Substance Use, Demographic and Socioeconomic Factors Are Independently Associated With Postpartum HIV Care Engagement in the Southern United States, 1999–2016

Abstract

BackgroundRetention in care (RIC) and viral suppression (VS) are associated with reduced HIV transmission and mortality. Studies addressing postpartum engagement in HIV care have been limited by small sample size, short follow-up, and a lack of data from the Southeast United States.MethodsHIV-positive adult women with ≥1 prenatal visit at the Vanderbilt Obstetrics Comprehensive Care Clinic from 1999 to 2015 were included. Poor RIC was defined as not having ≥2 encounters per year, ≥90 days apart; poor VS was a viral load >200 copies/mL. Modified Poisson regression was used to estimate adjusted relative risks (aRRs) of poor postpartum RIC and VS.ResultsAmong 248 women over 2070 person-years of follow-up, 37.6% person-years had poor RIC and 50.4% lacked VS. Prenatal substance use was independently associated with poor RIC (aRR, 1.40; 95% confidence interval [CI], 1.08–1.80) and poor VS (aRR, 1.20; 95% CI, 1.04–1.38), and lack of VS at enrollment was associated with poor RIC (aRR, 1.64; 95% CI, 1.15–2.35) and poor VS (aRR, 1.59; 95% CI, 1.30–1.94). Hispanic women were less likely and women with lower educational attainment were more likely to have poor RIC. Women >30 years of age and married women were less likely to have poor VS.ConclusionsIn this population of women in prenatal care at an HIV primary medical home in Tennessee, women with prenatal substance use and a lack of VS at enrollment into prenatal care were at greater risk of poor RIC and lack of VS postpartum. Interventions aimed at improving postpartum engagement in HIV care among these high-risk groups are needed.

Timing of HIV diagnosis relative to pregnancy and postpartum HIV care continuum outcomes among Latin American women, 2000 to 2017

“…LTFU, which is defined here as 12 months without care before study closure, but elsewhere, has been classified as the first 3-, 6-or 12-month gap in care). [20,35] Other potential barriers to inference include unmeasured confounding, potential selection biases (e.g. if HIV testing and care referral practices differed between women diagnosed during and before pregnancy, or the late presentation and HIV diagnosis of some women delayed ART initiation), and changes in clinical and programme management, such as guidelines for cART use during pregnancy and universal treatment (under WHO guidance from 2015), over an admittedly long study period spanning nearly 20 years.…”

“…Other factors found to be associated with a higher risk of LTFU in prior work are unemployment, lack of basic needs such as electricity in the home [18], substance use, lower educational attainment [20] and social factors that include fear of disclosure, lack of social support and negative experiences with providers [21]. It has also been shown that this population remains vulnerable to suboptimal health outcomes and lack of clinical care due to increased responsibilities, emotional stress and stigma related to HIV disclosure during pregnancy [21].…”

Low-Burden Universal Substance Use Screening in a Primary Care Clinic to Lower Implementation Barriers

“…Substance use is a risk factor for multiple negative health outcomes, including transmission of STDs and HIV. [1][2][3][4][5] A unique aspect of primary care is the understanding of the complex interplay between physical and behavioral health. Substance use and overuse are important components of behavioral health that can have a powerful impact on physical health.…”