Cooperative Agreement NU2GGH002359

HOSPITAL BASED BIRTH DEFECTS SURVEILLANCE IN KAMPALA - COMPREHENSIVE RELIABLE DATA ON THE BASELINE PREVALENCE AND RISK OF BIRTH DEFECTS IN RESOURCE-LIMITED COUNTRIES IS RARE OR NON-EXISTENT. CONCERNS HAVE BEEN RAISED ABOUT THE POSSIBILITY OF HIV ANTIRETROVIRAL THERAPY (ART) AT CONCEPTION OR EARLY PREGNANCY HAVING AN INCREASED RISK OF ADVERSE BIRTH OUTCOMES, INCLUDING BIRTH DEFECTS. HOWEVER, INTRODUCTION OF NEW DRUGS TO MANAGE HIV AND OTHER DISEASES DURING PREGNANCY CONTINUES. WITHOUT A SURVEILLANCE SYSTEM, IT IS DIFFICULT TO HAVE AN EFFECTIVE MEANS TO EVALUATE THE ASSOCIATION OF THESE NEW MEDICATIONS AND ADVERSE BIRTH OUTCOMES. THE PURPOSE OF THIS BIRTH DEFECT SURVEILLANCE SYSTEM IS TO CONTINUE TO PROVIDE BACKGROUND PREVALENCE RATES OF MAJOR EXTERNAL BIRTH DEFECT AND PROVIDE A MECHANISM TO DETERMINE IF THE MATERNAL USE OF DOLUTEGRAVIR, COTRIMOXAZOLE, AND OTHER MEDICATIONS IN EARLY PREGNANCY ARE ASSOCIATED WITH A HIGHER RISK OF BIRTH DEFECTS IN NEWBORNS AND OTHER ADVERSE PREGNANCY OUTCOMES; ESPECIALLY AS THEY TRANSITION TO DOLUTEGRAVIR AS THE PREFERRED ART REGIMEN INCREASES, TO PREVENT MOTHER TO CHILD TRANSMISSION OF HIV. THIS SURVEILLANCE PROJECT ALSO PROVIDES A UNIQUE OPPORTUNITY TO IMPROVE THE SURVIVAL OF NEWBORNS WITH BIRTH DEFECTS THROUGH STRENGTHENING REFERRAL LINKAGES AND MAKING PARTNERSHIPS WITH HEALTH FACILITIES/ORGANIZATIONS THAT PROVIDE CARE AND SUPPORT FOR AFFECTED CHILDREN AND THEIR FAMILIES. OVER THE FIVE-YEAR PERIOD OF THIS PROJECT, THE SURVEILLANCE TEAM WILL WORK IN COLLABORATION WITH UGANDA MINISTRY OF HEALTH (MOH) AND KEY STAKEHOLDERS TO EXPAND THE SURVEILLANCE TO OTHER REGIONS IN THE COUNTRY AND INCORPORATE BIRTH DEFECT SURVEILLANCE INTO THE NATIONAL SYSTEM TO ENSURE SUSTAINABILITY AFTER THE END OF THE PROJECT. THE LONG-TERM OUTCOMES OF THIS PROJECT INCLUDE A SUSTAINABLE BIRTH DEFECT SURVEILLANCE SYSTEM INTEGRATED WITHIN UGANDA?S PUBLIC HEALTH SYSTEM; EVIDENCE OF CURRENT BIRTH DEFECT PREVALENCE AND COMMON RISK FACTORS, WHICH WILL GUIDE POLICY ON BIRTH DEFECT PREVENTION AND IMPROVE CARE FOR NEWBORNS WITH BIRTH DEFECTS. FURTHERMORE, FINDINGS FROM THIS PROJECT WILL INFORM MOH, WHO, AND PEPFAR ON USE OF SPECIFIC HIV, TB, AND OTHER MEDICATIONS DURING PREGNANCY.