Birth Outcomes and Retention in Care among HIV-Exposed Infants at a Tertiary Care Hospital in Thailand

Abstract

Objective: To describe birth outcomes and retention in care at 6 and 18 months after birth and identify associated factors among pregnant women living with HIV and their infants. Materials and Methods: A retrospective descriptive study was conducted at a large tertiary care center in Bangkok, Thailand. Retention in care among postpartum women living with HIV was defined as the follow-up duration after delivery at an HIV clinic. High risk of HIV vertical transmission was defined according to a standard guideline. Results: Between January 2015 and December 2019, 153 pregnant women living with HIV with 154 live births of HIV-exposed infants were reviewed and categorized into 132 (86%) low risk and 21 (14%) high risk groups. The overall median maternal age was 31 years (IQR 26 to 35). High-risk mothers were younger at a median age of 25 years versus 32 years (p=0.009). Nineteen (12%) of the mothers experienced premature labor and 31 (20%) of the infants had low birth weight. Early infant diagnosis was completed among 143 (93%) of the HIV-exposed infants, with one child infected with HIV. Overall HIV transmission rate was 0.6% (95% CI 0.1 to 3.5). Pregnant women with detectable HIV RNA before delivery had a higher risk of low-birth-weight infants (aOR 3.19, 95% CI 1.12 to 9.04). Retention in care of postpartum women was 85.0% (95% CI 78.3 to 89.7) and 76.5% (95% CI 68.9 to 82.4), at 6 and 18 months after delivery, respectively. Mothers who initiated antiretroviral therapy (ART) before pregnancy had a higher probability ofretention in care at 85.5% (95% CI 76.0 to 91.5) compared to mothers who initiated ARV during pregnancy or after delivery at 65.7% (95% CI 53.3 to 75.5, p=0.012). Conclusion: High-risk HIV-exposed infants were at higher risk of loss in retention of care. Developing an effective program for this target population is needed. Keywords: Birth outcomes; HIV; HIV-exposed infant; Retention