In contrast to prior strategies for the prevention of mother-to-child transmission (PMTCT) of HIV that employed antiretroviral monotherapy and short courses of combination prophylaxis, the 2013 World Health Organization Consolidated Guidelines now recommend combination antiretroviral therapy (cART) for all HIV-infected pregnant and breastfeeding women, regardless of CD4 cell count, and encourage lifelong cART (Option B+). B+ has the potential to improve maternal health and mortality and reduce vertical transmission and sexual transmission to partners. However, preliminary data from Malawi and Uganda suggest that loss to follow-up varies greatly between 17% and 70%, and data on virologic outcomes are lacking. The objectives of this study are

(1) to evaluate rates and predictors of retention in care and virologic suppression among HIV-infected women who initiated lifelong cART during pregnancy and

(2) to elucidate individual, contextual, and health systems factors that influence women?s ability to remain in care and achieve virologic suppression.

We propose to leverage a well-characterized community-based cohort of previously cART-naïve, HIV-infected women who started lifelong cART during pregnancy and are 1 to 3 years postpartum. We will conduct a crosssectional study, tracking approximately 200 women to evaluate retention in care and virologic suppression, and perform logistic regression analyses of predictors of these outcomes. We will conduct individual, in-depth qualitative/quantitative interviews among patients and interview a sample of health care providers to examine barriers to and facilitators of retention in care and virologic suppression. This study will take place over one year and will be one of the first evaluations of women in B+ beyond 6 months postpartum and in subsequent pregnancies. The results of this research will provide preliminary data for an NIH-funded K23 mentored career development award application to design interventions to improve retention in care and virologic outcomes among childbearing HIV-infected women in East Africa.