Loss to Follow-Up after Pregnancy among Sub-Saharan Africa-Born Women Living with Human Immunodeficiency Virus in England, Wales and Northern Ireland: Results from a Large National Cohort

Shema Tariq; Jonathan Elford; Cuong Chau; Clare French; Mario Cortina-Borja; Alison Brown; Valerie Delpech; Pat A. Tookey

doi:10.1097/OLQ.0000000000000442

Loss to Follow-Up after Pregnancy among Sub-Saharan Africa-Born Women Living with Human Immunodeficiency Virus in England, Wales and Northern Ireland: Results from a Large National Cohort

Shema Tariq^*, Jonathan Elford, Cuong Chau, Clare French, Mario Cortina-Borja, Alison Brown, Valerie Delpech, Pat A. Tookey

^*Corresponding author for this work

HIV & Aids Reporting

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

Abstract

Background Little is known about retention in human immunodeficiency virus (HIV) care in HIV-positive women after pregnancy in the United Kingdom. We explored the association between loss to follow-up (LTFU) in the year after pregnancy, maternal place of birth and duration of UK residence, in HIV-positive women in England, Wales, and Northern Ireland. Methods We analyzed combined data from 2 national data sets: the National Study of HIV in Pregnancy and Childhood; and the Survey of Prevalent HIV Infections Diagnosed, including pregnancies in 2000 to 2009 in women with diagnosed HIV. Logistic regression models were fitted with robust standard errors to estimate adjusted odds ratios (AOR). Results Overall, 902 of 7211 (12.5%) women did not access HIV care in the year after pregnancy. Factors associated with LTFU included younger age, last CD4 in pregnancy of 350 cells/μL or greater and detectable HIV viral load at the end of pregnancy (all P < 0.001). On multivariable analysis, LTFU was more likely in sub-Saharan Africa-born (SSA-born) women than white UK-born women (AOR, 2.17; 95% confidence interval, 1.50-3.14; P < 0.001). The SSA-born women who had migrated to the UK during pregnancy were 3 times more likely than white UK-born women to be lost to follow-up (AOR, 3.19; 95% confidence interval, 1.94-3.23; P < 0.001). Conclusions One in 8 HIV-positive women in England, Wales, and Northern Ireland did not return for HIV care in the year after pregnancy, with SSA-born women, especially those who migrated to the United Kingdom during pregnancy, at increased risk. Although emigration is a possible explanatory factor, disengagement from care may also play a role.

Original language	English
Pages (from-to)	283-289
Number of pages	7
Journal	Sexually Transmitted Diseases
Volume	43
Issue number	5
DOIs	https://doi.org/10.1097/OLQ.0000000000000442
Publication status	Published - 1 May 2016

Bibliographical note

Funding Information:
ST was funded by the UK Medical Research Council (MRC) to conduct this work (Award number: G0701648 ID 85538, administered by City University London). Any views expressed in this paper are those of the authors, and not necessarily those of the funders. When this work was carried out the National Study of HIV in Pregnancy and Childhood received core funding from the Health Protection Agency (grant number GHP/003/013/003). The Population, Policy and Practice Programme benefitted from funding support from the MRC in its former capacity as the MRC Centre of Epidemiology for Child Health (grant number G0400546). The University College London Institute of Child Health received a proportion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme. Clare French was funded by a Medical Research Council PhD studentship.

Publisher Copyright:
Copyright © 2016 American Sexually Transmitted Diseases Association.

Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.

Keywords

HIV
postpartum period
pregnancy
women

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/OLQ.0000000000000442

Cite this

Tariq, S., Elford, J., Chau, C., French, C., Cortina-Borja, M., Brown, A., Delpech, V., & Tookey, P. A. (2016). Loss to Follow-Up after Pregnancy among Sub-Saharan Africa-Born Women Living with Human Immunodeficiency Virus in England, Wales and Northern Ireland: Results from a Large National Cohort. Sexually Transmitted Diseases, 43(5), 283-289. https://doi.org/10.1097/OLQ.0000000000000442

