Retention in Care of HIV-Positive Postpartum Females in Kumasi, Ghana

Reece, Rebecca; Norman, Betty; Kwara, Awewura; Flanigan, Timothy P.; Rana, Aadia

doi:10.1177/2325957415603507

Cited by 13 publications

(13 citation statements)

References 20 publications

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“…The proportion of women (67.4%) who remained in the PMTCT programme at 6 weeks postpartum is mostly consistent with a study in Ghana (66%) 32 and Rwanda (68.4%) 33 but slightly higher in (73.8%) KwaZulu Natal, a province in South Africa, 34 and the Democratic Republic of Congo (76.4%). 35 This rate may, however, be moderately high because of the short postpartum time; 6 weeks, under review as other studies have reported a decline in the proportion of women who remain in care at 6, 12 and 36 months postpartum.…”

Section: Discussionsupporting

confidence: 87%

Staying, leaving and returning: Trends of prevention of mother-to-child transmission retention among newly diagnosed HIV-positive pregnant and postpartum women

Abraham

Clow

2021

Int J STD AIDS

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Uptake of services and retention throughout the Prevention of Mother-to-Child Transmission continuum are necessary to achieve the goal of reducing Mother-to-Child Transmission of Human Immunodeficiency Virus (HIV). Adopting a retrospective cohort design, we tracked the uptake of services in a district hospital in Ghana from antenatal booking through to six weeks postnatal when early infant diagnosis was conducted. Of the 1252 pregnant women booked antenatally, 94.1% ( n = 1178) received pre-test counselling, 96.3% (1134) opted for HIV testing and 3.8% ( n = 43) women tested positive for HIV throughout the continuum. The retention rate at six weeks postpartum was 67.4%. Missed opportunities occurred throughout the programme and the highest disengagement, 58.9% (23/39) occurred antenatally. Instances of re-engagement were also recorded. Establishing measures to promote retention throughout the programme is critical to ensuring HIV-infected mothers maintain their health and their exposed newborns are HIV-free. This phase of the study provided a comprehensive view of retention in the absence of any baseline.

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Section: Discussionsupporting

confidence: 87%

Staying, leaving and returning: Trends of prevention of mother-to-child transmission retention among newly diagnosed HIV-positive pregnant and postpartum women

Abraham

Clow

2021

Int J STD AIDS

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“…Notably, the suboptimal retention and viral suppression rates observed in our study were similar to those seen in postpartum women from other US populations studied before 2012, including in Philadelphia, PA [10], Jackson, MS [27], Houston, TX [17], and Chapel Hill, NC [13]. International studies report similar challenges in South Africa [28], Ghana [29], and Uganda [30] for example, with some successful interventions reported in the literature [31–33]. Further, despite high levels of healthcare engagement during pregnancy, with an average number of prenatal care visits consistent with guidelines [34], retention and viral suppression among postpartum women in our study were even lower than those previously observed among men and women initiating HIV care in the same healthcare system, where 81% and 54% of patients were retained, and 63% and 44% were virally suppressed at 12 and 24 months, respectively.…”

Section: Discussionsupporting

confidence: 81%

HIV Care Continuum among Postpartum Women Living with HIV in Atlanta

Meade

Badell

Hackett

et al. 2019

Infectious Diseases in Obstetrics and Gynecology

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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.

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“…Low retention in HIV care in the postpartum period has been shown across multiple studies in and outside of sub-Saharan Africa, with more than one in five recent mothers living with HIV not remaining in care six months after giving birth (1)(2)(3)(4)(5)(6). A systematic review also found that postpartum women living with HIV have lower ART adherence rates (57%) than pregnant women (75%) (7).…”

Section: Introductionmentioning

confidence: 98%

Low Birthweight, Retention in HIV Care, and Adherence to ART Among Postpartum Women Living with HIV in Ghana

et al. 2018

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Care for low birthweight (LBW) infants can contribute to psychological difficulties and stigma among mothers living with HIV, creating challenges for antiretroviral therapy (ART) adherence and retention in HIV care. We explored how caring for LBW infants affects maternal ART adherence and retention in care. We conducted 30 in-depth interviews with postpartum women living with HIV in Accra, Ghana: 15 with LBW infants and 15 with normal birthweight (NBW) infants. Compared to mothers with NBW infants, mothers with LBW infants described how caring for their newborns led to increased caregiver burden, prolonged hospital stays, and stigma-contributing to incomplete ART adherence and missed clinical appointments. For a few women, care for LBW infants created opportunities for re-engagement in HIV care and motivation to adhere to ART. Results suggest women living with HIV and LBW babies in Ghana face increased challenges that impact their adherence to care and ART.

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Retention in Care of HIV-Positive Postpartum Females in Kumasi, Ghana

Cited by 13 publications

References 20 publications

Staying, leaving and returning: Trends of prevention of mother-to-child transmission retention among newly diagnosed HIV-positive pregnant and postpartum women

Staying, leaving and returning: Trends of prevention of mother-to-child transmission retention among newly diagnosed HIV-positive pregnant and postpartum women

HIV Care Continuum among Postpartum Women Living with HIV in Atlanta

Low Birthweight, Retention in HIV Care, and Adherence to ART Among Postpartum Women Living with HIV in Ghana

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