HIV Care Continuum among Postpartum Women Living with HIV in Atlanta

Abstract

Introduction. While increased healthcare engagement and antiretroviral therapy (ART) adherence occurs during pregnancy, women living with HIV (WLWH) are often lost to follow-up after delivery. We sought to evaluate postpartum retention in care and viral suppression and to identify associated factors among WLWH in a large public hospital in Atlanta, Georgia. Methods. Data from the time of entry into prenatal care until 24 months postpartum were collected by chart review from WLWH who delivered with ≥20 weeks gestational age from 2011 to 2016. Primary outcomes were retention in HIV care (two HIV care visits or viral load measurements >90 days apart) and viral suppression (<200 copies/mL) at 12 and 24 months postpartum. Obstetric and contraception data were also collected. Results. Among 207 women, 80% attended an HIV primary care visit in a mean 124 days after delivery. At 12 and 24 months, respectively, 47% and 34% of women were retained in care and 41% and 30% of women were virally suppressed. Attending an HIV care visit within 90 days postpartum was associated with retention in care at 12 months (aOR 3.66, 95%CI 1.72-7.77) and 24 months (aOR 4.71, 95%CI 2.00-11.10) postpartum. Receiving ART at pregnancy diagnosis (aOR 2.29, 95%CI 1.11-4.74), viral suppression at delivery (aOR 3.44, 95%CI 1.39-8.50), and attending an HIV care visit within 90 days postpartum (aOR 2.40, 95%CI 1.12-5.16) were associated with 12-month viral suppression, and older age (aOR 1.09, 95% CI 1.01-1.18) was associated with 24-month viral suppression. Conclusions. Long-term retention in HIV care and viral suppression are low in this population of postpartum WLWH. Prompt transition to HIV care in the postpartum period was the strongest predictor of optimal HIV outcomes. Efforts supporting women during the postpartum transition from obstetric to HIV primary care may improve long-term HIV outcomes in women.

Predictors and social determinants ofHIVtreatment engagement among post‐partum Black women living withHIVin southeastern United States

“…Many studies focused on US sample of post-partum women have recorded similar results (Adhikari et al, 2019;Meade et al, 2018Meade et al, , 2019. Our finding further contributes to evidence that the 3 months post-partum mark is a critical time point in which a significant number of WLWH are likely to disengage from treatment (Buchberg et al, 2015;Meade et al, 2018Meade et al, , 2019. Engagement at this critical point has been related…”

“…Also, for the PCE final model, we included PPE as an independent variable to examine for any relationship between engagement at 3 months and at 12 months. This decision was supported by literature findings that have noted such associations (Adhikari et al, 2019;Meade et al, 2018Meade et al, , 2019. The final model for PCE (Table 7) was significant at p < .001.…”

“…to longer term treatment engagement and viral suppression for postpartum WLWH (Adhikari et al, 2019;Meade et al, 2019). Therefore, immediate post-partum healthcare providers may proactively act to identify women likely to be lost at 3 months and intervene accordingly to retain them in care for longer periods.…”

Patterns of cesarean birth among women living with HIV in Ontario: A cross‐sectional, population‐level study

“…In order to support further development of maternity care guidelines for WLWH, our future studies will aim to better describe severe maternal morbidity and postpartum maternal health outcomes among WLWH. Furthermore, recent studies from the United States have highlighted a concerning gap in postpartum retention to HIV care, which has never been well characterized among WLWH living in Canada 38,39 . Our future studies will aim to provide a comprehensive view of the factors associated with adverse maternal health outcomes, and postpartum care retention.…”

Development of a predictive model for retention in HIV care using natural language processing of clinical notes

“…Because pregnant patients often have more frequent medical visits and receive more resources, patients experiencing pregnancy may be more likely to be retained in care than those who are not. 24,25 The phrase "congenital HIV" was also associated with retention in care. While others have found that patients with perinatally acquired HIV have had poor retention in care, these studies were predominantly performed among adolescents and often around the transition from pediatric to adult HIV care.…”