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Infectious Diseases in Obstetrics and Gynecology
Volume 2019, Article ID 8161495, 9 pages
https://doi.org/10.1155/2019/8161495
Research Article

HIV Care Continuum among Postpartum Women Living with HIV in Atlanta

1Brigham and Women’s Hospital, Department of Internal Medicine, Boston MA, USA
2Emory University School of Medicine, Atlanta GA, USA
3Emory University School of Medicine, Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Atlanta GA, USA
4Grady Memorial Hospital, Department of Medicine, Division of Infectious Diseases, Atlanta GA, USA
5Department of Biostatistics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
6Emory University School of Medicine, Department of Gynecology and Obstetrics, Division of Family Planning, Atlanta GA, USA
7Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta GA, USA
8Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta GA, USA
9Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta GA, USA

Correspondence should be addressed to Anandi N. Sheth; ude.yrome@htehsna

Received 29 November 2018; Accepted 4 February 2019; Published 14 February 2019

Academic Editor: Susan Cu-Uvin

Copyright © 2019 Christina M. Meade et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. While increased healthcare engagement and antiretroviral therapy (ART) adherence occurs during pregnancy, women living with HIV (WLWH) are often lost to follow-up after delivery. We sought to evaluate postpartum retention in care and viral suppression and to identify associated factors among WLWH in a large public hospital in Atlanta, Georgia. Methods. Data from the time of entry into prenatal care until 24 months postpartum were collected by chart review from WLWH who delivered with ≥20 weeks gestational age from 2011 to 2016. Primary outcomes were retention in HIV care (two HIV care visits or viral load measurements >90 days apart) and viral suppression (<200 copies/mL) at 12 and 24 months postpartum. Obstetric and contraception data were also collected. Results. Among 207 women, 80% attended an HIV primary care visit in a mean 124 days after delivery. At 12 and 24 months, respectively, 47% and 34% of women were retained in care and 41% and 30% of women were virally suppressed. Attending an HIV care visit within 90 days postpartum was associated with retention in care at 12 months (aOR 3.66, 95%CI 1.72-7.77) and 24 months (aOR 4.71, 95%CI 2.00-11.10) postpartum. Receiving ART at pregnancy diagnosis (aOR 2.29, 95%CI 1.11-4.74), viral suppression at delivery (aOR 3.44, 95%CI 1.39-8.50), and attending an HIV care visit within 90 days postpartum (aOR 2.40, 95%CI 1.12-5.16) were associated with 12-month viral suppression, and older age (aOR 1.09, 95% CI 1.01-1.18) was associated with 24-month viral suppression. Conclusions. Long-term retention in HIV care and viral suppression are low in this population of postpartum WLWH. Prompt transition to HIV care in the postpartum period was the strongest predictor of optimal HIV outcomes. Efforts supporting women during the postpartum transition from obstetric to HIV primary care may improve long-term HIV outcomes in women.