How Engaged in HIV Care are Pregnant Women?

Women with HIV who are pregnant display a high level of engagement in HIV care before their pregnancy, during, and after, according to a paper published in The Lancet HIV.

Investigators from London compared pregnant and non-pregnant women, both with HIV, in order to examine changes in engagement with HIV care before, during, and after pregnancy. The study authors wrote that women with HIV face challenges in engaging in HIV care after the birth of their child, measured by clinic attendance. They also have challenges in medication adherence in the postpartum period compared to prior to the pregnancy. Some of the barriers to care include increased demands on women’s time, less employer flexibility, inadequate child care facilities to attend appointments.

The 1116 matched pairs of pregnant and non-pregnant women in the study were identified from 25 HIV clinics in the UK with a live birth reported between January 2000 and December 2017, the study authors explained. The investigators also noted that the median age of the women was 34 years, and 80 percent were Black. The authors also observed that about two-thirds of the women had initiated ART before their estimated or pseudo conception date, with a median exposure to ART of 42 months.

The study authors determined that for pregnant women, the proportion of time engaged in care increased during pregnancy and after pregnancy compared with the period before pregnancy. They found that among the non-pregnant women, engagement in HIV care was consistent among the three equivalent stages of pseudo pregnancy. These trends were similar among younger women (those aged less than 35 years) and among women who had been diagnosed more recently (within 2 years), the study authors also noted.

Compared to the stage before pregnancy, the odds of engagement in HIV care increased by 67 percent during and 17 percent after pregnancy and pseudo pregnancy stages among the women, the study authors found. But this association differed by control status, the investigators said. For example, the increased engagement in HIV care during and after pregnancy was only seen among pregnant women. There was a slight increase in engagement in HIV care during the pseudo pregnancy stage among non-pregnant women, however, the study authors observed that the increase was smaller than the one noted among pregnant women during the equivalent stage. For the non-pregnant women, there was no change in engagement after the stage of pseudo pregnancy, they said.

All in all, the women were engaged in HIV care for 80 percent of their follow-up time, which the study authors noted is similar to previously published reports focused on men and women in the UK. They considered that a “good level of engagement in HIV care,” they wrote.

“The high levels of engagement in HIV care seen by women living with HIV during pregnancy is testament to their commitment to their health and wellbeing in this vulnerable period,” the study authors concluded. “These findings suggest that the antenatal period provides a key opportunity to empower women to engage in care in the immediate 12 months after pregnancy through the provision of information, by addressing structural barriers to health care access, and by strengthening relationships with clinics and health care providers.”