“I am scared, I do not want to lie”: Exploring the impacts of COVID-19 on engagement in care, perceived health, relationship dynamics, and parenting among postpartum women with HIV in South Africa

Author:

Stanton Amelia M.1,Blyler Abigail P.2,Mosery Nzwakie3,Goodman Georgia R.4,Vanderkruik Rachel4,Sithole Kedibone3,Bedoya C. Andres4,Smit Jennifer3,Psaros Christina4

Affiliation:

1. Boston University

2. University of Pennsylvania

3. University of the Witwatersrand

4. Massachusetts General Hospital

Abstract

Abstract Background COVID-19 and efforts to manage widespread infection may compromise HIV care engagement. The COVID-19-related factors linked to reduced HIV engagement have not been assessed among postpartum women with HIV, who are at heightened risk of attrition under non-pandemic circumstances. To mitigate the effects of the pandemic on care engagement and to prepare for future public health crises, it is critical to understand how COVID-19 has impacted (1) engagement in care and (2) factors that may act as barriers to care engagement. Methods A quantitative assessment of COVID-19-related experiences was added to a longitudinal cohort study assessing predictors of postpartum attrition from HIV care among women in South Africa. Participants (N = 266) completed the assessment at 6, 12, 18, or 24 months postpartum between June and November of 2020. Those who endorsed one or more challenge related to engagement in care (making or keeping HIV care appointments, procuring HIV medications, procuring contraception, and/or accessing immunization services for infants; n = 55) were invited to complete a brief qualitative interview, which explored the specific factors driving these challenges, as well as other impacts of COVID-19 on care engagement. Within this subset, 53 participants completed an interview; qualitative data were analyzed via rapid analysis. Results Participants described key challenges that reduced their engagement in HIV care and identified four other domains of COVID-19-related impacts: physical health, mental health, relationship with a partner or with the father of the baby, and motherhood/caring for the new baby. Within these domains, specific themes and subthemes emerged, with some positive impacts of COVID-19 also reported (e.g., increased quality time, improved communication with partner, HIV disclosure). Coping strategies for COVID-19-related challenges (e.g., acceptance, spirituality, distraction) were also discussed. Conclusions About one in five participants reported challenges accessing HIV care, medications, or services, and they faced complex, multilayered barriers to remaining engaged. Physical health, mental health, relationships with partners, and ability to care for their infant were also affected. Given the dynamic nature of the pandemic and general uncertainty about its course, ongoing assessment of pandemic-related challenges among postpartum women is needed to avoid HIV care disruptions and to support wellbeing.

Publisher

Research Square Platform LLC

Reference53 articles.

1. Mathieu E, Ritchie H, Rodés-Guirao L et al. Coronavirus Pandemic (COVID-19). Our World Data. Published online March 5, 2020. Accessed November 6, 2022. https://ourworldindata.org/coronavirus/country/south-africa

2. COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State;Tesoriero JM;JAMA Netw Open,2021

3. Davies MA. HIV and risk of COVID-19 death: a population cohort study from the Western Cape Province, South Africa. medRxiv. Published online July 3, 2020:2020.07.02.20145185. doi:10.1101/2020.07.02.20145185

4. In-hospital mortality among immunosuppressed patients with COVID-19: Analysis from a national cohort in Spain;Suárez-García I;PLoS ONE,2021

5. UNAIDS. UNAIDS 2018 Estimates: Progress towards 90-90-90 Target. Joint United Nations Programme on HIV/AIDS; 2018. https://aidsinfo.unaids.org/.

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