To evaluate the impact of a Perinatal Medical Case Management (PCM) Program for women living with HIV (WLWH). Characteristics of pregnant and postpartum WLWH were compared between those who engaged in PCM and those who did not. Using secondary data collected from routine HIV surveillance, multivariable regression models were used to evaluate the association between PCM and four outcomes adapted from the HIV care continuum. In multivariable models, compared to WLWH not in PCM, participants (n = 448, 52.8%) were almost twice as likely to achieve HIV suppression before delivery (aOR 1.90 [1.33, 2.71], p = 0.0005); were more likely to be retained in HIV care 1 year postpartum (aOR 1.59 [1.17, 2.16], p = 0.0029); and were equally likely to engage in HIV care within 90-days of delivery (aOR 1.21 [0.88, 1.65], p = 0.236) and be virally suppressed 1 year postpartum (aOR 1.26 [0.90, 1.77], p = 0.178). PCM is an important intervention for preventing perinatal HIV transmission and closings gaps in the HIV care continuum for WLWH during pregnancy and postpartum.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Centers for Disease Control and Prevention. HIV among pregnant women, infants, and children. 2016. https://www.cdc.gov/hiv/group/gender/pregnantwomen/index.html. Accessed 25 Nov 2016.
Centers for Disease Control and Prevention. HIV Among Women. 2016. https://www.cdc.gov/hiv/group/gender/women/. Accessed 12 Dec 2016.
Hess K, Hu X, Lansky A, Mermin J, Hall HI. Estimating the lifetime risk of a diagnosis of HIV infection in the United States. Paper presented at: CROI; 24 Feb 2016; Boston, MA.
Whitmore SK, Taylor AW, Espinoza L, Shouse RL, Lampe MA, Nesheim S. Correlates of mother-to-child transmission of HIV in the United States and Puerto Rico. Pediatrics. 2012;129(1):e74–81.
Camacho-Gonzalez AF, Kingbo MH, Boylan A, Eckard AR, Chahroudi A, Chakraborty R. Missed opportunities for prevention of mother-to-child transmission in the United States. AIDS. 2015;29(12):1511–5.
Kalichman SC, Grebler T. Stress and poverty predictors of treatment adherence among people with low-literacy living with HIV/AIDS. Psychosom Med. 2010;72(8):810–6.
Gielen AC, Ghandour RM, Burke JG, Mahoney P, McDonnell KA, O’Campo P. HIV/AIDS and intimate partner violence: intersecting women’s health issues in the United States. Trauma Violence Abuse. 2007;8(2):178–98.
Kapetanovic S, Christensen S, Karim R, et al. Correlates of perinatal depression in HIV-infected women. AIDS Patient Care STDS. 2009;23(2):101–8.
Philadelphia Department of Public Health. Archived AIDS Activities Coordinating Office HIV surveillance reports. http://www.phila.gov/health/aaco/aacodataresearch.html. Accessed 30 Nov 2016.
Momplaisir FM, Brady KA, Fekete T, Thompson DR, Diez Roux A, Yehia BR. Time of HIV diagnosis and engagement in prenatal care impact virologic outcomes of pregnant women with HIV. PLoS ONE. 2015;10(7):e0132262. doi:10.1371/journal.pone.0132262.
Adams JW, Brady KA, Michael YL, Yehia BR, Momplaisir FM. Postpartum engagement in HIV care: an important predictor of long-term retention in care and viral suppression. Clin Infect Dis. 2015;61(12):1880–7.
Panel on treatment of HIV-infected pregnant women and prevention of perinatal transmission. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States. 2015. http://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf. Accessed 28 Nov 2016.
Nachega JB, Uthman OA, Anderson J, et al. Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis. AIDS. 2012;26(16):2039–52.
Mellins CA, Chu C, Malee K, et al. Adherence to antiretroviral treatment among pregnant and postpartum HIV-infected women. AIDS Care. 2008;20(8):958–68.
Katz MH, Cunningham WE, Fleishman JA, et al. Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons. Ann Intern Med. 2001;135(8 Part 1):557–65.
Magnus M, Schmidt N, Kirkhart K, et al. Association between ancillary services and clinical and behavioral outcomes among HIV-infected women. AIDS Patient Care STDS. 2001;15(3):137–45.
Philadelphia Department of Public Health. AIDS Activities Coordinating Office (AACO) Perinatal Medical Case Management Standards. [unpublished standard]. Philadelphia, PA: AIDS Activities Coordinating Office; 2012.
Pediatric AIDS Chicago Prevention Initiative. Enhanced case management. 2016. http://www.pregnantandpositive.org/programs/enhanced-case-management/. Accessed 4 Nov 2016.
Los Angeles Department of Public Health. Los Angeles County standards for perinatal HIV prevention and care. 2005. http://publichealth.lacounty.gov/wwwfiles/ph/hae/hiv/LOS_ANGELES_COUNTY_STANDARDS_FOR_PERINATAL_HIV_PREVENTION.pdf. Accessed 28 Oct 2016.
Centers for Disease Control and Prevention. Enhanced perinatal surveillance-15 areas, 2005-2008. HIV Surveillance Supplemental Report. April 2011; 16(No.2). http://www.cdc.gov/hiv/pdf/statistics_2005_2008_HIV_Surveillance_Report_vol_16_no2.pdf. Accessed 6 Oct 2016.
