Advisory Committee Chair
Jeff Szychowski
Advisory Committee Members
Yi Nengjun
Dustin Long
Janet Turan
Lloyd Edwards
Stacey Cofield
Document Type
Dissertation
Date of Award
1-1-2025
Degree Name by School
Doctor of Public Health (DrPH) School of Public Health
Abstract
The joint United Nations Programme on HIV/AIDS (UNAIDS) has set targets to end the HIV epidemic by improving HIV diagnosis, treatment, and viral suppression to reduce new infections and improve health outcomes for people living with HIV (PLHIV), including pregnant and postpartum women living with HIV (PPWH). After diagnosis, linking PPWH to antiretroviral (ART) treatment is critical to suppress the virus and prevent mother-to-child transmission (MTCT) of HIV. Continuous engagement in care is essential for achieving and maintaining virologic suppression in the peripartum and postpartum period for PPWH, both for their own health and the health of their family. Disengagement from care and treatment failure are two common indicators to assess efforts contributing to ending HIV and improving public health. This dissertation investigates the risk factors for suboptimal treatment outcomes of disengagement from care and treatment failure among PPWH in low-resource settings. The first paper summarizes the existing literature between June 2017 and March 2024 on risk factors of suboptimal treatment outcomes among PPWH in a scoping review. The second paper explores the demographic, clinical, and psychosocial risk factors of these suboptimal outcomes while incorporating prior knowledge through hierarchical Bayesian analyses. The third and final paper utilizes penalized regression Least Absolute Shrinkage and Selection Operator (LASSO), a penalized regression method to to develop and validate a multivariable model for predicting the risk of suboptimal outcomes among PPWH. This dissertation employs a range of methodologies, including predictive modeling and Bayesian analyses, to provide an in-depth understanding of the risk factors associated with and prediction of PPWH at high risk of suboptimal outcomes of disengagement from care or treatment failure. The findings enrich the existing knowledge base and offer actionable insights for strengthening efforts for retention in HIV care and sustained virologic suppression. By pinpointing and addressing the drivers of these suboptimal outcomes, healthcare providers and public health policymakers can implement targeted strategies to improve care retention and, in turn, optimize individual health outcomes for PPWH and reduce MTCT.
Recommended Citation
Okotchi, Kevin Owuor, "Investigating Risk Of Suboptimal Hiv Treatment Outcomes (Treatment Failure And Disengagement) Among Pregnant And Postpartum Women Living With Hiv" (2025). All ETDs from UAB. 6881.
https://digitalcommons.library.uab.edu/etd-collection/6881
Comments
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