title: Loss to follow-up before and after delivery among women testing HIV positive during pregnancy in Johannesburg, South Africa.
abstract: OBJECTIVE
  HIV-positive pregnant women are at heightened risk of becoming lost to follow-up (LTFU) from HIV care. We examined LTFU before and after delivery among pregnant women newly diagnosed with HIV.
  
  
  METHODS
  Observational cohort study of all pregnant women ≥18 years (N = 300) testing HIV positive for the first time at their first ANC visit between January and June 2010, at a primary healthcare clinic in Johannesburg, South Africa. Women (n = 27) whose delivery date could not be determined were excluded.
  
  
  RESULTS
  Median (IQR) gestation at HIV testing was 26 weeks (21-30). Ninety-eight per cent received AZT prophylaxis, usually started at the first ANC visit. Of 139 (51.3%) patients who were ART eligible, 66.9% (95% CI 58.8-74.3%) initiated ART prior to delivery; median (IQR) ART duration pre-delivery was 9.5 weeks (5.1-14.2). Among ART-eligible patients, 40.5% (32.3-49.0%) were cumulatively retained through 6 months on ART. Of those ART-ineligible patients at HIV testing, only 22.6% (95% CI 15.9-30.6%) completed CD4 staging and returned for a repeat CD4 test after delivery. LTFU (≥1 month late for last scheduled visit) before delivery was 20.5% (95% CI 16.0-25.6%) and, among those still in care, 47.9% (95% CI 41.2-54.6%) within 6 months after delivery. Overall, 57.5% (95% CI 51.6-63.3%) were lost between HIV testing and 6 months post-delivery.
  
  
  CONCLUSIONS
  Our findings highlight the challenge of continuity of care among HIV-positive pregnant women attending antenatal services, particularly those ineligible for ART.
authors: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa kclouse@unc.edu
authors: Kate
authors: K
authors: Clouse
authors: Audrey
authors: A
authors: Pettifor
authors: Kate
authors: K
authors: Shearer
authors: Mhairi
authors: M
authors: Maskew
authors: Jean
authors: J
authors: Bassett
authors: Bruce
authors: B
authors: Larson
authors: Annelies
authors: A
authors: Van Rie
authors: Ian
authors: I
authors: Sanne
authors: Matthew P
authors: MP
authors: Fox
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003266:Continuity of Patient Care; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006679:HIV Seropositivity / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D059012:Lost to Follow-Up; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology; D011181:Postnatal Care / Q000523:psychology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011295:Prenatal Care / Q000523:psychology*; D013019:South Africa; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
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