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Adherence to HIV Care After Pregnancy Among Women in Sub-Saharan Africa: Falling Off the Cliff of the Treatment Cascade

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Abstract

Increased access to testing and treatment means HIV can be managed as a chronic illness, though successful management requires continued engagement with the health care system. Most of the global HIV burden is in sub-Saharan Africa where rates of new infections are consistently higher in women versus men. Pregnancy is often the point at which an HIV diagnosis is made. While preventing mother to child transmission (PMTCT) interventions significantly reduce the rate of vertical transmission of HIV, women must administer ARVs to their infants, adhere to breastfeeding recommendations, and test their infants for HIV after childbirth. Some women will be expected to remain on the ARVs initiated during pregnancy, while others are expected to engage in routine testing so treatment can be reinitiated when appropriate. The postpartum period presents many barriers to sustained treatment adherence and engagement in care. While some studies have examined adherence to postpartum PMTCT guidelines, few have focused on continued engagement in care by the mother, and very few examine adherence beyond the 6-week postpartum visit. Here, we attempt to identify gaps in the research literature and make recommendations on how to address barriers to ongoing postpartum HIV care.

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Acknowledgments

Dr. Psaros’ time was supported by NIMH grant number K23MH096651. Additional author time was supported by K24MH094214 (Safren) and K24MH87227 (Bangsberg).

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Conflict of Interest

Christina Psaros, Steven A. Safren, and David R. Bangsberg declare grant support from NIMH.

Jocelyn E. Remmert and Jennifer A. Smit declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02140, USA

    Christina Psaros, Jocelyn E. Remmert, David R. Bangsberg & Steven A. Safren

  2. Harvard Medical School, Boston, MA, USA

    Christina Psaros, David R. Bangsberg & Steven A. Safren

  3. Harvard School of Public Health, Boston, MA, USA

    David R. Bangsberg

  4. Maternal, Adolescent and Child Health Research, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa

    Jennifer A. Smit

  5. School of Pharmacy and Pharmacology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

    Jennifer A. Smit

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  1. Christina Psaros
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Correspondence to Christina Psaros.

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Psaros, C., Remmert, J.E., Bangsberg, D.R. et al. Adherence to HIV Care After Pregnancy Among Women in Sub-Saharan Africa: Falling Off the Cliff of the Treatment Cascade. Curr HIV/AIDS Rep 12, 1–5 (2015). https://doi.org/10.1007/s11904-014-0252-6

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