Background: Many women living with HIV (WLWH) experience poor postpartum retention in HIV care. There are limited evidence-based interventions in the United States aimed at increasing retention of WLWH postpartum; however, evidence from low-resource settings suggest that women who receive peer mentoring experience higher retention and viral suppression postpartum. Methods: We conducted 15 semistructured interviews with pregnant or postpartum women from an urban U.S. clinic to assess factors influencing maternal adherence to antiretroviral therapy (ART) and retention in HIV care. We then assessed the acceptability of a peer intervention in mitigating barriers to sustain adherence and retention in care postpartum. Interviews were audio taped, transcribed, and analyzed. Codes were developed and applied to all transcripts, and matrices were used to facilitate comparisons across different types of participants. Results: Participants included low-income black and Hispanic women with a mean age of 31 years (range 22–42). Social support and concern for infants' well-being were strong facilitators for engaging in care. Psychosocial challenges, such as stigma and isolation, fear of disclosure, and depression, negatively influenced adherence to ART and engagement in care. Regardless of their level of adherence to ART, women felt that peer mentoring would be an acceptable intervention to reinforce skill-related ART adherence and sustain engagement in care after delivery. Conclusion: A peer mentor mother program is a promising intervention that can improve the care continuum of pregnant and postpartum women in the United States. Messaging that maximizes maternal support and women's motivation to keep their infant healthy may leverage retention in care postpartum.

BackgroundMany women living with HIV (WLWH) fall out of the care continuum after delivery. Existing evidence-based interventions are aimed at increasing retention of WLWH outside the perinatal period but none, in the US, focus on improving retention postpartum. mothers2mothers (m2m) is a peer mentor mother program developed in South Africa and successfully implemented in six African countries, with evidence of increased self-efficacy and retention in HIV care postpartum. Here, we assess the acceptability of an adapted version of m2m in the US.MethodsIn depth interviews were conducted with five pregnant and four postpartum WLWH receiving prenatal and HIV care in a Philadelphia clinic, to assess barriers and facilitators to retention in HIV care during pregnancy and postpartum. We also assessed participants’ acceptability of m2m with the goal to adapt the program to meet their needs. All interviews were audio-taped, transcribed and analyzed. Codes were developed and applied to all transcripts and matrices were used to facilitate comparisons across different types of participants.ResultsParticipants included low-income Black and Hispanic women with a mean age was 35 (range 23–42). Regardless of their stage in the care continuum, women found m2m to be an acceptable intervention to help sustain engagement in care after delivery and discussed ways to tailor the program to fit their needs. Participants reported experiencing trauma related to interpersonal violence and conflicts, stigma from HIV or HIV disclosure, and struggles with substance use. Many experienced depression or had a history of suicidal ideation or attempt. An overarching finding was that women’s strongest motivator for staying in care was to protect the health and well-being of their baby. In addition, the majority of women found that family support, especially from their mothers, enhanced their coping skills, and in turn, facilitated their retention in care.Conclusionm2m is a promising intervention with the potential to improve the care continuum of WLWH who are pregnant or postpartum. The program will need to be adapted using a trauma informed approach to meet the needs of WLWH. Messaging will need to maximize on maternal support and women’s motivation to keep their infant healthy to leverage retention in care postpartum.Disclosures All authors: No reported disclosures.