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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Loss to follow-up before and after delivery among women testing HIV positive during pregnancy in Johannesburg, South Africa
Tropical Medicine and International Health, Volume 18, No. 4, Year 2013
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Description
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. © 2013 Blackwell Publishing Ltd.
Authors & Co-Authors
Clouse, Kate A.M.
South Africa, Johannesburg
University of the Witwatersrand
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Pettifor, Audrey E.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Shearer, Kate
South Africa, Johannesburg
University of the Witwatersrand
Maskew, Mhairi
South Africa, Johannesburg
University of the Witwatersrand
Bassett, Jean
South Africa, Johannesburg
Witkoppen Health and Welfare Centre
Larson, Bruce A.
South Africa, Johannesburg
University of the Witwatersrand
United States, Boston
School of Public Health
van Rie, Annelies
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Sanne, Ian
South Africa, Johannesburg
University of the Witwatersrand
Fox, Matthew P.
South Africa, Johannesburg
University of the Witwatersrand
United States, Boston
School of Public Health
United States, Boston
Boston University
Statistics
Citations: 107
Authors: 9
Affiliations: 5
Identifiers
Doi:
10.1111/tmi.12072
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
South Africa
Participants Gender
Female