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Loss to Follow-up before and after Delivery among Women Testing HIV Positive during Pregnancy in Johannesburg, South Africa

Citation

Clouse, Kate; Pettifor, Audrey E.; Shearer, Kate; Maskew, Mhairi; Bassett, Jean F.; Larson, Bruce; Van Rie, Annelies T.; Sanne, Ian; & Fox, Matthew P. (2013). Loss to Follow-up before and after Delivery among Women Testing HIV Positive during Pregnancy in Johannesburg, South Africa. Tropical Medicine and International Health, 18(4), 451-460. PMCID: PMC3600093

Abstract

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 CD4 staging and returned for a repeat CD4 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.

URL

http://dx.doi.org/10.1111/tmi.12072

Reference Type

Journal Article

Year Published

2013

Journal Title

Tropical Medicine and International Health

Author(s)

Clouse, Kate
Pettifor, Audrey E.
Shearer, Kate
Maskew, Mhairi
Bassett, Jean F.
Larson, Bruce
Van Rie, Annelies T.
Sanne, Ian
Fox, Matthew P.

PMCID

PMC3600093