Postpartum Engagement in HIV Care: An Important Predictor of Long-term Retention in Care and Viral Suppression.
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.
AIDS Activities Coordinating Office, Philadelphia Department of Public Health.
Joëlla W
JW
Adams
AIDS Activities Coordinating Office, Philadelphia Department of Public Health Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania.
Kathleen A
KA
Brady
Department of Epidemiology, Drexel University School of Public Health.
Yvonne L
YL
Michael
Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania.
Baligh R
BR
Yehia
Division of Infectious Diseases and HIV Medicine, Drexel University School of Medicine, Philadelphia, Pennsylvania.
Florence M
FM
Momplaisir
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D055118:Medication Adherence; D015143:Philadelphia; D049590:Postpartum Period; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
HIV care continuum; HIV/AIDS; maternal health; postpartum; retention in care