Differentiated models of care for postpartum women on antiretroviral therapy in Cape Town, South Africa: a cohort study

摘要

Background: The numbers of women initiating lifelong antiretroviral therapy (ART) during pregnancy and postpartum is increasing rapidly, presenting a burden on health systems and an urgent need for scalable models of care for this population. In a pilot project, we referred postpartum women who initiated ART during pregnancy to a community‐based model of differentiated ART services. Methods: Eligible women (on ART for at least 3 months with viral load (VL) Results: Through September 2015, n = 129 women were enrolled (median age, 28 years; median time postpartum, 10 days). Overall, 65% ( n = 84) chose adherence clubs and 35% ( n = 45) chose PHCs; there were no demographic or clinical predictors of this choice. Location of service delivery was commonly cited as a reason for choice by women selecting either model of care; shorter waiting times, ability to receive ART from lay counsellors and less frequent appointments were motivations for choosing adherence clubs. Among women choosing adherence clubs, 15% never attended the service and another 11% attended the service but were not retained through six months postpartum. Overall, 86% of women ( n = 111) remained in the evaluation through 6 months postpartum; in this group, there were no differences in VL Discussion: Adherence clubs may be a valuable model for postpartum women initiating ART in pregnancy, with good short‐term outcomes observed during this critical period. To support optimal implementation, further research is needed into patient preferences for models of care, with consideration of integration of maternal and child health services, while ART adherence and retention require ongoing consideration in this population.