation, and routine monitoring can enhance accountability and improve maternal and neonatal outcomes. These findings support scalable, equity-focused interventions aligned with global efforts to reclaim progress in maternal and child health. |
| Presenters and Affiliations | Wisdom Kudzo Axame University of Health and Allied Sciences Margaret Kweku University of Health and Allied Sciences Fred Newton Bibka University of Health and Allied Science |
