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<p>Longitudinal patterns of engagement in care among women living with HIV (WHIV) during the perinatal period are poorly understood. We employed group-based trajectory modeling to (1) describe trajectories of HIV visit engagement; and (2) identify predictors of membership in suboptimal care trajectories. Data came from a prospective cohort study across five urban clinics in Lilongwe, Malawi conducted between February 2020 and August 2022. Participants were followed from entry into antenatal care (ANC) through 9 months postpartum. Trajectories were defined for 375 participants based on whether (1) ≥1 HIV care visit was attended; or (2) ≥1 HIV care visit was missed for each three-month interval during follow-up. Over a maximum of 15 months of follow-up, we identified two distinct trajectory groups for each HIV visit engagement outcome: “lower” (7%) vs. “consistently high” (93%) probability of attending a visit groups and “higher” (86%) vs. “consistently low” (14%) probability of missing a visit groups. Age &lt;25 years (odds ratio (OR) = 3.82, 95% CI 1.25, 11.73) or &gt;1&#xa0;hour of travel time to the clinic (OR = 3.54, 95% CI 1.44, 8.69) were associated with membership in the “lower” probability of attending a visit trajectory group. Enrollment after the start of the COVID-19 pandemic (OR = 0.23, 95% CI 0.07, 0.74) and higher gestational age at enrollment (OR = 0.28, 95% CI 0.09, 0.86) were protective against membership in the “lower” probability of attending a visit and the “higher” probability of missing a visit trajectory groups, respectively. In settings where missed visits are common, visit attendance may be an important indicator of care engagement.</p>

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Trajectories of HIV Visit Engagement During the Perinatal Period among Women in Lilongwe, Malawi

  • 期刊论文

  • 发表日期：

    2025年1月17日

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  • Danielle Giovenco,
  • Yu Li,
  • Wiza Kumwenda,
  • Madelyn Frey,
  • Shaphil Wallie,
  • Mina C. Hosseinipour,
  • Angela M. Bengtson

摘要

Longitudinal patterns of engagement in care among women living with HIV (WHIV) during the perinatal period are poorly understood. We employed group-based trajectory modeling to (1) describe trajectories of HIV visit engagement; and (2) identify predictors of membership in suboptimal care trajectories. Data came from a prospective cohort study across five urban clinics in Lilongwe, Malawi conducted between February 2020 and August 2022. Participants were followed from entry into antenatal care (ANC) through 9 months postpartum. Trajectories were defined for 375 participants based on whether (1) ≥1 HIV care visit was attended; or (2) ≥1 HIV care visit was missed for each three-month interval during follow-up. Over a maximum of 15 months of follow-up, we identified two distinct trajectory groups for each HIV visit engagement outcome: “lower” (7%) vs. “consistently high” (93%) probability of attending a visit groups and “higher” (86%) vs. “consistently low” (14%) probability of missing a visit groups. Age <25 years (odds ratio (OR) = 3.82, 95% CI 1.25, 11.73) or >1 hour of travel time to the clinic (OR = 3.54, 95% CI 1.44, 8.69) were associated with membership in the “lower” probability of attending a visit trajectory group. Enrollment after the start of the COVID-19 pandemic (OR = 0.23, 95% CI 0.07, 0.74) and higher gestational age at enrollment (OR = 0.28, 95% CI 0.09, 0.86) were protective against membership in the “lower” probability of attending a visit and the “higher” probability of missing a visit trajectory groups, respectively. In settings where missed visits are common, visit attendance may be an important indicator of care engagement.