The role of women's health care providers in improving retention in HIV treatment and care for women after pregnancy in the Russian Federation

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Russia has one of the fastest growing HIV epidemics and also one of the worst situations with antiretroviral therapy coverage in the world. Major efforts have been made to improve the prevention of mother-to-child transmission (PMTCT) in the country in recent years; however, enrollment in and adherence to longer-term HIV treatment and care remains a problem. HIV counseling and testing is part of routine antenatal care in Russia, and pregnancy is an important opportunity for diagnosing HIV. AIDS Centers are the centralized health care centers for the provision of HIV services across Russia and the collaboration between providers at AIDS Centers and providers at women's health clinics (where antenatal care is provided) remains a much needed area for exploration throughout the country. The objective of this qualitative study is to better understand how antenatal care providers may influence longer-term engagement in HIV treatment and care among women who are diagnosed with HIV during pregnancy in Russia. The proposed study aims to 1. Describe what, if any, actions women who are diagnosed with HIV during pregnancy take in regard to getting further HIV treatment and care services postpartum; 2. Understand the current practice of providers in women's health clinics in diagnosing and counseling women about HIV during pregnancy and the extent to which these providers collaborate with local AIDS Centers to improve linkage to longer-term HIV treatment and care for women who are diagnosed with HIV during pregnancy; and, 3. Identify intervention opportunities for the improvement of longer-term retention in HIV care and treatment among women who are diagnosed with HIV during pregnancy. This community-based, exploratory study utilizes qualitative research methods in order to obtain the in-depth, contextual data necessary to address these aims. We will conduct in-depth interviews with 56 women who received their HIV diagnosis during pregnancy and in-depth interviews with 35 health care providers at women's health clinics and AIDS Centers in seven sites across Russia. The proposed study is reflective of a strong university-community partnership dedicated to improving adherence to HIV treatment and care for women living with HIV. Ultimately, the results of the proposed study will serve as preliminary data to develop an intervention that strengthens the capacity of and collaboration between providers at women's health clinics with AIDS Centers in order to advance linkage to and adherence to longer-term HIV treatment and care for women living with HIV.