Toward improving retention in HIV care after pregnancy: lessons from a post-pandemic cohort in the United States.

Introduction: People living with HIV (PLWH) often experience low rates of retention in HIV care (RIC) and suboptimal viral suppression postpartum. Understanding contemporary barriers to RIC is crucial to identify risk factors for loss to care and thereby improve support during this vulnerable transition. This work aimed to identify factors associated with adequate RIC, defined as two HIV care visits ≥90 days apart in the first year postpartum. Methods: Electronic records were retrospectively reviewed for PLWH who delivered from 2019 to 2023 and received prenatal care within a single county health system. Variables were collected related to both maternal and neonatal HIV and obstetric or pediatric care. Variables were analyzed using descriptive statistics, and Kaplan-Meier curves were used to assess viral suppression during pregnancy and the first year postpartum. A Random Forest machine learning model was used to determine variables of relative importance for prediction of adequate RIC. Multivariable logistic regression was used to evaluate impact of identified variables on RIC. Results: Of 182 pregnancies, sixty individuals (33%) achieved adequate postpartum RIC. Adequate RIC correlated with year of delivery ( Discussion: Postpartum RIC was suboptimal in this contemporary US single-site cohort. Engagement in prenatal and postpartum obstetric care predicted improved postpartum RIC. Further qualitative research is essential to improve deeper understanding of patterns of engagement perinatally in order to develop effective interventions to improve support for individuals during this difficult transition.