Optimal retention in HIV care postpartum is necessary to benefit the health and wellbeing of mothers and their infants. However, postpartum retention in HIV care among low-income women is suboptimal, particularly in the Southern United States. A mixed-methods study was conducted to identify factors associated with postpartum retention in care among HIV-infected women. Participants (n = 35) were recruited during pregnancy at two county clinics and completed self-report demographic and psychosocial surveys. Twenty-two women who returned for a postpartum appointment completed a semi-structured interview about lifestyle factors and retention in care. Of the participants enrolled at baseline, 71.4% completed a follow-up with an obstetrician (OB), while 57.1% completed a follow-up with a primary care physician (PCP). High CD4 count at delivery, low viral load at baseline, low levels of depression, high interpersonal social support, and fewer other children were significantly associated with completion of postpartum follow-up. Barriers and facilitators to retention identified during qualitative interviews included competing responsibilities for time, lack of social support outside of immediate family members, limited transportation access, experiences of institutionalized stigma, knowledge about the benefits of adherence, and strong relationships with healthcare providers. OB and PCP follow-up postpartum was suboptimal in this sample. Findings underscore the importance of addressing depressive symptoms, social support, viral suppression, competing responsibilities for time, institutionalized stigma, and transportation issues in order to reduce the barriers that inhibit women from seeking postpartum HIV care.

Guidelines for HIV primary care include visits every 3 months (up to 6 months in those with stable HIV). During pregnancy, women with HIV commonly attend once weekly to once monthly visits; however, after delivery, many are lost to follow-up. Our goal was to assess the frequency of loss to primary care follow-up postpartum and to identify predictors of loss to care. A retrospective chart review of HIV-infected women in a Houston prenatal program was done. Optimal care was defined as one visit to HIV primary care providers (PCPs) every 6 months within the first year after delivery, and loss to follow-up as no visits within the first postpartum year. Multivariate logistic regression analysis was used to identify factors associated with loss to follow-up. Charts (n=213) were analyzed for follow-up with PCPs. The loss to follow-up rate was 39% in the first postpartum year. Associated factors were younger age, black race, late entry to prenatal care, and no plans for contraception. Predictors of loss to primary care after pregnancy can be used to identify specific subpopulations of pregnant women at highest risk for falling out of care.

In adults with HIV with or at increased risk for ASCVD, participants treated with LDMTX had more safety events than with placebo but the pre-specified non-inferiority margin of 15% was not exceeded. LDMTX had no significant effect on endothelial function or inflammatory biomarkers but was associated with a significant decrease in CD8+ T-cells. The balance of risks and potential benefits of LDMTX in this population will require additional investigation.

Supplemental digital content is available in the text