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abstract = "Background Little is known about retention in human immunodeficiency virus (HIV) care in HIV-positive women after pregnancy in the United Kingdom. We explored the association between loss to follow-up (LTFU) in the year after pregnancy, maternal place of birth and duration of UK residence, in HIV-positive women in England, Wales, and Northern Ireland. Methods We analyzed combined data from 2 national data sets: the National Study of HIV in Pregnancy and Childhood; and the Survey of Prevalent HIV Infections Diagnosed, including pregnancies in 2000 to 2009 in women with diagnosed HIV. Logistic regression models were fitted with robust standard errors to estimate adjusted odds ratios (AOR). Results Overall, 902 of 7211 (12.5%) women did not access HIV care in the year after pregnancy. Factors associated with LTFU included younger age, last CD4 in pregnancy of 350 cells/μL or greater and detectable HIV viral load at the end of pregnancy (all P < 0.001). On multivariable analysis, LTFU was more likely in sub-Saharan Africa-born (SSA-born) women than white UK-born women (AOR, 2.17; 95% confidence interval, 1.50-3.14; P < 0.001). The SSA-born women who had migrated to the UK during pregnancy were 3 times more likely than white UK-born women to be lost to follow-up (AOR, 3.19; 95% confidence interval, 1.94-3.23; P < 0.001). Conclusions One in 8 HIV-positive women in England, Wales, and Northern Ireland did not return for HIV care in the year after pregnancy, with SSA-born women, especially those who migrated to the United Kingdom during pregnancy, at increased risk. Although emigration is a possible explanatory factor, disengagement from care may also play a role.",

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author = "Shema Tariq and Jonathan Elford and Cuong Chau and Clare French and Mario Cortina-Borja and Alison Brown and Valerie Delpech and Tookey, {Pat A.}",

note = "Funding Information: ST was funded by the UK Medical Research Council (MRC) to conduct this work (Award number: G0701648 ID 85538, administered by City University London). Any views expressed in this paper are those of the authors, and not necessarily those of the funders. When this work was carried out the National Study of HIV in Pregnancy and Childhood received core funding from the Health Protection Agency (grant number GHP/003/013/003). The Population, Policy and Practice Programme benefitted from funding support from the MRC in its former capacity as the MRC Centre of Epidemiology for Child Health (grant number G0400546). The University College London Institute of Child Health received a proportion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme. Clare French was funded by a Medical Research Council PhD studentship. Publisher Copyright: Copyright {\textcopyright} 2016 American Sexually Transmitted Diseases Association. Copyright: Copyright 2018 Elsevier B.V., All rights reserved.",

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Tariq, S, Elford, J, Chau, C, French, C, Cortina-Borja, M, Brown, A , Delpech, V & Tookey, PA 2016, 'Loss to Follow-Up after Pregnancy among Sub-Saharan Africa-Born Women Living with Human Immunodeficiency Virus in England, Wales and Northern Ireland: Results from a Large National Cohort', Sexually Transmitted Diseases, vol. 43, no. 5, pp. 283-289. https://doi.org/10.1097/OLQ.0000000000000442

Loss to Follow-Up after Pregnancy among Sub-Saharan Africa-Born Women Living with Human Immunodeficiency Virus in England, Wales and Northern Ireland: Results from a Large National Cohort. / Tariq, Shema; Elford, Jonathan; Chau, Cuong et al.
In: Sexually Transmitted Diseases, Vol. 43, No. 5, 01.05.2016, p. 283-289.

Research output: Contribution to journal › Article › peer-review

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T1 - Loss to Follow-Up after Pregnancy among Sub-Saharan Africa-Born Women Living with Human Immunodeficiency Virus in England, Wales and Northern Ireland

T2 - Results from a Large National Cohort

AU - Tariq, Shema

AU - Elford, Jonathan

AU - Chau, Cuong

AU - French, Clare

AU - Cortina-Borja, Mario

AU - Brown, Alison

AU - Delpech, Valerie

AU - Tookey, Pat A.

