A surreal illustration depicting a safety net protecting a mother and child with Mount Kilimanjaro in the background.

Postpartum HIV Care: Are We Reaching Everyone?

Mira Elwood in Health & Wellness August 2025 • 4 min read.

"New research from Tanzania highlights who's at risk of falling through the cracks in PMTCT programs, and what we can do about it."

For two decades, prevention of mother-to-child transmission (PMTCT) programs have dramatically reshaped the landscape of HIV treatment and prevention in low- and middle-income countries. Beyond preventing vertical transmission, PMTCT serves as a crucial entry point for broader HIV care, helping to lower community viral load and slow the epidemic. Yet, studies reveal a persistent challenge: women in these programs don't always stay engaged in care as effectively as needed.

Now, a new study from Kilimanjaro, Tanzania, sheds light on the factors impacting postpartum HIV care engagement. Researchers followed 200 women enrolled in PMTCT programs, tracking their engagement and identifying associated factors. Their findings offer valuable insights into who is most at risk and what interventions can make a difference.

This article breaks down the study's key findings, highlighting the specific challenges faced by women in PMTCT programs and exploring actionable strategies to improve care engagement and ensure better health outcomes for mothers and their children.

Who's Missing from Postpartum HIV Care?

A surreal illustration depicting a safety net protecting a mother and child with Mount Kilimanjaro in the background.

The Tanzanian study revealed that six months after delivery, a concerning 21% of participants exhibited poor care engagement. This was defined as having an elevated viral load (HIV RNA >200 copies/mL) or, if viral load data was unavailable, being lost to follow-up in clinical records or self-reporting being out of care. A deeper dive into the data identified several key factors associated with this disengagement:

Researchers found younger women were statistically more likely to be off track with the program's expectations. For each additional year of age, women were 7% less likely to show signs of inadequate engagement. Women who shared their HIV status were 47% less likely to experience poor care engagement. First-time mothers who entered antenatal care already knowing their HIV status faced a significantly higher risk of disengagement – more than four times higher.

Age: Younger women struggle more with care engagement.
Disclosure: Keeping HIV status secret hinders care.
First-Time Mothers: New moms with existing HIV diagnoses need extra support.

These findings highlight specific vulnerabilities within PMTCT programs. Younger women may face unique social and emotional challenges, while those who haven't disclosed their status may lack crucial support networks. And for first-time mothers already living with HIV, the transition to motherhood can create additional barriers to care.

Turning Insights into Action: Strengthening PMTCT Programs

The Tanzanian study underscores the need for comprehensive support systems within PMTCT programs. Comprehensive counseling on HIV disclosure, alongside community-based stigma reduction programs, is essential to create a supportive environment for people living with HIV. This encourages open communication and reduces the isolation that can hinder care engagement.

Women presenting to antenatal care with an established HIV status require targeted support during the crucial period surrounding childbirth, particularly those pregnant for the first time. This may involve peer mentoring, enhanced education about the importance of consistent care, and proactive follow-up to address any challenges they may face.

By addressing these specific needs, PMTCT programs can improve care engagement, leading to better health outcomes for mothers and their children, and ultimately contributing to the goal of an AIDS-free generation. The lesson from this article provides an opportunity to reassess, improve communication, reduce the stigma, and proactively support new mothers who have known their status, but need encouragement through education and community in a critical moment of their lives.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1080/09540121.2018.1550248, Alternate LINK

Title: Predictors Of Postpartum Hiv Care Engagement For Women Enrolled In Prevention Of Mother-To-Child Transmission (Pmtct) Programs In Tanzania

Subject: Public Health, Environmental and Occupational Health

Journal: AIDS Care

Publisher: Informa UK Limited

Authors: Melissa H. Watt, Cody Cichowitz, Godfrey Kisigo, Linda Minja, Brandon A. Knettel, Elizabeth T. Knippler, James Ngocho, Preeti Manavalan, Blandina T. Mmbaga

Published: 2018-11-22

Everything You Need To Know

What are PMTCT programs and why are they important?

PMTCT, or prevention of mother-to-child transmission programs, are crucial for preventing the transmission of HIV from mothers to their children. These programs have reshaped HIV treatment and prevention, serving as an entry point for broader HIV care, lowering community viral load, and slowing the epidemic. However, the challenge lies in ensuring women remain engaged in these programs effectively.

According to the Tanzanian study, what specific groups of women are most at risk of disengaging from postpartum HIV care within PMTCT programs?

The Tanzanian study identified that younger women, women who haven't disclosed their HIV status, and first-time mothers already living with HIV are at a higher risk of disengagement from PMTCT programs. Specifically, younger women face social and emotional challenges, those who haven't disclosed lack support, and first-time mothers with existing HIV diagnoses encounter additional barriers to care.

What were the key findings of the Tanzanian study regarding postpartum HIV care engagement, specifically in terms of viral load and engagement rates?

The Tanzanian study found that 21% of participants exhibited poor care engagement six months after delivery. This was determined by having an elevated viral load (HIV RNA >200 copies/mL) or, if viral load data was unavailable, being lost to follow-up or self-reporting being out of care. The study further revealed that for each additional year of age, women were 7% less likely to show signs of inadequate engagement, while women who shared their HIV status were 47% less likely to experience poor care engagement.

What actionable steps can be taken to improve care engagement within PMTCT programs, based on the insights from the Tanzanian study?

To strengthen PMTCT programs, the Tanzanian study underscores the need for comprehensive support systems, including counseling on HIV disclosure and community-based stigma reduction programs. Creating a supportive environment encourages open communication and reduces the isolation that can hinder care engagement. These interventions aim to address the specific vulnerabilities of younger women, those who haven't disclosed their status, and first-time mothers with existing HIV diagnoses.

What are the broader implications if women disengage from PMTCT programs after giving birth?

The implications of disengagement from PMTCT programs are significant. For mothers, it can lead to a decline in their own health and an increased risk of opportunistic infections. For their children, it elevates the risk of contracting HIV and compromises their overall well-being. Furthermore, disengagement can contribute to a higher community viral load, potentially hindering efforts to control the HIV epidemic. Therefore, maintaining engagement is crucial for both individual and public health.