Postpartum HIV care continuum outcomes in the southeastern USA

Chen, Jane S.; Pence, Brian W.; Rahangdale, Lisa; Patterson, Kristine B.; Farel, Claire E; Durr, Amy L.; Antono, Amanda C; Zakharova, Oksana; Eron, Joseph J.; Napravnik, Sonia

doi:10.1097/qad.0000000000002094

Cited by 13 publications

(7 citation statements)

References 41 publications

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“…Our study, conducted in recent years in a large-volume center in the Southern US, demonstrates that postpartum WLWH still have remarkably low 12 and 24 month retention (47% and 34%) and viral suppression (41% and 30%). 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].…”

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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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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“…53 A recent study in the United States examined retention in HIV care postpartum and found that receiving less than 12 weeks of antenatal ART was negatively associated with HIV care retention at 24 months postpartum, underscoring the importance of efforts to maximize engagement in care throughout the peripartum period. 54 Maintaining adherence to ART is important for all women, but of particular concern in this scenario are women who may experience repeat pregnancies during this time period.…”

Section: Engagement In Care and The Fourth Trimestermentioning

confidence: 99%

Why Everyone (Almost) with HIV Needs to Be on Treatment

Farel

Dennis

2019

Infectious Disease Clinics of North America

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The introduction of potent combination antiretroviral therapy (ART) in the mid-1990s changed the landscape of human immunodeficiency virus (HIV), bringing marked improvements in morbidity and mortality. 1,2 The designation of these regimens as highly active antiretroviral therapy [HAART], represented a shift in how these medications were perceived. ART had evolved from pills that may slow the devastating progress of HIV to regimens that could more reliably and sustainably suppress viral replication and restore a person to health. The development of plasma HIV viral load assays allowed clinicians and people with HIV (PWH) to monitor this progress. In the present day, more than 20 years after the introduction of effective ART, the term ART is routinely used and reflects the current state of the science: all ART is highly active, potent, durable, and generally well tolerated (Fig. 1A).

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“…In order to support further development of maternity care guidelines for WLWH, our future studies will aim to better describe severe maternal morbidity and postpartum maternal health outcomes among WLWH. Furthermore, recent studies from the United States have highlighted a concerning gap in postpartum retention to HIV care, which has never been well characterized among WLWH living in Canada 38,39 . Our future studies will aim to provide a comprehensive view of the factors associated with adverse maternal health outcomes, and postpartum care retention.…”

Section: Discussionmentioning

confidence: 99%

Patterns of cesarean birth among women living with HIV in Ontario: A cross‐sectional, population‐level study

Shoemaker

Saiyin

Smith

et al. 2021

Birth

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Background In Canada, as is found globally, women of reproductive age are a growing demographic of persons living with HIV. Combination antiretroviral therapy (cART) treatment enables women living with HIV (WLWH) to become pregnant without perinatal transmission, and they are increasingly planning to become pregnant. Since 2014, Canadian guidelines no longer recommend routine elective cesarean birth (CB) for women who are virally suppressed and receiving cART. It is unknown whether their obstetric care has changed since this update. Our objective was to describe trends in cesarean births among WLWH in Ontario, Canada, over a 12‐year period. Methods Our research is co‐led and codesigned with WLWH. We conducted a retrospective population‐level cohort study using linked health administrative databases at ICES (formally, the Institute for Clinical and Evaluative Sciences). Participants were all women who gave birth in Ontario, between 2006/07 and 2017/18. We assessed their intrapartum characteristics and used multivariable regression to determine an association between HIV status and CB, controlling for sociodemographic and clinical variables. Results Since 2014, the overall proportion of CB among WLWH remained stable and was higher than among women without HIV (39.9% vs 29.0%, P < 0.001). In addition, the proportion of primary CB decreased between 2006 and 2010 and between 2014 and 2018 (28.5%‐19.3%), whereas the proportion of repeat CB increased (13.1%‐20.5%, P = 0.013). Conclusions Because of decreasing HIV‐related indications for CB, more practitioners may be following the guidelines for first‐time mothers. Currently, no guidelines exist for care of WLWH with a previous CB, and opportunities for vaginal birth may be missed in this population.

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Postpartum HIV care continuum outcomes in the southeastern USA

Abstract: Objective: Evaluate postpartum HIV care outcomes.

Cited by 13 publications

References 41 publications

HIV Care Continuum among Postpartum Women Living with HIV in Atlanta

HIV Care Continuum among Postpartum Women Living with HIV in Atlanta

Why Everyone (Almost) with HIV Needs to Be on Treatment

Patterns of cesarean birth among women living with HIV in Ontario: A cross‐sectional, population‐level study

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