COVID-19 Pandemic: Engagement in Obstetric Care for Women with HIV and Substance Use Disorder

Background: HIV and substance use disorder are major risk factors for poor obstetric outcomes and women who live with both conditions should be closely monitored during pregnancy and postpartum. It is unclear what engagement in obstetric care for women living with HIV and substance use disorder look like before and during the COVID-19 pandemic. This literature review aims to examine engagement in obstetric care for women living with HIV and substance use disorder before and during the COVID-19 pandemic and offer strategies to increase engagement in care during the COVID-19 pandemic for this vulnerable population. Methods: A literature review was conducted on January 12, 2021 across major databases including Pubmed, PsychInfo, Cochrane, and CINAHL. Results: A total of 6 studies were included in this review. Studies either assessed outcome of engagement in care among pregnant women living with HIV or pregnant women with substance use disorder. Our findings demonstrate that pregnant women with HIV or substance use disorder tend to have comorbid conditions and are less likely to be engaged in obstetric care, and this trend is aggravated by the COVID-19 pandemic. Approaches to care during the COVID-19 pandemic included expanding services outside of the clinic to virtual visits, telephonic engagement, text messaging, or electronic mail. Conclusion: Pregnant women with HIV and/or substance use disorder are at much higher risk for poor engagement in obstetric care, suboptimal financial and social support, and adverse outcomes. We recommend each in-person clinic visit be accompanied by thorough screening for mental health issues, and psychosocial difficulties. Referral services should be ready and accessible if the woman screens positive. Nurses are an integral part of ensuring proper care coordination and follow-up. More research is needed to examine engagement in obstetric care for women with both HIV and substance use disorder during the COVID-19 pandemic.