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Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania.

Publication ,  Journal Article
Watt, MH; Cichowitz, C; Kisigo, G; Minja, L; Knettel, BA; Knippler, ET; Ngocho, J; Manavalan, P; Mmbaga, BT
Published in: AIDS care
June 2019

Prevention of mother-to-child transmission of HIV (PMTCT) is a foundational component of a comprehensive HIV treatment program. In addition to preventing vertical transmission to children, PMTCT is an important catch-point for universal test-and-treat strategies that can reduce community viral load and slow the epidemic. However, systematic reviews suggest that care engagement in PMTCT programs is sub-optimal. This study enrolled a cohort of 200 women initiating PMTCT in Kilimanjaro, Tanzania, and followed them to assess HIV care engagement and associated factors. Six months after delivery, 42/200 (21%) of participants were identified as having poor care engagement, defined as HIV RNA >200 copies/mL or, if viral load was unavailable, being lost-to-follow-up in the clinical records or self-reporting being out of care. In a multivariable risk factor analysis, younger women were more likely to have poor postpartum care engagement; with each year of age, women were 7% less likely to have poor care engagement (aRR: 0.93; 95% CI: 0.89, 0.98). Additionally, women who had told at least one person about their HIV status were 47% less likely to have poor care engagement (aRR: .53; 95% CI: 0.29, 0.97). Among women who entered antenatal care with an established HIV diagnosis, those who were pregnant for the first time had increased risk of poor care engagement (aRR 4.16; 95% CI 1.53, 11.28). The findings suggest that care engagement remains a concern in PMTCT programs, and must be addressed to realize the goals of PMTCT. Comprehensive counseling on HIV disclosure, along with community-based stigma reduction programs to provide a supportive environment for people living with HIV, are crucial to address barriers to care engagement and support long-term treatment. Women presenting to antenatal care with an established HIV status require support for care engagement during the crucial period surrounding childbirth, particularly those pregnant for the first time.

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Published In

AIDS care

DOI

EISSN

1360-0451

ISSN

0954-0121

Publication Date

June 2019

Volume

31

Issue

6

Start / End Page

687 / 698

Related Subject Headings

  • Viral Load
  • Tanzania
  • Social Stigma
  • Public Health
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Postpartum Period
  • Patient Acceptance of Health Care
  • Mothers
  • Lost to Follow-Up
 

Citation

APA
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ICMJE
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Watt, M. H., Cichowitz, C., Kisigo, G., Minja, L., Knettel, B. A., Knippler, E. T., … Mmbaga, B. T. (2019). Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania. AIDS Care, 31(6), 687–698. https://doi.org/10.1080/09540121.2018.1550248
Watt, Melissa H., Cody Cichowitz, Godfrey Kisigo, Linda Minja, Brandon A. Knettel, Elizabeth T. Knippler, James Ngocho, Preeti Manavalan, and Blandina T. Mmbaga. “Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania.AIDS Care 31, no. 6 (June 2019): 687–98. https://doi.org/10.1080/09540121.2018.1550248.
Watt MH, Cichowitz C, Kisigo G, Minja L, Knettel BA, Knippler ET, et al. Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania. AIDS care. 2019 Jun;31(6):687–98.
Watt, Melissa H., et al. “Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania.AIDS Care, vol. 31, no. 6, June 2019, pp. 687–98. Epmc, doi:10.1080/09540121.2018.1550248.
Watt MH, Cichowitz C, Kisigo G, Minja L, Knettel BA, Knippler ET, Ngocho J, Manavalan P, Mmbaga BT. Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania. AIDS care. 2019 Jun;31(6):687–698.

Published In

AIDS care

DOI

EISSN

1360-0451

ISSN

0954-0121

Publication Date

June 2019

Volume

31

Issue

6

Start / End Page

687 / 698

Related Subject Headings

  • Viral Load
  • Tanzania
  • Social Stigma
  • Public Health
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Postpartum Period
  • Patient Acceptance of Health Care
  • Mothers
  • Lost to Follow-Up