Postpartum HIV care improves retention, outcomes
Postpartum women with HIV are at high risk for virologic failure due to poor retention in HIV care, and researchers have recommended that clinicians engage the women in HIV care within 90 days of delivery to maintain viral load suppression and improve clinical outcomes.
“Our study highlights the importance of establishing quality HIV and prenatal care throughout pregnancy and of engaging women in HIV care in the immediate postpartum period,” Joëlla W. Adams, MPH, from the AIDS Activities Coordinating Office in the Philadelphia Department of Public Health, and colleagues wrote in Clinical Infectious Diseases. “Clinicians and other stakeholders should make sustained HIV care engagement a high priority.”
Adams and colleagues retrospectively evaluated 561 postpartum women with HIV (695 deliveries) in Philadelphia who delivered between 2005 and 2011. The researchers categorized the women’s age, race and ethnicity and history of substance abuse. Clinically, the women were evaluated based on time from HIV diagnosis, any previous pregnancies while infected with HIV and whether they received ART during their pregnancy.
The researchers defined adequate prenatal care using the Kessner Index, noting the number of prenatal visits, which trimester the women entered prenatal care and the week of gestational delivery. They determined HIV care engagement after delivery based on CD4 cell counts or viral load within the first 90 days.
While 92% of women received some form of HIV care with either ART or an HIV laboratory test, Adams and colleagues found that 43% of women received adequate prenatal care, while 31% received intermediate care and 27% had inadequate or no care.
Women who had postpartum care within 90 days after delivery were significantly more likely to be retained at 1 year postpartum (adjusted OR = 11.38; 95% CI, 7.74-16.68) and 2 years postpartum (aOR = 6.19; 95% CI, 4.04-9.5). Women who had postpartum care within 90 days of delivery also were more likely to be virally suppressed at 1 year postpartum (aOR = 2.6; 95% CI, 1.82-3.73) and 2 years postpartum (aOR = 1.4, 95%; CI, 1.01-1.95).
However, Adams and colleagues noted poor postpartum engagement, with only 38% of women receiving HIV care after delivery. Postpartum HIV care was associated with a previous pregnancy while having HIV (aOR = 0.61; 95% CI, 0.43 - 0.86) and year of delivery.
“Laudable progress has been made to eliminate [mother-to-child transmission] and now increased attention on improving maternal HIV care engagement is needed,” the researchers wrote. “Doing so has the potential to improve health outcomes far beyond pregnancy.” – by Jeff Craven
Disclosure: The researchers report no relevant financial disclosures.