Women in the HIV Care Continuum: Assessing Re-linking Women to Care and Maintaining Viral Suppression Postpartum in Philadelphia from 2012 to 2023

The purpose of this study was to describe the HIV care continuum postpartum in a cohort of postpartum women with HIV (WWH) in Philadelphia, and assess the impact of the City's perinatal case management (PCM) program on engagement in the HIV care continuum. A cohort of 937 mothers who gave birth between 1/1/2012 and 12/31/2023 and who lived, gave birth, or received perinatal and pediatric care in Philadelphia, PA were enrolled. Using public health surveillance data, the impact of PCM use on engagement in care at 90 days postpartum, retention in care at 1-year postpartum, and viral suppression at 1-year postpartum was assessed using logistic regression with robust standard errors. Overall, 51.1%, 65.4%, and 42.0% of the population was engaged in care at 90 days, and retained in care and virally suppressed at 1-year, respectively. A larger percentage of PCM users than non-users were engaged in care at 90 days (56.4% versus 43.9%) and retained in care (73.2% versus 59.2%) and virally suppressed (48.2% versus 37.1%) at 1 year. After controlling for confounders, PCM use was significantly associated with increased engagement in care at 90 days (aOR = 1.403 [1.030-1.913]), retention in care at 1 year (aOR = 1.576 [1.163-2.136]), and viral suppression at 1 year (aOR = 1.412 [1.060-1.881]). Philadelphia's PCM program is effective in improving engagement in the HIV care continuum during the postpartum period. Other US cities, particularly those with high HIV prevalence, should consider adopting a similar city-funded PCM program for pregnant and postpartum WWH.