Improving Perinatal HIV Care during the COVID-19 Pandemic: Implementing a Mobile Integrated Health Program to Close the Gap.

Abstract

Background: Pregnant people with HIV (PWH) often experience loss to follow-up and viral non-suppression after delivery, contributing to morbidity and HIV transmission. The COVID-19 pandemic disrupted health systems and exacerbated health disparities, including for PWH and their infants. To improve perinatal HIV outcomes, we implemented a perinatal care program in September 2020 that offered multidisciplinary home visits through a Mobile Integrated Health (MIH) unit within a large, safety-net healthcare system in Atlanta, Georgia.

Methods: We analyzed data collected from PWH who delivered one year before (8/31/19-8/31/20; pre-implementation) to six months after (9/1/20-2/28/21; post-implementation) MIH implementation to compare HIV clinical outcomes. We evaluated barriers, facilitators, and patient preferences through exit surveys with MIH program participants.

Results: Overall, 32 (53%) delivered before and 28 (47%) PWH delivered after MIH implementation; majority were non-Hispanic Black. Three-fourths who delivered post-MIH utilized MIH, mostly (62%) for postpartum obstetric visits. HIV visit attendance within 3 months and retention in care at 6 months of delivery were significantly higher post-implementation (p = 0.04). Participants noted that the MIH program significantly improved appointment scheduling and access to healthcare services during the pandemic (p < 0.05). Participants highly rated the preferability, convenience, safety, and use of the MIH program for future pregnancies.

Conclusions: Implementation of a perinatal MIH program for PWH and their infants led to significant improvement in engagement in HIV care after delivery. Our findings demonstrate that novel, interdisciplinary programming can fill critical gaps in care delivery, including during periods of healthcare disruption.