title: Postpartum Loss to HIV Care and HIV Viral Suppression among Previously Diagnosed HIV-Infected Women with a Live Birth in New York State.
abstract: Mother-to-child-transmission of HIV in the United States has been greatly reduced, with clear benefits for the child. However, little is known about factors that predict maternal loss to HIV care in the postpartum year. This retrospective cohort study included 980 HIV-positive women, diagnosed with HIV at least one year before pregnancy, who had a live birth during 2008-2010 in New York State. Women who did not meet the following criterion in the 12 months after the delivery-related hospital discharge were considered to be lost to HIV care: two or more laboratory tests (CD4 or HIV viral load), separated by at least 90 days. Adjusted relative risks (aRR) and 95% confidence intervals (CI) for predictors of postpartum loss to HIV care were identified with Poisson regression, solved using generalized estimating equations. Having an unsuppressed (>200 copies/mL) HIV viral load in the postpartum year was also evaluated. Overall, 24% of women were loss to HIV care during the postpartum year. Women with low participation in HIV care during preconception were more likely to be lost to HIV care during the postpartum year (aRR: 2.70; 95% CI: 2.09-3.49). In contrast, having a low birth weight infant was significantly associated with a decreased likelihood of loss to HIV care (aRR: 0.72; 95% CI: 0.53-0.98). While 75% of women were virally suppressed at the last viral load before delivery only 44% were continuously suppressed in the postpartum year; 12% had no viral load test reported in the postpartum year and 44% had at least one unsuppressed viral load test. Lack of engagement in preconception HIV-related health care predicts postpartum loss to HIV care for HIV-positive parturient women. Many women had poor viral control during the postpartum period, increasing the risk of disease progression and infectivity.
authors: AIDS Institute, New York State Department of Health, Albany, New York, United States of America.|School of Public Health, University at Albany, State University of New York, Albany, New York, United States of America.
authors: Carol-Ann
authors: http://orcid.org/0000-0001-8451-2887
authors: CA
authors: Swain
authors: AIDS Institute, New York State Department of Health, Albany, New York, United States of America.|School of Public Health, University at Albany, State University of New York, Albany, New York, United States of America.
authors: Lou C
authors: LC
authors: Smith
authors: School of Public Health, City University of New York, New York, New York, United States of America.
authors: Denis
authors: D
authors: Nash
authors: Center for Community Health, New York State Department of Health, Albany, New York, United States of America.
authors: Wendy P
authors: WP
authors: Pulver
authors: School of Public Health, University at Albany, State University of New York, Albany, New York, United States of America.
authors: Victoria
authors: V
authors: Lazariu
authors: AIDS Institute, New York State Department of Health, Albany, New York, United States of America.
authors: Bridget J
authors: BJ
authors: Anderson
authors: AIDS Institute, New York State Department of Health, Albany, New York, United States of America.
authors: Barbara L
authors: BL
authors: Warren
authors: School of Public Health, University at Albany, State University of New York, Albany, New York, United States of America.
authors: Guthrie S
authors: GS
authors: Birkhead
authors: Institute for Health and the Environment, University at Albany, State University of New York, Albany, New York, United States of America.
authors: Louise-Anne
authors: LA
authors: McNutt
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000998:Antiviral Agents / Q000627:therapeutic use; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D050498:Live Birth; D059012:Lost to Follow-Up; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D000998:Antiviral Agents