Postpartum disengagement from care common in pregnant women with HIV
Women with HIV who initiate antiretroviral therapy during pregnancy often disengage from care, especially after delivery, according to data presented at AIDS 2014 by researchers from the University of Cape Town in South Africa.
“Recent international guidelines call for universal use of triple-drug ART in HIV-infected women during pregnancy and postpartum,” Tamsin Phillips, an MPH student, and colleagues wrote in the study abstract. “There are, however, concerns regarding potentially high levels of non-adherence and/or disengagement from care that may attenuate the benefits of ART for HIV transmission and maternal health.”
The cohort study included 358 women initiating ART during pregnancy from 2011 to September 2012 at a large antenatal clinic. The women were identified based on CD4 cell counts of 350 cells/mcL or less and initiated a regimen of tenofovir (Viread, Gilead Sciences), lamivudine and efavirenz (Sustiva, Bristol-Myers Squibb). The outcomes were missed visits — returning to care 14 to 56 days late — and disengagement — more than 56 days late for a scheduled visit.
By 6 months postpartum, 24% of the women had missed at least one visit and 32% had disengaged from care. Forty-nine percent of the women had either missed a visit or disengaged from care 6 months postpartum. Disengagement from care more than doubled postpartum compared with the antenatal period: 6.2 per 100 woman-months vs. 2.4 per 100 woman-months. After adjustment for age, starting CD4 count and site of ART initiation, later gestational age at initiation (HR=1.04: 95% CI, 1-1.07) and new HIV diagnosis (HR=0.63; 95% CI, 0.43-0.94) were predictors of disengagement from care.
“Further research is required to understand reasons for non-adherence and disengagement from care and the implications thereof in the context of pregnancy,” the researchers said. “Women newly diagnosed with HIV and those presenting for antenatal care at later gestational ages may be particularly vulnerable, and there is an urgent need for interventions to promote retention among all HIV-infected women during pregnancy and after delivery.
For more information:
Phillips T. #MOPDB0102. Presented at: 20th International AIDS Conference; July 20-25, 2014; Melbourne, Australia.