Abstract
Background: Little is known about retention in HIV care in HIV-positive women after pregnancy in the UK. We explored the association between loss to follow-up (LTFU) in the year after pregnancy, maternal place of birth and duration of UK residence, in HIV-positive women in England, Wales and Northern Ireland (EW&NI).
Methods: We analyzed combined data from two national datasets: the National Study of HIV in Pregnancy and Childhood; and the Survey of Prevalent HIV Infections Diagnosed, including pregnancies in 2000-2009 in women with diagnosed HIV. Logistic regression models were fitted with robust standard errors to estimate adjusted odds ratios (AOR).
Results: Overall, 902/7211(12.5%) women did not access HIV care in the year after pregnancy. Factors associated with LTFU included younger age, last CD4 in pregnancy ≥ 350 cells/μl and detectable HIV viral load at the end of pregnancy (all p< 0.001). On multivariable analysis, LTFU was more likely in Sub-Saharan Africa-born (SSA-born) women than white UK-born women (AOR 2.17; 95% confidence interval (CI): 1.50, 3.14; p< 0.001). SSA-born women who had migrated to the UK during pregnancy were three times more likely than white UK-born women to be lost to follow-up (AOR 3.19; 95% CI: 1.94, 3.23; p<0.001).
Conclusions: One in eight HIV-positive women in EW&NI did not return for HIV care in the year after pregnancy, with SSA-born women, especially those who migrated to the UK during pregnancy, at increased risk. Although emigration is a possible explanatory factor, disengagement from care may also play a role.
Methods: We analyzed combined data from two national datasets: the National Study of HIV in Pregnancy and Childhood; and the Survey of Prevalent HIV Infections Diagnosed, including pregnancies in 2000-2009 in women with diagnosed HIV. Logistic regression models were fitted with robust standard errors to estimate adjusted odds ratios (AOR).
Results: Overall, 902/7211(12.5%) women did not access HIV care in the year after pregnancy. Factors associated with LTFU included younger age, last CD4 in pregnancy ≥ 350 cells/μl and detectable HIV viral load at the end of pregnancy (all p< 0.001). On multivariable analysis, LTFU was more likely in Sub-Saharan Africa-born (SSA-born) women than white UK-born women (AOR 2.17; 95% confidence interval (CI): 1.50, 3.14; p< 0.001). SSA-born women who had migrated to the UK during pregnancy were three times more likely than white UK-born women to be lost to follow-up (AOR 3.19; 95% CI: 1.94, 3.23; p<0.001).
Conclusions: One in eight HIV-positive women in EW&NI did not return for HIV care in the year after pregnancy, with SSA-born women, especially those who migrated to the UK during pregnancy, at increased risk. Although emigration is a possible explanatory factor, disengagement from care may also play a role.
Original language | English |
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Pages (from-to) | 283-289 |
Number of pages | 7 |
Journal | Sexually Transmitted Diseases |
Volume | 43 |
Issue number | 5 |
DOIs | |
Publication status | Published - May 2016 |