Loss to follow-up of HIV-infected women after delivery: The Swiss Mother and Child HIV Cohort Study Karoline Aebi-Popp, Roger Kouyos, Barbara Bertisch, Cornelia Stähelin, Christoph Rudin, Irene Hoesli, Begoña Martinez deTejada, Marcel Stoeckle, Enos Bernasconi, Matthias Cavassini, Claudia Grawe, Thanh Doco Lecompte, Martin Rickenbach, ClaireThorne, Jan Fehr and the Swiss Mother and Child HIV Cohort Study and the Swiss HIV Cohort Study Karoline Aebi-Popp Department of Infectious Diseases University Hospital Bern, Switzerland

Background Prevention of Mother to Child Transmission of HIV (MTCT) Prevention of MTCT as gateway to engage in HIV care for those newly diagnosed and for those who have lost contact with HIV services Use of antiretroviral therapy (ART) has reduced MTCT of HIV from 20-30% to rates below 0.5% 2012 the WHO declared the Option B plus as strategy recommending lifelong combined ART for women after pregnancy

Background HIV infected pregnant women are motivated to engage in HIV medical care to successfully prevent transmission of HIV to their babies After delivery childcare and competing commitments might lead to disengagement from HIV care Engagement in HIV care beyond pregnancy is crucial to preserve maternal health and to prevent adverse outcomes in subsequent pregnancies

Background Aim of this study was to evaluate the proportion of women who were Lost to Follow up (LTFU) after giving birth Secondary aim was to identify risk factors and possible reasons for not attending HIV services after delivery Further we wanted to describe the impact on CD4 and Viral load parameters for women coming back after being LTFU

Methods We analysed data on 719 pregnancies within the Swiss HIV Cohort Study from and with information on follow-up visits available Definitions: – delayed return to HIV care: >180 days after delivery – LTFU: no follow up > 365 days following delivery. Logistic regression analysis was used to identify risk factors for a LTFU event after delivery

Results Median maternal age at delivery: 32 years (IQR 28-36) Ethnicity: 357 (50%) black, 280 (39%) white, 56 (8%) Asian 107(15%) women with history of IDU 524 (73%) HIV diagnosis before pregnancy, of those 79% diagnosed with HIV >3 years and 65% already on ART at time of conception 181 diagnosed during pregnancy: 80 (44%) 1st trimester, 67 (37%) 2nd trimester and 34 (19%) 3rd trimester

Results Reasons „never returned“: 15 no response 8 emigrated 5 stopped study 5 changed doctor 3 deaths 2 unknown

Results Detectable VL at delivery and history of IDU asosciated with LTFU

Results

Example of subsequent pregnancies: VL and CD 4 Thanks to R. Kouyos Results

Conclusion Pregnant women with HIV are prone to disengage from sustainable HIV care after delivery. In this cohort, failure to suppress HIV VL until delivery as well as history of IDU were associated with postnatal disengagement from care. The continuation of ART after delivery has benefits in terms of maternal health and future pregnancy outcomes but requires continuous engagement in HIV care.

Conclusion How to engage and retain women in HIV care Counselling which take into account women`s perceptions about HIV and readiness for therapy Establish an environment that is woman centered and responsive (flexible hours, child care on site, multidisciplinary team). Coordinate medical and social service support teams, including assistance with health system navigation and mental health services Implementation of patient`s networking groups ( e.g. PFS Switzerland )