Dean BB, Hart RL, Buchacz K, et al. HIV laboratory monitoring reliably identifies persons engaged in care. J Acquir Immune Defic Syndr. 2015;68(2):133–9.
Rebeiro P, Althoff KN, Lau B, et al. Laboratory measures as proxies for primary care encounters: implications for quantifying clinical retention among HIV-infected adults in North America. Am J Epidemiol. 2015;182(11):952–60.
United States Department of Health and Human Services Health Resources Service Administration. HIV/AIDS Bureau core performance measures. 2013; http://hab.hrsa.gov/deliverhivaidscare/coremeasures.pdf. Accessed 20 Nov 2016.
Panel on antiretroviral guidelines for adults and adolescents. Archived adult and adolescent guidelines: guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. 2016. https://aidsinfo.nih.gov/guidelines/archive/adult-and-adolescent-guidelines. Accessed 2 Nov 2016.
Kessner DM, Institute of Medicine Panel on Health Services Research. Infant death: an analysis by maternal risk and health care. Vol 1. Washington, DC: Institute of Medicine; 1973.
Hart JE, Jeon CY, Ivers LC, et al. Effect of directly observed therapy for highly active antiretroviral therapy on virologic, immunologic, and adherence outcomes: a meta-analysis and systematic review. J Acquir Immune Defic Syndr. 2010;54(2):167–79.
Mbuagbaw L, Sivaramalingam B, Navarro T, et al. Interventions for enhancing adherence to antiretroviral therapy (ART): a systematic review of high quality studies. AIDS Patient Care STDS. 2015;29(5):248–66.
Higa DH, Marks G, Crepaz N, Liau A, Lyles CM. Interventions to improve retention in HIV primary care: a systematic review of U.S. studies. Curr HIV/AIDS Rep. 2012;9(4):313–25.
Chaiyachati KH, Ogbuoji O, Price M, Suthar AB, Negussie EK, Bärnighausen T. Interventions to improve adherence to antiretroviral therapy: a rapid systematic review. AIDS. 2014;28(Suppl 2):S187–204.
Melekhin VV, Shepherd BE, Jenkins CA, et al. Postpartum discontinuation of antiretroviral therapy and risk of maternal AIDS-defining events, non-AIDS-defining events, and mortality among a cohort of HIV-1-infected women in the United States. AIDS Patient Care STDS. 2010;24(5):279–86.
Quinlivan EB, Fletcher J, Eastwood EA, Blank AE, Verdecias N, Roytburd K. Health status of HIV-infected women entering care: baseline medical findings from the women of color initiative. AIDS Patient Care STDS. 2015;29(Suppl 1):S11–9.
Ickovics JR, Hamburger ME, Vlahov D, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV epidemiology research study. JAMA. 2011;285(11):1466–74.
Rubin LH, Cook JA, Grey DD, et al. Perinatal depressive symptoms in HIV-infected versus HIV-uninfected women: a prospective study from preconception to postpartum. J Women’s Health. 2011;20(9):1287–95.
Buchberg MK, Fletcher FE, Vidrine DJ, et al. A mixed-methods approach to understanding barriers to postpartum retention in care among low-income, HIV-infected women. AIDS Patient Care STDS. 2015;29(3):126–32.
Lambert JS, Avramovic G, Jackson V, Sammon N, Lally S, Campbell FJ. Investigation into the reasons for maternal default from HIV care postpartum: a 3-year retrospective review. AIDS Patient Care STDS. 2014;28(1):1–3.
Stein MD, Crystal S, Cunningham WE, et al. Delays in seeking HIV care due to competing caregiver responsibilities. Am J Public Health. 2000;90(7):1138–40.
Martin M, Del Cacho E, Codina C, et al. Relationship between adherence level, type of the antiretroviral regimen, and plasma HIV type 1 RNA viral load: a prospective cohort study. AIDS Res Hum Retroviruses. 2008;24(10):1263–8.
Puskas CM, Forrest JI, Parashar S, et al. Women and vulnerability to HAART non-Adherence: a literature review of treatment adherence by gender from 2000 to 2011. Curr HIV/AIDS Rep. 2011;8(4):277–87.
Rosen S, Maskew M, Fox MP, et al. Initiating antiretroviral therapy for HIV at a patient’s first clinic visit: the RapIT randomized controlled trial. PLoS Med. 2016;13(5):e1002015. doi:10.1371/journal.pmed.1002015.
The authors would like to thank to Joëlla Adams, Mary Hovinga, Melissa Miller, Monica Moses, Tanner Nassau, and Deborah Storm for their contributions to the conduct of this study. This work was partially supported by CDC Grant IU62PS003959-01/13-20643-02.
Conflict of interest
All authors, no potential conflict of interest.
All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Full committee IRB approval was obtained from the Philadelphia Department of Public Health. Data were collected as part of routine HIV surveillance activities.
About this article
Cite this article
Anderson, E.A., Momplaisir, F.M., Corson, C. et al. Assessing the Impact of Perinatal HIV Case Management on Outcomes Along the HIV Care Continuum for Pregnant and Postpartum Women Living With HIV, Philadelphia 2005–2013. AIDS Behav 21, 2670–2681 (2017). https://doi.org/10.1007/s10461-017-1714-9