The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV
Abstract Background South Africa is home to more people living with HIV than any other country, including nearly one in three pregnant women attending antenatal care. Access to antiretroviral therapy (ART) has increased substantially since the start of the national ART program in 2004, with > 95%...
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-020-09679-1 |
| _version_ | 1818452653117538304 |
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| author | Kate Clouse Babatyi Malope-Kgokong Jacob Bor Cornelius Nattey Maanda Mudau Mhairi Maskew |
| author_facet | Kate Clouse Babatyi Malope-Kgokong Jacob Bor Cornelius Nattey Maanda Mudau Mhairi Maskew |
| author_sort | Kate Clouse |
| collection | DOAJ |
| description | Abstract Background South Africa is home to more people living with HIV than any other country, including nearly one in three pregnant women attending antenatal care. Access to antiretroviral therapy (ART) has increased substantially since the start of the national ART program in 2004, with > 95% ART coverage during pregnancy and delivery, and vertical transmission of HIV greatly reduced. However, women who initiate ART during pregnancy are at heightened risk of dropping out of care, particularly after delivery, leading to the potential for viral transmission, morbidity and mortality. It is difficult to evaluate the success of policies of expanded access to ART care, and assess continuity of care, due to the lack of a national longitudinal HIV care database. Also, patient movement between unlinked facilities. For the first time on a national level, we propose to utilize routinely-collected laboratory data to develop and validate a cohort of pregnant women living with HIV in South Africa in a way that is uniquely robust to facility transfer. Methods Using laboratory test data matched to facility type, we will identify entry to antenatal care to build the cohort, then describe key treatment milestones, including 1) engagement in antenatal care, 2) initiation of ART, 3) HIV viremia, and 4) continuity of HIV care in the postpartum period. Second, we will measure the effect of system-wide factors impacting continuity of care among pregnant women. We will assess policies of expanded treatment access on continuity of care using regression-discontinuity analyses. We then will assess mobility and its effect on continuity of care during and after pregnancy. Third, we will identify individual-level risk factors for loss from HIV care in order to develop targeted interventions to improve engagement in HIV care. Discussion This work will create the world’s largest national cohort of pregnant women living with HIV. This novel cohort will be a powerful tool available to policymakers, clinicians and researchers for improving our understanding of engagement in care among pregnant women in South Africa and assessing the performance of the South African national ART program in caring for pregnant women living with HIV. Trial registration N/A (not a clinical trial). |
| first_indexed | 2024-12-14T21:26:30Z |
| format | Article |
| id | doaj.art-c5b0cd16b4754e4ab23f144ef7475471 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-14T21:26:30Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-c5b0cd16b4754e4ab23f144ef74754712022-12-21T22:46:47ZengBMCBMC Public Health1471-24582020-11-0120111110.1186/s12889-020-09679-1The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIVKate Clouse0Babatyi Malope-Kgokong1Jacob Bor2Cornelius Nattey3Maanda Mudau4Mhairi Maskew5Vanderbilt University School of NursingAcademic Affairs and Research, National Health Laboratory ServiceHealth Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the WitwatersrandHealth Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the WitwatersrandAcademic Affairs and Research, National Health Laboratory ServiceHealth Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the WitwatersrandAbstract Background South Africa is home to more people living with HIV than any other country, including nearly one in three pregnant women attending antenatal care. Access to antiretroviral therapy (ART) has increased substantially since the start of the national ART program in 2004, with > 95% ART coverage during pregnancy and delivery, and vertical transmission of HIV greatly reduced. However, women who initiate ART during pregnancy are at heightened risk of dropping out of care, particularly after delivery, leading to the potential for viral transmission, morbidity and mortality. It is difficult to evaluate the success of policies of expanded access to ART care, and assess continuity of care, due to the lack of a national longitudinal HIV care database. Also, patient movement between unlinked facilities. For the first time on a national level, we propose to utilize routinely-collected laboratory data to develop and validate a cohort of pregnant women living with HIV in South Africa in a way that is uniquely robust to facility transfer. Methods Using laboratory test data matched to facility type, we will identify entry to antenatal care to build the cohort, then describe key treatment milestones, including 1) engagement in antenatal care, 2) initiation of ART, 3) HIV viremia, and 4) continuity of HIV care in the postpartum period. Second, we will measure the effect of system-wide factors impacting continuity of care among pregnant women. We will assess policies of expanded treatment access on continuity of care using regression-discontinuity analyses. We then will assess mobility and its effect on continuity of care during and after pregnancy. Third, we will identify individual-level risk factors for loss from HIV care in order to develop targeted interventions to improve engagement in HIV care. Discussion This work will create the world’s largest national cohort of pregnant women living with HIV. This novel cohort will be a powerful tool available to policymakers, clinicians and researchers for improving our understanding of engagement in care among pregnant women in South Africa and assessing the performance of the South African national ART program in caring for pregnant women living with HIV. Trial registration N/A (not a clinical trial).http://link.springer.com/article/10.1186/s12889-020-09679-1HIV/AIDSPregnancyPostpartumWomen living with HIV/AIDSSouth AfricaBig data |
| spellingShingle | Kate Clouse Babatyi Malope-Kgokong Jacob Bor Cornelius Nattey Maanda Mudau Mhairi Maskew The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV BMC Public Health HIV/AIDS Pregnancy Postpartum Women living with HIV/AIDS South Africa Big data |
| title | The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV |
| title_full | The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV |
| title_fullStr | The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV |
| title_full_unstemmed | The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV |
| title_short | The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV |
| title_sort | south african national hiv pregnancy cohort evaluating continuity of care among women living with hiv |
| topic | HIV/AIDS Pregnancy Postpartum Women living with HIV/AIDS South Africa Big data |
| url | http://link.springer.com/article/10.1186/s12889-020-09679-1 |
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