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Protocol for a prospective evaluation of postpartum engagement in HIV care among women living with HIV in South Africa
  1. Christina Psaros1,2,
  2. Amelia M Stanton1,2,
  3. C Andres Bedoya1,2,
  4. Nzwakie Mosery3,
  5. Shannon Evans3,
  6. Lynn Turner Matthews4,
  7. Jessica Haberer1,5,
  8. Mark Vangel1,6,
  9. Steven Safren7,
  10. Jennifer A Smit3
  1. 1 Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3 MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa
  4. 4 Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  5. 5 Center for Global Health, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
  6. 6 Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  7. 7 Department of Psychology, University of Miami, Coral Gables, Florida, USA
  1. Correspondence to Dr Christina Psaros; cpsaros{at}


Introduction KwaZulu-Natal (KZN), South Africa (SA) has the highest prevalence of pregnant women living with HIV in the world. Pregnancy and the postpartum period offer opportunities to engage women in HIV care, to prevent perinatal transmission and to optimise maternal and infant well-being. However, research suggests that remaining engaged in HIV care during this time can be challenging.

Methods and analysis We are conducting a 5-year prospective cohort study among pregnant women living with HIV in KZN to estimate the rates and factors associated with attrition from HIV care during this critical period. To determine who is most likely to fall out of care, we are examining a range of relevant variables informed by a socioecological model of HIV care, including individual, relational, community and healthcare system variables. We are enrolling 18–45-year-old women, at 28 weeks or more of pregnancy, who are living with HIV and currently taking antiretroviral therapies. Participants complete quantitative assessments at baseline (pregnancy) and at 6, 12, 18 and 24 months postpartum. A subset of women and their partners are invited to complete qualitative interviews to further explore their experiences in HIV care. The main study outcomes are suppressed HIV RNA and retention in care at each study assessment. Our understanding of the factors that drive postpartum attrition from HIV care will ultimately inform the development of interventions to facilitate continued engagement in postpartum HIV care.

Ethics and dissemination This protocol has been approved by the Human Research Ethics Committee (Medical) at The University of the Witwatersrand (Johannesburg, SA) and the Partners Human Research Committee at Partners HealthCare (Boston, Massachusetts, USA). Site support and approval were obtained from the District Hospital and the KZN Provincial Department of Health. Results will be disseminated through peer-reviewed manuscripts, reports and both local and international presentations (Ethics Registration #170 212).

  • HIV & AIDS
  • protocols & guidelines
  • public health
  • mental health
  • maternal medicine
  • pregnancy
  • retention in care

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  • Contributors CP is the principal investigator (PI) of the study. AS is a postdoctoral fellow on the project and led the development of the manuscript with CP and with input from all authors. CAB is the US-based project director coordinating study operations, including managing the database. NM is the South African-based project director; in this capacity, NM helps oversee all study operations, including supervising and training research assistants to collect the data. SE serves as medical director of the project and is therefore responsible for managing the HIV RNA testing, genotyping and sample storage. LTM, JH and SS are consultants with expertise in women’s reproductive health and the psychosocial aspects of HIV care. MV is responsible for conducting the statistical analyses and JAS is the site PI.

  • Funding This work is supported by funding from the NIH (R01 MH112385-01; 5T32MH116140-02). All authors, except for AS, were funded by R01 MH112385-01 (PI: Psaros). AS is funded by a T32 training grant (5T32MH116140-02). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests LTM has worked as a paid consultant for Merck Pharmaceuticals.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally reviewed.

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