Abstract
Background: Many women living with HIV (WLWH) experience poor postpartum retention in HIV care. There are limited evidence-based interventions in the United States aimed at increasing retention of WLWH postpartum; however, evidence from low-resource settings suggest that women who receive peer mentoring experience higher retention and viral suppression postpartum.Methods: We conducted 15 semistructured interviews with pregnant or postpartum women from an urban U.S. clinic to assess factors influencing maternal adherence to antiretroviral therapy (ART) and retention in HIV care. We then assessed the acceptability of a peer intervention in mitigating barriers to sustain adherence and retention in care postpartum. Interviews were audio taped, transcribed, and analyzed. Codes were developed and applied to all transcripts, and matrices were used to facilitate comparisons across different types of participants.Results: Participants included low-income black and Hispanic women with a mean age of 31 years (range 22–42). Social support and concern for infants' well-being were strong facilitators for engaging in care. Psychosocial challenges, such as stigma and isolation, fear of disclosure, and depression, negatively influenced adherence to ART and engagement in care. Regardless of their level of adherence to ART, women felt that peer mentoring would be an acceptable intervention to reinforce skill-related ART adherence and sustain engagement in care after delivery.Conclusion: A peer mentor mother program is a promising intervention that can improve the care continuum of pregnant and postpartum women in the United States. Messaging that maximizes maternal support and women's motivation to keep their infant healthy may leverage retention in care postpartum.
Highlights
Women living with HIV (WLWH) experience poor viral suppression during labor and delivery and in the postpartum period.[1,2] An elevated viral load increases the risk of perinatal transmission of HIV and can lead to maternal progression to AIDS. the United States is reaching elimination goals for perinatal transmission of HIV,[3] racial disparities persist with perinatal transmission being 10 times higher among blacks compared to Hispanics and a Yetunde Akinde et al 2019; Published by Mary Ann Liebert, Inc
Study participants thought that the peer mentor intervention would be an acceptable measure to mitigate challenges in the postpartum period
Many of the challenges that women reported in the qualitative interviews regarding antiretroviral therapy (ART) adherence and retention in HIV care postpartum have been previously described in low- and high-resource settings
Summary
Women living with HIV (WLWH) experience poor viral suppression during labor and delivery and in the postpartum period.[1,2] An elevated viral load increases the risk of perinatal transmission of HIV and can lead to maternal progression to AIDS. the United States is reaching elimination goals for perinatal transmission of HIV,[3] racial disparities persist with perinatal transmission being 10 times higher among blacks compared to Hispanics and a Yetunde Akinde et al 2019; Published by Mary Ann Liebert, Inc. Despite this period of vulnerability, there is a lack of evidence-based interventions aimed at improving retention and viral suppression postpartum for U.S women.[5]. Social support and concern for infants’ well-being were strong facilitators for engaging in care Psychosocial challenges, such as stigma and isolation, fear of disclosure, and depression, negatively influenced adherence to ART and engagement in care. Messaging that maximizes maternal support and women’s motivation to keep their infant healthy may leverage retention in care postpartum
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