Re-engagement in HIV care among mothers living with HIV in South Africa over 36 months post-birth

Mj, Rotheram-Borus; Tomlinson, Mark; Scheffler, Aaron; Im, Le Roux

doi:10.1097/qad.0000000000000837

Cited by 16 publications

(13 citation statements)

References 8 publications

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“…Perhaps, due to their HIV, MLH are more engaged with the health care system and take children to the hospital with less severe symptoms. However, in a related publication (49), we have shown that MLH only slowly reengage in HIV care following childbirth. By three years post-birth, only 62% of MLH have reengaged in health care.…”

Section: Discussionmentioning

confidence: 82%

Adjustment of a Population of South African Children of Mothers Living With/and Without HIV Through Three Years Post-Birth

et al. 2016

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Background Mothers Living with HIV (MLH) and their children are typically studied to ensure that perinatal HIV transmission is blocked. Yet, HIV impacts MLH and their children lifelong. We examine child outcomes from pregnancy to three years post-birth among a peri-urban population of pregnant MLH and Mothers without HIV (MWOH). Methods Almost all pregnant women in 12 neighborhoods (98%; N=584) in Cape Town, South Africa were recruited and repeatedly assessed within two weeks of birth (92%), at 6 months (88%), 18 months (84%), and three years post-birth (86%). There were 186 MLH and 398 MWOH. Controlling for neighborhood and repeated measures, child and maternal outcomes were contrasted over time using longitudinal random effects regression analyses. For measures collected only at three years, outcomes were analyzed using multiple regressions. Results Compared to MWOH, MLH had less income, more informal housing and food insecurity, used alcohol more often during pregnancy, and were more depressed during pregnancy and over time. Only 4.8% of MLH's children were seropositive; seropositive children were excluded from additional analyses. Children of MLH tended to have significantly lower weights (p<.10) over time (i.e., lower weight-for-age Z-scores) and were also hospitalized significantly more often than children of MWOH (p<.01). Children of MLH and MWOH died at similar rates (8.5%) and were similar in social and behavioral adjustment, vocabulary, and executive functioning at three years post-birth. Conclusions Despite living in households with fewer resources and having more depressed mothers, only the physical health of children of MLH is compromised, compared to children of MWOH. In township neighborhoods with extreme poverty, social, behavioral, language, and cognitive functioning appear similar over the first three years of life between children of MLH and MWOH.

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Section: Discussionmentioning

confidence: 82%

Adjustment of a Population of South African Children of Mothers Living With/and Without HIV Through Three Years Post-Birth

et al. 2016

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“…However, most of this attrition occurred by six months of age. Similarly, there is evidence that the immediate postpartum period is also a time of increased risk for attrition among HIV‐positive mothers . This suggests that the first six months of postpartum follow‐up might represent an especially vulnerable period, and that interventions to mitigate attrition or promote retention of mother‐infant pairs might have a greater impact if focused on and implemented early in the EID cascade.…”

Section: Discussionmentioning

confidence: 99%

Attrition of HIV‐exposed infants from early infant diagnosis services in low‐ and middle‐income countries: a systematic review and meta‐analysis

et al. 2018

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IntroductionIdentification and retention of HIV‐exposed infants in early infant diagnosis (EID) services helps to ensure optimal health outcomes. This systematic review and meta‐analysis examines the magnitude of attrition from EID services in low‐ and middle‐income countries (LMICs).MethodsWe performed a comprehensive database search through April 2016. We included original studies reporting retention/attrition data for HIV‐exposed infants in LMICs. Outcomes included loss to follow‐up (LTFU), death and overall attrition (LTFU + death) at time points along the continuum of EID services. At least two authors determined study eligibility, performed data extraction and made quality assessments. We used random‐effects meta‐analytic methods to aggregate effect sizes and perform meta‐regression analyses. This study adhered to PRISMA reporting guidelines.ResultsWe identified 3040 unique studies, of which 92 met eligibility criteria and were included in the quantitative synthesis. The included studies represent data from 110,805 HIV‐exposed infants, the majority of whom were from Africa (77%). LTFU definitions varied widely, and there was significant variability in outcomes across studies. The bulk of attrition occurred in the first six months of follow‐up, with additional losses over time. Overall, 39% of HIV‐exposed infants were no longer in care at 18 months. When restricted to non‐intervention studies, 43% were not retained at 18 months.ConclusionsThese findings underscore the high attrition of HIV‐exposed infants from EID services in LMICs and the urgent need for implementation research and resources to improve retention among this vulnerable population.

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“…14 Despite this astounding achievement, there is mounting evidence that women who initiate ART during pregnancy may be at very high risk of LTFU, 15–18 with re-engagement in routine HIV care after delivery a particular concern. 19,20 Suggested reasons for this high LTFU include a lack of perception of need for treatment, 16,21 increased financial burden, 16,22 and stigma. 23–26 In our recent work, we have observed that HIV-positive women reported difficulty in providing a “valid reason” to be seen at a clinic after giving birth; while pregnant, clinic attendance is accepted, but after delivery, clinic attendance and medication adherence are viewed with societal and familial suspicion.…”

Section: Introductionmentioning

confidence: 99%

Mobility and Clinic Switching Among Postpartum Women Considered Lost to HIV Care in South Africa

Clouse

Vermund

Maskew

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

105

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Objective Retention in HIV care, particularly among postpartum women, is a challenge to national antiretroviral therapy (ART) programs. Retention estimates may be underestimated due to unreported transfers. We explored mobility and clinic switching among patients considered lost to follow-up (LTFU). Design Observational cohort study. Methods Of 788 women initiating ART during pregnancy at six public clinics in Johannesburg, South Africa, 300 (38.1%) were LTFU (no visit ≥3 months). We manually searched for these women in the South African National Health Laboratory Services database to assess continuity of HIV care. We used geographic information systems tools to map mobility to new facilities. Results Over one–third (37.6%) of women showed evidence of continued HIV care after LTFU. Of these, 67.0% continued care in the same province as the origin clinic. Compared to those who traveled outside of the province for care, these same-province “clinic shoppers” stayed out-of-care longer [median 373 days (IQR: 175–790) vs. 175.5 days (IQR: 74–371)] and had a lower CD4+ cell count upon re-entry [median 327 cells/µL (IQR: 196–576) vs. 493 cells/µL (IQR: 213–557). When considering all women with additional evidence of care as engaged in care, cohort LTFU dropped from 38.1% to 25.0%. Conclusions We found evidence of continued care after LTFU and identified local and national clinic mobility among postpartum women. Laboratory records do not show all clinic visits and manual matching may have been under- or overestimated. A national health database linked to a unique identifier is necessary to improve reporting and patient care among highly mobile populations.

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Re-engagement in HIV care among mothers living with HIV in South Africa over 36 months post-birth

Cited by 16 publications

References 8 publications

Adjustment of a Population of South African Children of Mothers Living With/and Without HIV Through Three Years Post-Birth

Adjustment of a Population of South African Children of Mothers Living With/and Without HIV Through Three Years Post-Birth

Attrition of HIV‐exposed infants from early infant diagnosis services in low‐ and middle‐income countries: a systematic review and meta‐analysis

Mobility and Clinic Switching Among Postpartum Women Considered Lost to HIV Care in South Africa

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