Eliminating mother-to-child transmission of HIV (MTCT) in sub-Saharan Africa is hindered by limited understanding of HIV-testing and HIV-care engagement among pregnant and breastfeeding women. We investigated HIV-testing and HIV-care engagement during pregnancy and breastfeeding from 2014 to 2018 in the Agincourt Health and Demographic Surveillance System (HDSS). We linked HIV patient clinic records to HDSS pregnancy data. We modelled time to a first recorded HIV-diagnosis following conception, and time to antiretroviral therapy (ART) initiation following diagnosis using Kaplan-Meier methods. We performed sequence and cluster analyses for all pregnancies linked to HIV-related clinic data to categorise MTCT risk period engagement patterns and identified factors associated with different engagement patterns using logistic regression. We determined factors associated with ART resumption for women who were lost to follow-up (LTFU) using Cox regression. Since 2014, 15% of 10,735 pregnancies were recorded as occurring to previously (51%) or newly (49%) HIV-diagnosed women. New diagnoses increased until 2016 and then declined. We identified four MTCT risk period engagement patterns (i) early ART/stable care (51.9%), (ii) early ART/unstable care (34.1%), (iii) late ART initiators (7.6%), and (iv) postnatal seroconversion/early, stable ART (6.4%). Year of delivery, mother’s age, marital status, and baseline CD4 were associated with these patterns. A new pregnancy increased the likelihood of treatment resumption following LTFU. Almost half of all pregnant women did not have optimal ART coverage during the MTCT risk period. Programmes need to focus on improving retention, and leveraging new pregnancies to re-engage HIV-positive women on ART.

中文翻译：

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怀孕和母乳喂养期间艾滋病毒护理的参与模式：南非东北部一项队列研究的结果


撒哈拉以南非洲地区消除艾滋病毒母婴传播 (MTCT) 的工作因孕妇和哺乳期妇女对艾滋病毒检测和艾滋病毒护理参与的了解有限而受到阻碍。我们在阿金库尔健康和人口监测系统 (HDSS) 中调查了 2014 年至 2018 年怀孕和母乳喂养期间的艾滋病毒检测和艾滋病毒护理参与情况。我们将 HIV 患者临床记录与 HDSS 妊娠数据联系起来。我们使用 Kaplan-Meier 方法对受孕后首次记录的 HIV 诊断时间以及诊断后开始抗逆转录病毒治疗 (ART) 的时间进行了建模。我们对与 HIV 相关临床数据相关的所有妊娠进行了序列和聚类分析，以对 MTCT 风险期参与模式进行分类，并使用逻辑回归确定了与不同参与模式相关的因素。我们使用 Cox 回归确定了失访女性 (LTFU) 恢复 ART 的相关因素。自 2014 年以来，记录的 10,735 例怀孕中，有 15% 发生在先前 (51%) 或新近 (49%) 被诊断出艾滋病毒的女性身上。 2016 年之前新诊断病例有所增加，然后有所下降。我们确定了四种 MTCT 风险期参与模式 (i) 早期 ART/稳定护理 (51.9%)、(ii) 早期 ART/不稳定护理 (34.1%)、(iii) 晚期 ART 启动者 (7.6%) 和 (iv) 产后血清转化/早期、稳定的 ART (6.4%)。分娩年份、母亲年龄、婚姻状况和基线 CD4 与这些模式相关。新妊娠增加了 LTFU 后恢复治疗的可能性。几乎一半的孕妇在 MTCT 风险期内没有获得最佳的 ART 覆盖率。项目需要重点关注提高保留率，并利用新怀孕让艾滋病毒呈阳性的女性重新接受抗逆转录病毒治疗。