Contribution of syphilis to adverse pregnancy outcomes in people living with and without HIV in south Brazil: 2008-2018.

BACKGROUND: Syphilis co-infection among pregnant people living with HIV (PLH) may worsen pregnancy outcomes. We evaluated the impact of syphilis co-infection on pregnancies in south Brazil. METHODS: Data was extracted from hospital records between 1/1/2008 -12/31/2018. Preterm birth (PTB), low birth weight (LBW < 2500 g), and a composite adverse infant outcome [AIO: HIV vertical transmission, loss to follow-up before HIV diagnosis (LTFU), stillbirth, congenital syphilis] were evaluated among pregnancies without HIV and syphilis (PWOH+S), PLH mono-infection, syphilis mono-infection (PLS), and PLH with syphilis (PLH + S). RESULTS: Among 48,685 deliveries where patients were tested for HIV and syphilis, 1,353 (2.8%) occurred in PLH; of these, 181 (13.4%) were HIV/syphilis co-infected (PLH + S). Among PLH, 2.4% of infants acquired HIV and 13.1% were LTFU. Among all PLS, 70.5% of infants acquired congenital syphilis. Across the cohort, 1.2% stillbirths/neonatal deaths occurred. 37.0% of PLH + S did not initiate ART versus 15.4% of PLH mono-infection (p < 0.001). 37.6% of PLH + S had VDRL titers > 1:16 compared to 21.7% of PLS only (p < 0.001). Among PLH, syphilis co-infection and unknown/high VDRL titers ( > 1:16) increased AIO risk more (aRR:3.96, 95%CI:3.33-4.70) compared to low VDRL titers ( < 1:8) (aRR:3.51, 95%CI:2.90-4.25). Unsuppressed viremia ( > 50 copies/mL) was associated with risk of PTB (aRR:1.43, 95%CI:1.07-1.92) and AIO (aRR:1.38, 95%CI:1.11-1.70) but not LBW. Lack of prenatal care was significant in predicting PTB and LBW in all PLH and PLS mono-infection. CONCLUSION: Syphilis co-infection worsens adverse infant outcomes in all women and compounds negative effects of HIV infection during pregnancy. Effective syphilis treatment and HIV VL suppression are paramount for optimal obstetric care.

Tailored medication adherence incentives for high-risk children with asthma: a pilot study.

Objective: While reminder-based electronic monitoring systems have shown promise in enhancing inhaled corticosteroid (ICS) adherence in select populations, more engaging strategies may be needed in families of children with high-risk asthma. This study assesses the acceptability and feasibility of gain-framed ICS adherence incentives in families of urban, minority children with frequent asthma hospitalization.Methods: We enrolled children aged 5-11 years with multiple yearly asthma hospitalizations in a 2-month, mixed methods, ICS adherence incentive pilot study. All participants received inhaler sensors and a smartphone app to track ICS use. During month 1, families received daily adherence reminders and weekly feedback, and children earned up to $1/day for complete adherence. No reminders, feedback, or incentives were provided in month 2. We assessed feasibility and acceptability using caregiver surveys and semi-structured interviews and ICS adherence using electronic monitoring data.Results: Of the 29 families approached, 20 enrolled (69%). Participants were primarily Black (95%), publicly insured (75%), and averaged 2.9 asthma hospitalizations in the prior year. Fifteen of the 16 caregivers (94%) surveyed at month 2 liked the idea of receiving adherence incentives. Mean adherence was significantly higher in month 1 compared with month 2 (80% vs. 33%, mean difference = 47%; 95% CI [33, 61], p < 0.001). Caregivers reported that their competing priorities often limited adherence, while incentives helped motivate child adherence.Conclusions: ICS adherence incentives were acceptable and feasible in a high-risk cohort of children with asthma. Future studies should assess the efficacy of adherence incentives in enhancing ICS adherence in high-risk children.