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Population mobility and retention in HIV care among postpartum women in South Africa

Kate Clouse, Ph.D., M.P.H.

Kate Clouse, Ph.D., M.P.H., research assistant professor at Vanderbilt, has received a career development award to explore the impact of frequent population mobility on retention in HIV care among postpartum women in South Africa.

HIV-positive pregnant and postpartum women in South Africa are at increased risk of dropping out of HIV care, particularly after delivery. Failure to reconnect to routine HIV care after delivery endangers the life of the mother and infant. Estimates of patient drop-out are limited by the lack of a national linked HIV database in South Africa. For decades, frequent, cyclical population mobility between rural and urban areas has been common in South Africa. If individuals move from facility to facility, their records are not automatically transferred. Thus, estimates of retention and loss to follow-up typically are limited to a single facility only. Retention in HIV care among postpartum women is further complicated by the cultural tradition of returning to the mother’s rural home after delivery, but this travel and its impact on the continuity of HIV care is poorly characterized in retention literature.

Dr. Clouse and her South African collaborators, including the Health Economics and Epidemiology Research Office (HE2RO) and Witkoppen Health and Welfare Centre in Johannesburg, will explore the extent to which population mobility – particularly around the time of delivery – contributes to misclassification of retention in care outcomes, as well as to poor retention in care. Dr. Clouse will analyze existing HIV data, followed by in-depth, qualitative research with HIV-positive pregnant women. The goal of this research is to collect critical information about the impact of frequent population mobility on retention in HIV care among a particular group at high risk of drop out, in order to develop targeted, effective interventions to improve continuity of care.

Clouse’s research is supported by a Career Development Award (K01-MH-107256-01) from the National Institute of Mental Health (NIMH).