Follow-Up Care Among HIV-Infected Pregnant Women in Mississippi

Abstract

Background: Data from the Centers for Disease Control and Prevention (CDC) indicate that reproductive-age black women in the Southeast are disproportionately affected by the HIV epidemic. There are few data describing HIV infection, pregnancies, and follow-up care in this population. Methods: A retrospective chart review was performed at the Perinatal HIV Service at the University of Mississippi Medical Center in Jackson, Mississippi, to identify HIV-infected women 18 years of age with deliveries from 1999 to 2006. Optimal follow-up was defined as at least two follow-up visits with an HIV provider within 1 year of delivery. Univariate and multivariate logistic regression analyses were used to identify factors associated with optimal adherence. Results: We identified 274 women with 297 total deliveries. Median age was 25, and 89% were black. Only 37% of women had two or more visits with an HIV provider in the postpartum year. On univariate analysis, presentation before the third trimester was associated with optimal follow-up ( p ¼ 0.04). On multivariate analyses, presentation before the third trimester was the only variable associated with optimal follow-up (odds ratio [OR] 2.1, p ¼ 0.02). Conclusions: The poor follow-up rates in this growing population highlight the critical need for research and development of targeted interventions to improve rates of retention in care, particularly in women with late trimester presentation.

Postpartum Human Immunodeficiency Virus Care Among Women Diagnosed During Pregnancy

“…4 Diagnosis later in pregnancy was associated with a higher likelihood of loss to follow-up, a finding consistent with previous studies. 7,8 In addition to aggressive follow-up of women diagnosed later in pregnancy, there is precedent for antepartum interventions, administered as an adjunct to standard prenatal care, that promote behavior change. For example, a study of screening for diabetes mellitus among women with gestational diabetes reported a significant increase in testing in the 6 months after delivery among women who received an educational intervention.…”

“…Our assessment of HIV care outcomes therefore captured encounters with medical care providers even if these encounters occurred at multiple facilities, a limitation of previous clinic-based studies. 7,8 The use of CD4 count and viral load laboratory tests as proxy measures for HIV medical care may limit our ability to evaluate postpartum retention in care and HIV viral suppression because we did not capture medical visits unless a test was ordered. Alternatively, CD4 and viral load tests may overestimate care if they are conducted in the absence of a medical visit.…”

Combination Antiretroviral Treatment for Women Previously Treated Only in Pregnancy

“…Even outside the research environment, many women find it difficult to attend doctor visits in the post partum period. Rana et al found that only 37% of women are able to keep two or more visits with their HIV provider during the post partum year (25). In contrast, the women in A5227 were generally presenting for re-treatment well after the first post-partum year.…”

A Mixed-Methods Approach to Understanding Barriers to Postpartum Retention in Care Among Low-Income, HIV-Infected Women

“…15 Non-adherence to HIV care postpartum, specifically not attending regular physician appointments, has previously been associated with younger age, initiation of care in the third trimester, more health-related symptoms, discontinuation of ART postpartum psychiatric co-morbidities, and African-American race. 1,3 Postpartum, HIV-infected women are instructed to schedule follow-up visits at 6 weeks following a vaginal delivery and at both 2 and 6 weeks following a Cesareansection. Subsequently, women are asked to resume seeing their primary care provider (PCP) if they are on stable therapy, every 3-6 months.…”