The objective of this study was to determine the effects of HIV-centered obstetric care (HCC) on maternal and fetal outcomes. The primary outcome of interest is perinatal HIV transmission.METHODS:
This was a retrospective cohort study HIV-infected women and their HIV-exposed infants who delivered from 2000 to 2014. Prior to 2009, women received care in a high risk pregnancy clinic (HRC). In 2009, a HCC service was established, staffed by obstetrician specialists with HIV medical training, a social worker, and a patient advocate. HIV-infected women delivering after 2009 received HCC. Maternal and neonatal outcomes, including perinatal HIV transmission rates, were compared between HIV-infected women receiving HRC compared to HCC. Continuous variables were compared with Student's t test and Wilcoxon rank sum tests. Categorical variables were compared using χ2 test and Fisher's exact test.RESULTS:
161 women delivered 217 HIV-exposed pregnancies from 2000–2014; four women delivered twins (2%). Seventy-eight women (36%) received HCC. Three perinatal HIV transmissions (2%) occurred among women in HRC compared none in women receiving HCC. Women in HCC were more likely to have HIV RNA viral loads (VL) <1,000 at delivery (12% vs 26%, P=.02), use a long-acting reversible contraceptive (LARC) method (26% vs 2%, P<.0001), return for a postpartum visit (80% vs 63%, P=.01), and had lower median VL postpartum (40 copies/mL vs 1855, P<.0001).CONCLUSION:
Implementing an HCC model may reduce perinatal HIV transmission, improve maternal virologic control during pregnancy, increase postpartum LARC use, and improve HIV care compliance.