HIV-positive pregnant women at significant risk of loss to follow up from HIV Care after delivery in South Africa

In 2017, according to UNAIDS, more than 90% of HIV-positive pregnant women accessed antiretroviral (ART) medicines to prevent mother-to child transmission of HIV in Southern Africa, and recent research suggests access and adherence to ART remains high during pregnancy due in part to the scale up of national antenatal (ANC) and ART care clinics. 

Engagement in HIV care after delivery, however, can be challenging.

Kate Clouse, Ph.D., M.P.H., and colleagues recently published two articles on engagement in care among postpartum women living with HIV in South Africa. Findings from both studies reported in the Journal of the International AIDS Society suggest HIV-positive pregnant and postpartum women in South Africa face difficulties adhering to long-term HIV care.

In Linkage to care, mobility, and retention of HIV-positive postpartum women in antiretroviral therapy services in South Africa, the authors explore challenges HIV-positive postpartum women face when receiving antiretroviral (ART) care. During pregnancy, HIV-positive women often begin receiving antenatal care (ANC) and ART at an integrated clinic that offers both services. Postpartum, they must transfer clinics in order to continue receiving ART care; however, adhering to long-term treatment is often difficult. Challenges include linkage to care at a new ART clinic postpartum, mobility and distance to the new clinic, and adherence to treatment at the new clinic. This study in Cape Town, South Africa provides evidence from over 30 months of following a cohort of women who initiated ART in an integrated ANC and ART clinic and transferred to an ART clinic postpartum. Results show 41% of women were not retained in care at both 12 and 24 months after ART initiation. Less than two-thirds of women were still receiving treatment at both 12 and 24 months after ART initiation. Several common factors were associated with retention in care, including attending one clinic, being married, and having a planned pregnancy. These results add to existing literature and provide evidence for retention of ART care beyond 12 months. 

Another study, "I will leave the baby with my mother": Long-distance travel and follow-up care among HIV-positive pregnant and postpartum women in South Africa, researched mobility of mother and infant before and after delivery and their adherence to HIV care. Many HIV-positive women in South Africa face challenges adhering to care after delivery. One reason is due to long-distance travel. Typically, the purpose of long-distance travel among these women was to visit family for help with the baby. Long-distance travel could interrupt care and cause women to transfer clinics or even cease care. While all women intended to continue with HIV care after delivery, few retained care at the destination site; one-third of women continued care at other clinics. Many women reported continuing care for the baby, not for themselves. In addition, many employed women returned to work, but some of these women left their HIV-exposed baby with family outside of town. This study provides new research on motivations for long-distance travel among peripartum, HIV-positive women in sub-Saharan Africa and their adherence to HIV care. Results show mobility impacts engagement in HIV care and provides important implications on reasons of loss to follow-up of HIV care among postpartum women living with HIV.

Kate Clouse, Ph.D., M.P.H., Assistant Professor of Medicine, Division of Infectious Diseases, and VIGH Core Faculty Member