The integration of antiretroviral therapy (ART) services
into antenatal care for prevention of mother-to-child transmission has resulted
in the need to transfer HIV-infected women to general ART clinics after
delivery. Transfer of patients on ART between services may present a challenge
to adherence and retention, but there are few data describing this step in the
HIV care cascade for women starting ART in pregnancy.
We described postpartum transfer of care in a cohort of
women initiating ART during pregnancy and referred from integrated antenatal
ART services to general ART clinics. Engagement in ART care at general ART
clinics was assessed through routine laboratory records and telephonic
interviews.
Overall, 279 postpartum women were transferred to ART
clinics. By 5 months post referral, between 74% and 91% of women had evidence of
engagement at an ART clinic depending on the outcome definition. In a
log-binomial model adjusted for age, CD4 cell count and being diagnosed with
HIV in the current pregnancy, additional months on ART before delivery improved
the likelihood of engagement in an ART clinic (relative risk: 1.05, 95%
confidence interval: 1.00 to 1.09, P = 0.036).
Postpartum transfer of ART care is an important and
previously neglected step in the HIV care cascade for pregnant women. Even in
this cohort of highly adherent women up to 25% did not remain in care after
transfer. Retention is required across all steps of the cascade, including
transfer of ART care after delivery, to maximize the benefits of ART for both
maternal and child health.
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By:
- 1*Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; †ICAP, Columbia University, Mailman School of Public Health, New York, NY; ‡Department of Medicine, Weill Cornell Medical College, New York, NY.
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