Retention in care among women with HIV : A systematic review of treatment continuity during pregnancy and postpartum

INTRODUCTION: Pregnant women with HIV are at risk of reduced engagement in HIV care during pregnancy and postpartum. Retention in care, defined as continuous engagement in HIV-related treatment and follow-up, is essential to achieve virological suppression and prevent vertical transmission. Contemporary evidence on retention in care during pregnancy and postpartum among women with HIV in high-income countries remains limited. Thus, the aim of this systematic review was to examine retention in care during pregnancy and postpartum in this population and context. METHODS: A systematic literature review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase and CINAHL were searched for observational studies including pregnant and/or postpartum women with HIV in high-income countries reporting retention in care outcomes. Screening, data extraction and quality assessment were performed independently by two reviewers. RESULTS: Of 5089 records identified, 11 cohort studies were included. Retention in care was higher during pregnancy than postpartum, with declines observed up to 24 months postpartum. Several studies reported improvements in retention in care between 1996 and 2019. Use of antiretroviral therapy (ART) with viral suppression during pregnancy was associated with more favourable postpartum retention in care and virological outcomes. Heterogeneity in outcome definitions and follow-up periods precluded meta-analysis. CONCLUSION: In high-income countries, most studies show high retention in care during pregnancy and declines after delivery. Retention in care has improved over time, and sufficient ART during pregnancy is associated with enhanced postpartum outcomes. Future research should prioritize standardized outcome definitions to strengthen evidence.