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Loss to follow‐up before and after delivery among women testing HIV positive during pregnancy in Johannesburg, South Africa
Author(s) -
Clouse Kate,
Pettifor Audrey,
Shearer Kate,
Maskew Mhairi,
Bassett Jean,
Larson Bruce,
Rie Annelies,
Sanne Ian,
Fox Matthew P.
Publication year - 2013
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12072
Subject(s) - medicine , pregnancy , human immunodeficiency virus (hiv) , observational study , obstetrics , cesarean delivery , lost to follow up , cohort , gestation , pediatrics , surgery , family medicine , genetics , biology
Objective HIV ‐positive pregnant women are at heightened risk of becoming lost to follow‐up ( LTFU ) from HIV care. We examined LTFU before and after delivery among pregnant women newly diagnosed with HIV . Methods Observational cohort study of all pregnant women ≥18 years ( N = 300) testing HIV positive for the first time at their first ANC visit between January and June 2010, at a primary healthcare clinic in Johannesburg, South Africa. Women ( n = 27) whose delivery date could not be determined were excluded. Results Median ( IQR ) gestation at HIV testing was 26 weeks (21–30). Ninety‐eight per cent received AZT prophylaxis, usually started at the first ANC visit. Of 139 (51.3%) patients who were ART eligible, 66.9% (95% CI 58.8–74.3%) initiated ART prior to delivery; median ( IQR ) ART duration pre‐delivery was 9.5 weeks (5.1–14.2). Among ART ‐eligible patients, 40.5% (32.3–49.0%) were cumulatively retained through 6 months on ART . Of those ART ‐ineligible patients at HIV testing, only 22.6% (95% CI 15.9–30.6%) completed CD 4 staging and returned for a repeat CD 4 test after delivery. LTFU (≥1 month late for last scheduled visit) before delivery was 20.5% (95% CI 16.0–25.6%) and, among those still in care, 47.9% (95% CI 41.2–54.6%) within 6 months after delivery. Overall, 57.5% (95% CI 51.6–63.3%) were lost between HIV testing and 6 months post‐delivery. Conclusions Our findings highlight the challenge of continuity of care among HIV ‐positive pregnant women attending antenatal services, particularly those ineligible for ART .