Loss to follow-up after pregnancy among Sub-Saharan Africa-born women living with HIV in England, Wales and Northern Ireland: results from a large national cohort

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.