Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

Abstract

Introduction: Young pregnant and postpartum women living with HIV (WLHIV) are at high risk of poor outcomes in prevention of mother-to-child transmission services. The aim of this systematic review was to collate evidence on strategies to improve retention in antenatal and/or postpartum care in this population. We also conducted a secondary review of strategies to increase attendance at antenatal care (ANC) and/or facility delivery among pregnant adolescents, regardless of HIV status, to identify approaches that could be adapted for adolescents and young WLHIV. Methods: Selected databases were searched on 1 December 2020, for studies published between January 2006 and November 2020, with screening and data abstraction by two independent reviewers. We identified papers that reported agedisaggregated results for adolescents and young WLHIV aged <25 years at the full-text review stage. For the secondary search, we included studies among female adolescents aged 10 to 19 years. Results and discussion: Of 37 papers examining approaches to increase retention among pregnant and postpartum WLHIV, only two reported age-disaggregated results: one showed that integrated care during the postpartum period increased retention in HIV care among women aged 18 to 24 years; and another showed that a lay counsellor-led combination intervention did not reduce attrition among women aged 16 to 24 years; one further study noted that age did not modify the effectiveness of a combination intervention. Mobile health technologies, enhanced support, active follow-up and tracing and integrated services were commonly examined as standalone interventions or as part of combination approaches, with mixed evidence for each strategy. Of 10 papers identified in the secondary search, adolescent-focused services and continuity of care with the same provider appeared to be effective in improving attendance at ANC and/or facility delivery, while home visits and group ANC had mixed results. Conclusions: This review highlights the lack of evidence regarding effective strategies to improve retention in antenatal and/ or postpartum care among adolescents and young WLHIV specifically, as well as a distinct lack of age-disaggregated results in studies examining retention interventions for pregnant WLHIV of all ages. Identifying and prioritizing approaches to improve retention of adolescents and young WLHIV are critical for improving maternal and child health.

HIV retesting for pregnant and breastfeeding women across maternal child health services in Nampula, Mozambique

“…It is possible that some adolescents at these facilities who tested HIV-positive at delivery and in the postnatal period had previously tested HIV-positive and subsequently dropped out of care. These findings underscore the importance of offering repeat testing for adolescent pregnant and postnatal women across the MCH cascade and the need to offer services targeted to their specific psychosocial needs to improve retention in this vulnerable group [26,27].…”

Strategies to improve antiretroviral therapy (ART) initiation and early engagement among men insub‐SaharanAfrica: A scoping review of interventions in the era of universal treatment

“…The lack of interventions specifically tailored to men may be a concern because men have unique needs that require specific responses [22,58]. A plethora of interventions specifically target women [24,59] because they also have unique needs-men are no different. Most interventions did not have a comparison group and had inconsistent outcome measures.…”

Factors that influence the uptake of postnatal care among adolescent girls: a qualitative evidence synthesis

“…The importance of addressing this gap is also noted in reviews of quantitative evidence focused on adolescent girls, where the positive impact of adolescent-focused services and continuity of care is noted to improve retention in maternal health services including ANC, delivery and PNC. 48 …”

“…These point to a gap in adolescent-sensitive maternal healthcare as part of high-quality integrated PNC, as well as ANC and preconception care. The importance of addressing this gap is also noted in reviews of quantitative evidence focused on adolescent girls, where the positive impact of adolescent-focused services and continuity of care is noted to improve retention in maternal health services including ANC, delivery and PNC 48…”