Comparing health outcomes in infants born to mothers initiated on ART during pregnancy and randomised to receive postpartum ART services from primary healthcare facilities or adherence clubs

Dinkele, Ryan

Comparing health outcomes in infants born to mothers initiated on ART during pregnancy and randomised to receive postpartum ART services from primary healthcare facilities or adherence clubs

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Introduction: Adherence clubs (ACs) increase retention in care among postpartum women living with HIV. However, the effect of maternal antiretroviral therapy (ART) provision through ACs on infant health remains unknown. Methods: This study utilised data from a parallel-arm randomised controlled trial that enrolled women who initiated ART during pregnancy, were within 70 days postpartum, and who met standard AC eligibility criteria (clinically stable and viral load <400 copies/mL). Consenting women were randomised to community-based ACs (n = 201) or routine primary healthcare (PHC) clinics (n = 194) for ART service delivery and followed for two years. Infant care was provided separately at “well baby” clinics. Outcome frequencies were calculated by summing the number of visits at which lower respiratory tract infection, diarrhoeal illness, care-seeking, and overnight hospitalisation were self-reported. Multivariate Poisson regression was then used to quantify the associations between each trial arm and study outcome, controlling for various maternal demographic and infant health covariates. Results: Data were available for 395 mother-infant pairs, representing 1681 visits. There were 27 and 20 instances of lower respiratory tract infection and 60 and 55 occurrences of diarrhoeal illness in PHC and AC trial arms, respectively. Lower respiratory tract infection (aIRR 0.73; 95% CI 0.39–1.32) and diarrhoeal illness (aIRR 0.87; 95% CI 0.60–1.27) were self-reported at equivalent rates between trial arms. Mothers attending ACs were less likely to report seek care (205 vs. 247 times) for their infants compared to mothers receiving ART from PHC clinics (aIRR 0.80; 95% CI 0.66–0.97). Infants of mothers attending ACs were reported as being hospitalised less frequently (15 vs. 26 times) compared to those within the PHC study arm (aIRR 0.55; 95% CI 0.28–1.07; p value = 0.083) but this was not statistically significant. Conclusions: Occurrence of illness was similar in both groups. However, mothers receiving ART from ACs were less likely to access care for their infants than those receiving ART from PHC clinics. While this may reflect the increased care demands associated with community-based ART service delivery, further research is needed to clarify the mechanisms underlying these differences in care-seeking behaviour.