Routine Electronic Mother-Infant Data (REMInD): A proof-of-Concept Data to Care Study to Support Retention in Maternal HIV Treatment and Infant HIV Testing in Cape Town, South Africa.

Abstract

Data to Care (D2C) strategies- using routine data to identify and re-engage people living with HIV who are not in care- have shown promise in high-income settings but remain underexplored in lower-resource and vertical HIV transmission prevention (VTP) contexts. In this prospective, single-arm, proof-of-concept study, we used facility-linked public sector electronic medical records (Provincial Health Data Centre [PHDC] data) to identify, validate and trace postpartum VTP gaps among 336 mothers living with HIV and their infants in Cape Town, South Africa (March 2021-April 2022). Of 302 observed gaps, 123 (41%) were false, while 179 (59%) were probable gaps affecting 133 mother-infant pairs. Overall, 16% of mothers did not link to HIV care within 12 weeks postpartum and 13% had ART dispensing gaps, while 10% and 17% of infants had no HIV test around 10 weeks and six months, respectively. Only 100 (56%) probable gaps were confirmed through telephonic tracing, with 47 mothers subsequently re-linked to care. Mobility, stigma, and employment challenges contributed to disengagement. While our D2C approach streamlined tracing efforts, re-engagement remained difficult. Strategies integrating D2C approaches with interventions addressing social determinants are needed.