Abstract

Recent evidence demonstrated improved birth outcomes among HIV-uninfected pregnant women protected by indoor residual spraying of insecticide (IRS). Evidence regarding its impact on HIV-infected pregnant women is lacking.Data were pooled from two studies conducted before-and-after an IRS campaign in Tororo, Uganda among HIV-infected pregnant women who received bednets, daily trimethoprim-sulfamethoxazole (TMP-SMX), and combination antiretroviral therapy (c-ART) at enrollment. Exposure was the proportion of pregnancy protected by IRS. Adverse birth outcomes included preterm birth, low birthweight, and fetal/neonatal death. Multivariate Poisson regression with robust standard errors was used to estimate risk ratios (RR).Of 565 women in our analysis, 380 (67%), 88 (16%), and 97 (17%) women were protected by IRS for 0%, >0-90%, and >90% of their pregnancy, respectively. Any IRS protection significantly reduced malaria incidence during pregnancy and placental malaria risk. Compared to no IRS protection, >90% IRS protection reduced preterm birth risk (RR=0.35; 95% CI: 0.15-0.84), with non-significant decreases in the risk of low birthweight (RR=0.68; 95% CI: 0.29-1.57) and fetal/neonatal death (RR=0.24; 95% CI: 0.04-1.52).Our exploratory analyses support the hypothesis that IRS may significantly reduce malaria and preterm birth risk among pregnant women with HIV receiving bednets, daily TMP-SMX, and c-ART.

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