Mother–child separation among women living with HIV and their children in the first four years postpartum in South Africa

Abstract

Objectives Mother–child pairs may separate during early life, yet the health impacts thereof are unclear. We explored the patterns and impact of separation among women living with HIV (WLHIV) and their children in South Africa. Methods WLHIV who had initiated antiretroviral therapy (ART) during pregnancy received HIV viral load (VL) testing and completed a timeline questionnaire of mother–child separation since delivery at 3–5 years post‐partum. Health care usage was abstracted from routine medical records. We examined associations between separation and (a) maternal health outcomes (engagement in HIV care and HIV viral suppression, [VS]) and (b) child health outcomes (post‐breastfeeding HIV testing and immunisation completion), using logistic regression. Results Of 346 mother–child pairs (median maternal age at antenatal ART initiation, 28 years), 24% were ever separated (median time to first separation 20 months, interquartile range [IQR] 9, 31). Most separated children were living with their grandmothers (65/83, 78%). Mothers who ever separated were younger, and more likely to be employed, and to reside in informal housing than those who never separated. Any separation reduced the odds of VS ≤ 50 copies/mL at four years post‐partum (odds ratio 0.57; 95% CI 0.34–0.93); associations were similar for VL ≤ 1000 copies/mL and maternal engagement in care. No association was found between separation and child confirmatory HIV testing or immunisation completion. Conclusions In this setting, mother–child separation is common in the first four years of life and appears associated with suboptimal maternal outcomes. Further research is required to understand the drivers and implications of mother–child separation.

Mobility during the post-partum period and viraemia in women living with HIV in South Africa

“… 28 Separation of mother and child has also previously been shown to be associated with an increased risk of viraemia in post-partum women on ART. 29 One explanation for this finding is that women are motivated to take their treatment to stay healthy while with their children, but this motivation may decrease when separated. Our results suggest that travel may also play a role in the increased risk of viraemia in women separated from their children.…”