A risk score to identify HIV-infected women most likely to become lost to follow-up in the postpartum period

Access to lifelong combination antiretroviral therapy (cART) is expanding among HIV-infected pregnant and breastfeeding women throughout sub-Saharan Africa (SSA). For this strategy to meaningfully improve maternal HIV outcomes, retention in HIV care is essential. We developed a risk score to identify women with high likelihood of loss to follow-up (LTFU) at 6 months postpartum from HIV care, using data from public health facilities in Lusaka, Zambia. LTFU was defined as not presenting for HIV care within 60 days of the last scheduled appointment. We used logistic regression to assess demographic, obstetric and HIV predictors of LTFU and to develop a simple risk score. Sensitivity and specificity were assessed at each risk score cut-point. Among 2029 pregnant women initiating cART between 2009 and 2011, 507 (25%) were LTFU by 6 months postpartum. Parity, education, employment status, WHO clinical stage, duration of cART during pregnancy and number of antenatal care visits were associated with LTFU (p-value < .10). A risk score cut-point of 11 (42nd percentile) had 85% sensitivity (95% CI 82%, 88%) and 22% specificity (95% CI 20%, 24%) to detect women LTFU and would exclude 20% of women from a retention intervention. A risk score cut-point of 18 (69th percentile) identified the 23% of women with the highest probability of LTFU and had sensitivity 32% (95% CI 28%, 36%) and specificity 80% (95% CI 78%, 82%). A risk score approach may be useful to triage a subset of women most likely to be LTFU for targeted retention interventions

Breastfeeding · Cart · Framingham Risk Score · Logistic regression · Obstetrics · Percentile · Pregnancy · Psychological intervention · Adolescent Sexual and Reproductive Health · Demography · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Nursing · Internal Medicine · Pediatrics

• Addressing Early Retention in Antenatal Care Among HIV-Positive Women Through a Simple Intervention in Kinshasa, DRC

  Open Access•Michelle M Gill, John Ditekemena et al.•AIDS and Behavior•2017

  Incluir item

• Experiences and Preferences in Zambia and South Africa for Delivery of HIV Treatment During a Client’s First Six Months

  Open Access•Nyasha Mutanda, Allison Morgan et al.•AIDS and Behavior•2025

  Incluir item

• Readiness for Antiretroviral Therapy

  Open Access•Brendan Maughan-Brown, Philip Smith et al.•AIDS and Behavior•2017

  Incluir item

• Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women (‘Option B+’) in Malawi

  Lyson Tenthani, Andreas D Haas et al.•AIDS•2014

  Incluir item

• Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV

  Open Access•Melanie Thompson, Melanie A Thompson et al.•Annals of Internal Medicine•2012

  Incluir item

• A Systematic Review of Individual and Contextual Factors Affecting ART Initiation, Adherence, and Retention for HIV-Infected Pregnant and Postpartum Women

  Open Access•Ian Hodgson, Mary L Plummer et al.•PLoS ONE•2014

  Incluir item

• Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa

  Open Access•Sydney Rosen, Matthew P Fox et al.•PLoS Medicine•2011

  Incluir item

• Socio-demographic factors associated with loss to follow-up of HIV-infected women attending a private sector PMTCT program in Maharashtra, India

  Mayuri Panditrao, Mayuri V Panditrao et al.•AIDS Care•2011

  Incluir item

• Barriers to care among people living with HIV in South Africa

  Laura M Bogart, Senica Chetty et al.•AIDS Care•2013

  Incluir item

• Do Social Support, Stress, Disclosure and Stigma Influence Retention in HIV Care for Latino and African American Men Who Have Sex with Men and Women

  Open Access•Amy Rock Wohl, Frank H Galván et al.•AIDS and Behavior•2010

  Incluir item