title: Implementation and Operational Research: Postpartum Transfer of Care Among HIV-Infected Women Initiating Antiretroviral Therapy During Pregnancy.
abstract: BACKGROUND
  The integration of antiretroviral therapy (ART) services into antenatal care for prevention of mother-to-child transmission has resulted in the need to transfer HIV-infected women to general ART clinics after delivery. Transfer of patients on ART between services may present a challenge to adherence and retention, but there are few data describing this step in the HIV care cascade for women starting ART in pregnancy.
  
  
  METHODS
  We described postpartum transfer of care in a cohort of women initiating ART during pregnancy and referred from integrated antenatal ART services to general ART clinics. Engagement in ART care at general ART clinics was assessed through routine laboratory records and telephonic interviews.
  
  
  RESULTS
  Overall, 279 postpartum women were transferred to ART clinics. By 5 months postreferral, between 74% and 91% of women had evidence of engagement at an ART clinic depending on the outcome definition. In a log-binomial model adjusted for age, CD4 cell count and being diagnosed with HIV in the current pregnancy, additional months on ART before delivery improved the likelihood of engagement in an ART clinic (relative risk: 1.05, 95% confidence interval: 1.00 to 1.09, P = 0.036).
  
  
  CONCLUSIONS
  Postpartum transfer of ART care is an important and previously neglected step in the HIV care cascade for pregnant women. Even in this cohort of highly adherent women up to 25% did not remain in care after transfer. Retention is required across all steps of the cascade, including transfer of ART care after delivery, to maximize the benefits of ART for both maternal and child health.
authors.affiliation: *Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; †ICAP, Columbia University, Mailman School of Public Health, New York, NY; ‡Department of Medicine, Weill Cornell Medical College, New York, NY.
authors.forename: Tamsin
authors.initials: T
authors.lastname: Phillips
authors.forename: Margaret L
authors.initials: ML
authors.lastname: McNairy
authors.forename: Allison
authors.initials: A
authors.lastname: Zerbe
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
mesh_terms: D000328:Adult; D000465:Algorithms; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D055118:Medication Adherence; D010342:Patient Acceptance of Health Care; D011181:Postnatal Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D013019:South Africa / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents