Factors Associated with Postpartum Loss to Follow-Up and Detectable Viremia After Delivery Among Pregnant Women Living with HIV
Pregnant women living with HIV are at risk for loss to follow-up and viral rebound after delivery. We conducted a retrospective cohort study of women with HIV who delivered at Parkland Hospital, Dallas, to identify factors associated with postpartum loss to HIV care 1 year after delivery. Logistic r...
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| Veröffentlicht in: | AIDS patient care and STDs 2019-01, Vol.33 (1), p.14-20 |
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| creator | Adhikari, Emily H Yule, Casey S Roberts, Scott W Rogers, Vanessa L Sheffield, Jeanne S Kelly, Mary Ann McIntire, Donald D Barnes, Arti |
| description | Pregnant women living with HIV are at risk for loss to follow-up and viral rebound after delivery. We conducted a retrospective cohort study of women with HIV who delivered at Parkland Hospital, Dallas, to identify factors associated with postpartum loss to HIV care 1 year after delivery. Logistic regression was used to identify factors predicting loss to follow-up. For a subset of women, we compared odds of viremia detectable at delivery and postpartum among women with higher versus lower pill burden regimens. We included 604 women with HIV who delivered between 2005 and 2015. Three hundred ninety-one (65%) women completed at least one visit with an HIV provider within 1 year of delivery. The follow-up rate among black, non-Hispanic women was 65%; 57% for white, non-Hispanic women; and 78% for Hispanic women. Women without follow-up presented for prenatal care later (17 vs. 11 weeks, p |
| doi_str_mv | 10.1089/apc.2018.0117 |
| format | Article |
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We conducted a retrospective cohort study of women with HIV who delivered at Parkland Hospital, Dallas, to identify factors associated with postpartum loss to HIV care 1 year after delivery. Logistic regression was used to identify factors predicting loss to follow-up. For a subset of women, we compared odds of viremia detectable at delivery and postpartum among women with higher versus lower pill burden regimens. We included 604 women with HIV who delivered between 2005 and 2015. Three hundred ninety-one (65%) women completed at least one visit with an HIV provider within 1 year of delivery. The follow-up rate among black, non-Hispanic women was 65%; 57% for white, non-Hispanic women; and 78% for Hispanic women. Women without follow-up presented for prenatal care later (17 vs. 11 weeks, p < 0.001), and were less likely to be on antiretroviral therapy at initial prenatal visit (29% vs. 49%, p < 0.001). Factors predicting loss to follow-up in multivariate analysis included low-level viremia at delivery [adjusted odds ratio (aOR) = 2.85, 95% confidence interval (CI) = 1.73-4.71] and failure to return for a postpartum visit (aOR = 3.19, 95% CI = 2.07-4.94). High antiretroviral pill burden (≥6 pills daily) was associated with viremia (>1000 copies/mL) at the first prenatal visit (OR = 8.7, 95% CI = 4.6-16.6) through 1 year postpartum (OR = 2.3, 95% CI = 1.2-4.4). Viremia at delivery, failure to return for a postpartum visit, and high pill burden during pregnancy are predictors of postpartum loss to HIV care.</description><identifier>ISSN: 1087-2914</identifier><identifier>EISSN: 1557-7449</identifier><identifier>DOI: 10.1089/apc.2018.0117</identifier><identifier>PMID: 30601060</identifier><language>eng</language><publisher>United States</publisher><subject>AIDS/HIV</subject><ispartof>AIDS patient care and STDs, 2019-01, Vol.33 (1), p.14-20</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c293t-c78e0098c99d724238510a56494872cf35d45fb6384d9ce0529ad35ed23f3c773</citedby><cites>FETCH-LOGICAL-c293t-c78e0098c99d724238510a56494872cf35d45fb6384d9ce0529ad35ed23f3c773</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30601060$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Adhikari, Emily H</creatorcontrib><creatorcontrib>Yule, Casey S</creatorcontrib><creatorcontrib>Roberts, Scott W</creatorcontrib><creatorcontrib>Rogers, Vanessa L</creatorcontrib><creatorcontrib>Sheffield, Jeanne S</creatorcontrib><creatorcontrib>Kelly, Mary Ann</creatorcontrib><creatorcontrib>McIntire, Donald D</creatorcontrib><creatorcontrib>Barnes, Arti</creatorcontrib><title>Factors Associated with Postpartum Loss to Follow-Up and Detectable Viremia After Delivery Among Pregnant Women Living with HIV</title><title>AIDS patient care and STDs</title><addtitle>AIDS Patient Care STDS</addtitle><description>Pregnant women living with HIV are at risk for loss to follow-up and viral rebound after delivery. We conducted a retrospective cohort study of women with HIV who delivered at Parkland Hospital, Dallas, to identify factors associated with postpartum loss to HIV care 1 year after delivery. Logistic regression was used to identify factors predicting loss to follow-up. For a subset of women, we compared odds of viremia detectable at delivery and postpartum among women with higher versus lower pill burden regimens. We included 604 women with HIV who delivered between 2005 and 2015. Three hundred ninety-one (65%) women completed at least one visit with an HIV provider within 1 year of delivery. The follow-up rate among black, non-Hispanic women was 65%; 57% for white, non-Hispanic women; and 78% for Hispanic women. Women without follow-up presented for prenatal care later (17 vs. 11 weeks, p < 0.001), and were less likely to be on antiretroviral therapy at initial prenatal visit (29% vs. 49%, p < 0.001). Factors predicting loss to follow-up in multivariate analysis included low-level viremia at delivery [adjusted odds ratio (aOR) = 2.85, 95% confidence interval (CI) = 1.73-4.71] and failure to return for a postpartum visit (aOR = 3.19, 95% CI = 2.07-4.94). High antiretroviral pill burden (≥6 pills daily) was associated with viremia (>1000 copies/mL) at the first prenatal visit (OR = 8.7, 95% CI = 4.6-16.6) through 1 year postpartum (OR = 2.3, 95% CI = 1.2-4.4). Viremia at delivery, failure to return for a postpartum visit, and high pill burden during pregnancy are predictors of postpartum loss to HIV care.