Elizabeth Topper, PhD

STAR: The Study of Treatment and Reproductive Outcomes among Women of Childbearing Age Living with and Without HIV in the Southern U.S.

Elizabeth F. Topper, Danielle Johnson, Seble Kassaye, Deborah L. Jones, Aadia Rana, Adaora Adimora, Daniel Westreich, Maria L. Alcaide, Anandi N. Sheth

Johns Hopkins University, Baltimore, MD (Topper and Johnson)
Georgetown University, Washington, DC (Kassaye)
University of Miami, Miami, FL (Jones and Alcaide)
University of Alabama, Birmingham, AL (Rana)
University of North Carolina, Chapel Hill, NC (Adimora and Westreich)
Emory University, Atlanta, GA (Sheth)

In the US, approximately 1.2 million people are currently living with HIV (LWH). About 19% of incident diagnoses are among women, particularly women of color, and incidence is highest in the South. The Study of Treatment and Reproductive outcomes (STAR) was designed to recruit and retain a cohort of 2,000 women of reproductive age (ages 18-45), to investigate reproductive, mental, and oral health in the context of HIV.

Enrollment began in March 2021 in Washington DC, Chapel Hill NC, Miami FL, Atlanta GA, Birmingham AL, and Jackson MS, and is ongoing. Participants are seen semiannually, in person for 1.5 years and via phone thereafter. Women pregnant or post-partum at their phone check-in have additional in-person visits. Herein we describe the baseline cohort.

As of August 31, 2023, we enrolled 750 women. At enrollment, 475 (63%) women were LWH, and 76 (10%) were pregnant. Of the pregnant women, 58 (76%) were LWH. A significantly higher proportion of women LWH were pregnant at baseline, compared to women without HIV (12% vs 7%, p=0.0132). Twenty-one percent (N=161) were age<30. Median (IQR) age was 37 (31-42) and was significantly lower among pregnant women (32 vs 38, p<0.001) and those without HIV (32 vs 39, p<0.001). There were 605 (81%) Black/African American and 78 (10%) Latina women. Women without HIV (14% vs 8%, p=0.058) were more likely to be Latina. Women enrolled during pregnancy were more likely to be: LWH (76% vs 62%, p=0.013), Latina (17% vs 10%, p=0.048), and have had sex with a man LWH (past 5 years, 32% vs 20%, p=0.005). Pregnant women were significantly less likely than non-pregnant women to have used illicit drugs in the past 5 years (11% vs 14%, p=0.008). No differences were found by race, income, education, or number of sex partners (p>0.05).

In this cohort of predominantly Black young women, we found a high proportion of HIV infection among young pregnant women, and a significantly higher proportion of pregnancy among Latina women. This cohort of young minority women serves as a platform for research on reproductive health and HIV.