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Review 2: "Antiretroviral Therapy Retention, Adherence, and Clinical Outcomes among Postpartum Women with HIV in Nigeria"

Reviewers point out the relevance of the study, and only make minor comments mainly about missing data.

Published onMay 26, 2024
Review 2: "Antiretroviral Therapy Retention, Adherence, and Clinical Outcomes among Postpartum Women with HIV in Nigeria"
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key-enterThis Pub is a Review of
Antiretroviral therapy retention, adherence, and clinical outcomes among postpartum women with HIV in Nigeria
Antiretroviral therapy retention, adherence, and clinical outcomes among postpartum women with HIV in Nigeria
Description

Abstract While research involving pregnant women with HIV has largely focused on the antepartum and intrapartum periods, few studies in Nigeria have examined the clinical outcomes of these women postpartum. This study aimed to evaluate antiretroviral therapy retention, adherence, and viral suppression among postpartum women in Nigeria. This retrospective clinical data analysis included women with a delivery record at the antenatal HIV clinic at Jos University Teaching Hospital between 2013 and 2017. Descriptive statistics quantified proportions retained, adherent (≥95% medication possession ratio), and virally suppressed up to 24 months postpartum. Among 1535 included women, 1497 met the triple antiretroviral therapy eligibility criteria. At 24 months, 1342 (89.6%) women remained in care, 51 (3.4%) reported transferring, and 104 (7.0%) were lost to follow-up. The proportion of patients with ≥95% medication possession ratio decreased from 79.0% to 69.1% over the 24 months. Viral suppression among those with results was 88.7% at 24 months, but <62% of those retained had viral load results at each time point. In multiple logistic regression, predictors of loss to follow-up included having a more recent HIV diagnosis, higher gravidity, fewer antenatal care visits, and a non-hospital delivery. Predictors of viral non-suppression included poorer adherence, unsuppressed/missing baseline viral load, lower baseline CD4+ T-cell count, and higher gravidity. Loss to follow-up rates were lower and antiretroviral therapy adherence rates similar among postpartum women at our study hospital compared with other sub-Saharan countries. Longer follow-up time and inclusion of multiple facilities for a nationally representative sample would be beneficial in future studies.

RR:C19 Evidence Scale rating by reviewer:

  • Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.

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Review: HIV care retention and adherence postpartum is important for maternal and child health, and these findings show that many women manage their HIV care disease very well postpartum, but there are key characteristics that can help to identify those who are at risk of disengagement from care, and these women need to be targeted with supplemental support to ensure good health outcomes.

This paper is very well written and the authors conducted a solid analysis of a large retrospective dataset of HIV care parameters among HIV+ pregnant women through 24 months post partum.  

The authors conclusions and inferences from the findings were appropriate, and also thoughtful regarding the approach to handling the missing data that was present-- both in terms of how this was handled analytically and in the discussion of implications.

This reviewer is comfortable with recommending that the paper be published as is.

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