title: A mixed-methods approach to understanding barriers to postpartum retention in care among low-income, HIV-infected women.
abstract: Optimal retention in HIV care postpartum is necessary to benefit the health and wellbeing of mothers and their infants. However, postpartum retention in HIV care among low-income women is suboptimal, particularly in the Southern United States. A mixed-methods study was conducted to identify factors associated with postpartum retention in care among HIV-infected women. Participants (n=35) were recruited during pregnancy at two county clinics and completed self-report demographic and psychosocial surveys. Twenty-two women who returned for a postpartum appointment completed a semi-structured interview about lifestyle factors and retention in care. Of the participants enrolled at baseline, 71.4% completed a follow-up with an obstetrician (OB), while 57.1% completed a follow-up with a primary care physician (PCP). High CD4 count at delivery, low viral load at baseline, low levels of depression, high interpersonal social support, and fewer other children were significantly associated with completion of postpartum follow-up. Barriers and facilitators to retention identified during qualitative interviews included competing responsibilities for time, lack of social support outside of immediate family members, limited transportation access, experiences of institutionalized stigma, knowledge about the benefits of adherence, and strong relationships with healthcare providers. OB and PCP follow-up postpartum was suboptimal in this sample. Findings underscore the importance of addressing depressive symptoms, social support, viral suppression, competing responsibilities for time, institutionalized stigma, and transportation issues in order to reduce the barriers that inhibit women from seeking postpartum HIV care.
authors.affiliation: 1 Department of Periodontics, University of Texas Health Science Center at San Antonio , San Antonio, Texas.
authors.forename: Meredith K
authors.initials: MK
authors.lastname: Buchberg
authors.forename: Faith E
authors.initials: FE
authors.lastname: Fletcher
authors.forename: Damon J
authors.initials: DJ
authors.lastname: Vidrine
authors.forename: Judy
authors.initials: J
authors.lastname: Levison
authors.forename: Marlyn Yvette
authors.initials: MY
authors.lastname: Peters
authors.forename: Robin
authors.initials: R
authors.lastname: Hardwicke
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Yu
authors.forename: Tanvir K
authors.initials: TK
authors.lastname: Bell
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D002648:Child; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic / Q000379:methods; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D049590:Postpartum Period / Q000523:psychology*; D011203:Poverty / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000523:psychology; D036301:Qualitative Research; D057566:Self Report; D057545:Social Stigma; D012944:Social Support; D012959:Socioeconomic Factors; D013781:Texas; D019562:Viral Load