Social support in postpartum women living with HIV referred to the adherence club differentiated service delivery model versus routine primary health services in South Africa

Chabaya, Walter

Social support in postpartum women living with HIV referred to the adherence club differentiated service delivery model versus routine primary health services in South Africa

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Introduction Globally, postpartum women in HIV care experience high levels of disengagement and viraemia. Group-based differentiated service delivery models, such as adherence clubs (ACs), improve virological outcomes, though mechanisms remain unclear. This study compared whether levels of social support differ between ACs and primary health care (PHC) clinics over time. Methods Data are from the PACART study (2016-2020) conducted in Cape Town, South Africa, in which postpartum women were randomised to ACs or PHC clinics (standard of care). A 12-item questionnaire which has been validated in this context was used to measure perceived availability of social support including instrumental and emotional support at baseline, 6 and 24 months postpartum. A mean score (range 1-5) was calculated for each visit. This analysis, conducted in 2024 using R Studio, included linear regression for baseline associations with social support and linear mixed-effects models for longitudinal changes in social support, adjusting for socio-demographic variables. Results Among 411 participants (median age 28 years; median duration of postpartum care 11 days), 49.9% were randomised to PHC clinics and 50.1% ACs. Median social support scores exceeded 4 and increased over time. In the PHC arm, perceived availability of social support scores were 4.08 (IQR 3.33-4.75) at baseline, 4.13 (IQR 3.67-4.92) at 6-months and 4.33 (IQR 3.67-5.00) at 24-months postpartum. For AC participants, scores were 4.04 (IQR 3.08-4.75), 4.08 (IQR 3.67-4.92) and 4.58 (IQR 3.67-5.00) at the same time points. At baseline, post-secondary education was significantly associated with social support in the multivariate model (= 0.85, 95% CI 0.04, 1.65). Longitudinally, duration of care was significantly associated with social support in multivariate models (= 0.01; 95% CI 0.003, 0.02). Referral site (AC versus PHC) was not significantly associated with social support in both univariate and multivariate models (multivariate: = -0.01; 95% CI -0.16, 0.13). Conclusions Social support was high and increased over time in both AC and PHC settings. Higher levels of education were associated with increased social support at baseline. These findings highlight that social support improves as time postpartum progresses, underscoring the need for strategies that strengthen social support early in the postpartum period.