A Longitudinal Assessment of Interruptions in HIV Clinic Visits and Virologic Failure among Pregnant and Postpartum Women in the Kabeho Study

Background: Antiretroviral therapy (ART) for women with HIV is recommended for life, yet most studies measure retention in HIV care and treatment as a binary outcome rather than patterns of intermittent clinic attendance. Pregnancy and the post-partum period are critical times to study interruptions in care, as retention among these women is particularly challenging and can affect the outcomes of both the mother and her child. Methods: The Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (Kabeho) study was an observational prospective cohort of 608 pregnant and postpartum women with HIV followed for 2 years. Clinic visit attendance was used to construct an interruption variable defined as a missed visit followed by a return to care. In multivariate analyses, we examined interruption patterns as predictors of virologic failure and detectable viral load. Results: During the study period, 48% of women had multiple visit interruptions and 29% had an interruption that lasted more than one month. Adjusting for age, ART regimen, time on ART, and CD4 count, the odds of virologic failure among women with multiple interruptions were almost 3 times higher than for women with one or no interruptions (aOR=2.72, 95%CI: 1.09, 6.77). The odds of virologic failure were nearly 3.5 times higher among women with an interruption lasting more than one month compared with women with shorter or no interruptions (aOR=3.47, 95%CI: 1.59, 7.66). Conclusions: Interruptions in HIV care visits are common with significant increases in virologic failure among women with multiple and long-term interruptions. Measuring patterns of interruption, rather than a single binary measure captures the fluid nature of lifetime and health-seeking behavior.