Factors Associated With Retention in HIV Care Within 12 Months Postpartum: A Retrospective Cohort Study

Abstract

Background: Loss to follow-up to HIV care after delivery puts birthing parents with HIV at higher risk of loss of viral suppression, disease progression, and HIV partner transmission. This study assessed factors associated with retention in postpartum HIV care.

Methods: This is a retrospective cohort study at a single academic medical center and included patients followed from January 2014 to December 2022. The primary outcome was retention in postpartum HIV care (any health care encounter discussing HIV medication adherence or viral load within 12 months postpartum). Data were analyzed using χ 2 and student t test for discrete and continuous variables. Univariate and multivariable log regressions were used to measure independent associations on care retention and health care utilization outcomes.

Results: Of the 111 patients with planned follow-up at our facility, 93 (83.8%) participants had ≥1 HIV care encounter within 12 months of delivery. Participants had a mean age of 31.2 (±5.84) years, were predominantly Black (79.3%), non-Hispanic (91%), and non-U.S. born (57.5%) with substantial exposure of prior IPV (29.6%). Participants retained in care were more likely to use ART during pregnancy (92/99% vs 16/94.2%, P = 0.01) and have viral suppression at delivery (n = 83/90% vs 12/67%, P = 0.02). Retention in care was negatively associated with substance use during pregnancy (aOR 0.29, 95% CI: 0.09 to 0.95) after adjustment for social health covariates.

Conclusions: Although almost 84% of participants were retained in HIV care within 12 months of delivery, substance use during pregnancy was a significant risk factor for HIV care attrition postpartum.

FIGURE 1.

Health care utilization within 12 months postpartum.