N1 - Funding Information: ST was funded by the UK Medical Research Council (MRC) to conduct this work (Award number: G0701648 ID 85538, administered by City University London). Any views expressed in this paper are those of the authors, and not necessarily those of the funders. When this work was carried out the National Study of HIV in Pregnancy and Childhood received core funding from the Health Protection Agency (grant number GHP/003/013/003). The Population, Policy and Practice Programme benefitted from funding support from the MRC in its former capacity as the MRC Centre of Epidemiology for Child Health (grant number G0400546). The University College London Institute of Child Health received a proportion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme. Clare French was funded by a Medical Research Council PhD studentship. Publisher Copyright: Copyright © 2016 American Sexually Transmitted Diseases Association. Copyright: Copyright 2018 Elsevier B.V., All rights reserved.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background Little is known about retention in human immunodeficiency virus (HIV) care in HIV-positive women after pregnancy in the United Kingdom. We explored the association between loss to follow-up (LTFU) in the year after pregnancy, maternal place of birth and duration of UK residence, in HIV-positive women in England, Wales, and Northern Ireland. Methods We analyzed combined data from 2 national data sets: the National Study of HIV in Pregnancy and Childhood; and the Survey of Prevalent HIV Infections Diagnosed, including pregnancies in 2000 to 2009 in women with diagnosed HIV. Logistic regression models were fitted with robust standard errors to estimate adjusted odds ratios (AOR). Results Overall, 902 of 7211 (12.5%) women did not access HIV care in the year after pregnancy. Factors associated with LTFU included younger age, last CD4 in pregnancy of 350 cells/μL or greater and detectable HIV viral load at the end of pregnancy (all P < 0.001). On multivariable analysis, LTFU was more likely in sub-Saharan Africa-born (SSA-born) women than white UK-born women (AOR, 2.17; 95% confidence interval, 1.50-3.14; P < 0.001). The SSA-born women who had migrated to the UK during pregnancy were 3 times more likely than white UK-born women to be lost to follow-up (AOR, 3.19; 95% confidence interval, 1.94-3.23; P < 0.001). Conclusions One in 8 HIV-positive women in England, Wales, and Northern Ireland did not return for HIV care in the year after pregnancy, with SSA-born women, especially those who migrated to the United Kingdom during pregnancy, at increased risk. Although emigration is a possible explanatory factor, disengagement from care may also play a role.

AB - Background Little is known about retention in human immunodeficiency virus (HIV) care in HIV-positive women after pregnancy in the United Kingdom. We explored the association between loss to follow-up (LTFU) in the year after pregnancy, maternal place of birth and duration of UK residence, in HIV-positive women in England, Wales, and Northern Ireland. Methods We analyzed combined data from 2 national data sets: the National Study of HIV in Pregnancy and Childhood; and the Survey of Prevalent HIV Infections Diagnosed, including pregnancies in 2000 to 2009 in women with diagnosed HIV. Logistic regression models were fitted with robust standard errors to estimate adjusted odds ratios (AOR). Results Overall, 902 of 7211 (12.5%) women did not access HIV care in the year after pregnancy. Factors associated with LTFU included younger age, last CD4 in pregnancy of 350 cells/μL or greater and detectable HIV viral load at the end of pregnancy (all P < 0.001). On multivariable analysis, LTFU was more likely in sub-Saharan Africa-born (SSA-born) women than white UK-born women (AOR, 2.17; 95% confidence interval, 1.50-3.14; P < 0.001). The SSA-born women who had migrated to the UK during pregnancy were 3 times more likely than white UK-born women to be lost to follow-up (AOR, 3.19; 95% confidence interval, 1.94-3.23; P < 0.001). Conclusions One in 8 HIV-positive women in England, Wales, and Northern Ireland did not return for HIV care in the year after pregnancy, with SSA-born women, especially those who migrated to the United Kingdom during pregnancy, at increased risk. Although emigration is a possible explanatory factor, disengagement from care may also play a role.

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KW - postpartum period

KW - pregnancy

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Loss to Follow-Up after Pregnancy among Sub-Saharan Africa-Born Women Living with Human Immunodeficiency Virus in England, Wales and Northern Ireland: Results from a Large National Cohort

Abstract

Bibliographical note

Keywords

UN SDGs

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