</description><subject>AIDS/HIV</subject><issn>1087-2914</issn><issn>1557-7449</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNo9kDtPxDAMgCME4j2yoowsPfK8JOMJOEA6CQYeY5VLXQhqm5LkQEz8dXK8BsuW_cmWP4SOKJlQos2pHd2EEaonhFK1gXaplKpSQpjNUhOtKmao2EF7Kb0QQjSTZBvtcDIltMQu-pxbl0NMeJZScN5maPC7z8_4NqQ82phXPV6ElHAOeB66LrxX9yO2Q4PPIYPLdtkBfvARem_xrM0Qy6DzbxA_8KwPwxO-jfA02CHjx9DDgBf-zZfu942r64cDtNXaLsHhb95H9_OLu7OranFzeX02W1SOGZ4rpzQQYrQzplFMMK4lJVZOhRFaMddy2QjZLqdci8Y4IJIZ23AJDeMtd0rxfXTys3eM4XUFKde9Tw66zg4QVqlmdMoKprkoaPWDulgej9DWY_S9jR81JfXaeV2c12vn9dp54Y9_V6-WPTT_9J9k_gV0ynys</recordid><startdate>201901</startdate><enddate>201901</enddate><creator>Adhikari, Emily H</creator><creator>Yule, Casey S</creator><creator>Roberts, Scott W</creator><creator>Rogers, Vanessa L</creator><creator>Sheffield, Jeanne S</creator><creator>Kelly, Mary Ann</creator><creator>McIntire, Donald D</creator><creator>Barnes, Arti</creator><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201901</creationdate><title>Factors Associated with Postpartum Loss to Follow-Up and Detectable Viremia After Delivery Among Pregnant Women Living with HIV</title><author>Adhikari, Emily H ; Yule, Casey S ; Roberts, Scott W ; Rogers, Vanessa L ; Sheffield, Jeanne S ; Kelly, Mary Ann ; McIntire, Donald D ; Barnes, Arti</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c293t-c78e0098c99d724238510a56494872cf35d45fb6384d9ce0529ad35ed23f3c773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>AIDS/HIV</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Adhikari, Emily H</creatorcontrib><creatorcontrib>Yule, Casey S</creatorcontrib><creatorcontrib>Roberts, Scott W</creatorcontrib><creatorcontrib>Rogers, Vanessa L</creatorcontrib><creatorcontrib>Sheffield, Jeanne S</creatorcontrib><creatorcontrib>Kelly, Mary Ann</creatorcontrib><creatorcontrib>McIntire, Donald D</creatorcontrib><creatorcontrib>Barnes, Arti</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>AIDS patient care and STDs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Adhikari, Emily H</au><au>Yule, Casey S</au><au>Roberts, Scott W</au><au>Rogers, Vanessa L</au><au>Sheffield, Jeanne S</au><au>Kelly, Mary Ann</au><au>McIntire, Donald D</au><au>Barnes, Arti</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors Associated with Postpartum Loss to Follow-Up and Detectable Viremia After Delivery Among Pregnant Women Living with HIV</atitle><jtitle>AIDS patient care and STDs</jtitle><addtitle>AIDS Patient Care STDS</addtitle><date>2019-01</date><risdate>2019</risdate><volume>33</volume><issue>1</issue><spage>14</spage><epage>20</epage><pages>14-20</pages><issn>1087-2914</issn><eissn>1557-7449</eissn><abstract>Pregnant women living with HIV are at risk for loss to follow-up and viral rebound after delivery. We conducted a retrospective cohort study of women with HIV who delivered at Parkland Hospital, Dallas, to identify factors associated with postpartum loss to HIV care 1 year after delivery. Logistic regression was used to identify factors predicting loss to follow-up. For a subset of women, we compared odds of viremia detectable at delivery and postpartum among women with higher versus lower pill burden regimens. We included 604 women with HIV who delivered between 2005 and 2015. Three hundred ninety-one (65%) women completed at least one visit with an HIV provider within 1 year of delivery. The follow-up rate among black, non-Hispanic women was 65%; 57% for white, non-Hispanic women; and 78% for Hispanic women. Women without follow-up presented for prenatal care later (17 vs. 11 weeks, p < 0.001), and were less likely to be on antiretroviral therapy at initial prenatal visit (29% vs. 49%, p < 0.001). Factors predicting loss to follow-up in multivariate analysis included low-level viremia at delivery [adjusted odds ratio (aOR) = 2.85, 95% confidence interval (CI) = 1.73-4.71] and failure to return for a postpartum visit (aOR = 3.19, 95% CI = 2.07-4.94). High antiretroviral pill burden (≥6 pills daily) was associated with viremia (>1000 copies/mL) at the first prenatal visit (OR = 8.7, 95% CI = 4.6-16.6) through 1 year postpartum (OR = 2.3, 95% CI = 1.2-4.4). Viremia at delivery, failure to return for a postpartum visit, and high pill burden during pregnancy are predictors of postpartum loss to HIV care.</abstract><cop>United States</cop><pmid>30601060</pmid><doi>10.1089/apc.2018.0117</doi><tpages>7</tpages></addata></record> |
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| source | Alma/SFX Local Collection |
| subjects | AIDS/HIV |
| title | Factors Associated with Postpartum Loss to Follow-Up and Detectable Viremia After Delivery Among Pregnant Women Living with HIV |
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