Details:

Alternative Title:
Obstet Gynecol
Publisher's site:
http://dx.doi.org/10.1097/AOG.0000000000001454
Personal Author:
Swain, Carol-Ann ; Smith, Lou C. ; Nash, Denis ; Pulver, Wendy P. ; Gordon, Daniel ; ... More +
Swain, Carol-Ann ; Smith, Lou C. ; Nash, Denis ; Pulver, Wendy P. ; Gordon, Daniel ; Bian, Fuqin ; Miranda, Wilson ; Anderson, Bridget J. ; Chicoine, Joyce ; Birkhead, Guthrie S. ; McNutt, Louise-Anne Less -
Description:
OBJECTIVE

To identify factors associated with continuity of care and human immunodeficiency virus (HIV) virologic suppression among postpartum women diagnosed with HIV during pregnancy in New York State.

METHODS

This retrospective cohort study was conducted among 228 HIV-infected women diagnosed during pregnancy between 2008 and 2010. Initial receipt of HIV-related medical care (first CD4 or viral load test after diagnosis) was evaluated at 30 days after diagnosis and before delivery. Retention in care (2 or more CD4 or viral load tests, 90 days or greater apart) and virologic suppression (viral load 200 copies/mL or less) were evaluated in the 12 months after hospital discharge.

RESULTS

Most women had their initial HIV-related care encounter within 30 days of diagnosis (74%) and before delivery (87%). Of these women, 70% were retained in the first year postpartum. Women waiting more than 30 days for their initial HIV-related care encounter were more likely diagnosed in the first (29%) compared with the third (11%) trimester and were of younger (younger than 25 years, 32%) compared with older (35 years or older, 13%) age. Loss to follow-up within the first year was significantly greater among women diagnosed in the third compared with the first trimester (adjusted relative risk 2.21, 95% confidence interval [CI] 1.41–3.45) and among women who had a cesarean compared with vaginal delivery (adjusted relative risk 1.76, 95% CI 1.07– 2.91). Of the 178 women with one or more HIV viral load test in the first year postpartum, 58% had an unsuppressed viral load.

CONCLUSION

Despite the high proportion retained in care, many women had poor postpartum virologic control. Robust strategies are needed to increase virologic suppression among newly diagnosed postpartum HIV-infected women.


Subjects:
[+]
Adult Age Factors CD4 Lymphocyte Count Female HIV Infections Humans Lost To Follow-Up Postnatal Care Postpartum Period Pregnancy Pregnancy Complications, Infectious Retrospective Studies Risk Factors Viral Load
Source:
Obstet Gynecol. 128(1):44-51.
Pubmed ID:
27275796
Pubmed Central ID:
PMC5557412
Document Type:
Journal Article
Funding:
P30 MH043520/MH/NIMH NIH HHS/United States ; U62 PS003966/PS/NCHHSTP CDC HHS/United States
P30 MH043520/MH/NIMH NIH HHS/United States ; U62 PS003966/PS/NCHHSTP CDC HHS/United States Less -
Place as Subject:
New York
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:dc322ce5def85e533c11954bb3ce4f48794c9e4c61e0e280f3556982407570d2
Download URL:
https://stacks.cdc.gov/view/cdc/47597/cdc_47597_DS1.pdf
File Type:

Supporting Files

• nihms893917.nxml

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