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Clin Infect Dis. 2015 Dec 15;61(12):1880-7. doi: 10.1093/cid/civ678. Epub 2015 Aug 11.

Postpartum Engagement in HIV Care: An Important Predictor of Long-term Retention in Care and Viral Suppression.

Author information

1
AIDS Activities Coordinating Office, Philadelphia Department of Public Health.
2
AIDS Activities Coordinating Office, Philadelphia Department of Public Health Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania.
3
Department of Epidemiology, Drexel University School of Public Health.
4
Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania.
5
Division of Infectious Diseases and HIV Medicine, Drexel University School of Medicine, Philadelphia, Pennsylvania.

Abstract

BACKGROUND:

Human immunodeficiency virus (HIV)-infected women are at risk of virologic failure postpartum. We evaluated factors influencing retention in care and viral suppression in postpartum HIV-infected women.

METHODS:

We conducted a retrospective cohort analysis (2005-2011) of 695 deliveries involving 561 HIV-infected women in Philadelphia. Multivariable logistic regression evaluated factors, including maternal age, race/ethnicity, substance use, antiretroviral therapy during pregnancy, timing of HIV diagnosis, previous pregnancy with HIV, adequacy of prenatal care, and postpartum HIV care engagement (≥ 1 CD4 count or viral load [VL] test within 90 days of delivery), associated with retention in care (≥ 1 CD4 count or VL test in each 6-month interval of the period with ≥ 60 days between tests) and viral suppression (VL ≤ 200 copies/mL at the last measure in the period) at 1 and 2 years postpartum.

RESULTS:

Overall, 38% of women engaged in HIV care within 90 days postpartum; with 39% and 31% retained in care and virally suppressed, respectively, at 1 year postpartum, and 25% and 34% retained in care and virally suppressed, respectively, at 2 years postpartum. In multivariable analyses, women who engaged in HIV care within 90 days of delivery were more likely to be retained (adjusted odds ratio [AOR], 11.38; 95% confidence interval [CI], 7.74-16.68) and suppressed (AOR, 2.60 [95% CI, 1.82-3.73]) at 1 year postpartum. This association persisted in the second year postpartum for both retention (AOR, 6.19 [95% CI, 4.04-9.50]) and suppression (AOR, 1.40 [95% CI, 1.01-1.95]).

CONCLUSIONS:

The prevalence of postpartum HIV-infected women retained in care and maintaining viral suppression is low. Interventions seeking to engage women in care shortly after delivery have the potential to improve clinical outcomes.

KEYWORDS:

HIV care continuum; HIV/AIDS; maternal health; postpartum; retention in care

PMID:
26265499
DOI:
10.1093/cid/civ678
[Indexed for MEDLINE]

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