{
  "abstract": "Background HIV pregnancy care ensures viral suppression, yet maintaining retention in care and antiretroviral therapy (ART) adherence remains a major challenge in the postpartum period, threatening long-term maternal health.Material and Methods A 32-year retrospective study (1994–2025) was conducted at the Ferrara HIV Center, including all women living with HIV (WLWH) with at least one pregnancy. The research evaluated ART adherence and clinical follow-up during pregnancy and the three years post-delivery. By analyzing clinic-demographic variables, we aimed to identify barriers to care and implement targeted strategies. A specific focus was placed on postpartum to optimize clinical management and long-term retention in care beyond the immediate delivery period.Results We enrolled 49 WLWH (81 pregnancies), mostly aged >45 (53.06%), Italian (53.06%) or African (34.69%) origin. Infection duration before pregnancy was <10 years in 75.5%. Comorbidities (32.66%) included psychiatric (10.2%), treatment-related (10.2%), gastrointestinal (8.16%), and neurological (4.08%) disorders. Of 60 births, 54.3% were C-sections, 9.87% vaginal. Adherence during the first pregnancy was high (ART 81.63%; follow-up 89.8%) but declined postpartum to 63.26% and 79.59%, respectively, with a 10.2% loss-to-follow-up. No significant differences in non-adherence emerged by HIV diagnosis timing (38.8% during pregnancy vs. 41.9% otherwise). Significant disparities emerged by origin: foreign-born women, particularly of African descent, exhibited higher non-adherence. In this subgroup, rates were 30.7% for ART and 15.3% for follow-up during pregnancy, with follow-up non-adherence rising to 38.46% postpartum. Maternal age influenced engagement: non-adherence peaked in women under 25, while those over 45 showed the most consistency. Thus, origin and younger age are stronger predictors of care interruption than the timing of diagnosis ( tables 1, 2, 3).Conclusions This study identifies a dual-phase pattern: while pregnancy drives high ART adherence, levels drop postpartum. The three-year period following delivery is a critical window of vulnerability, as neonatal care often supersedes maternal self-care once the incentive of preventing vertical transmission diminishes. It appears necessary to implement structured, multidisciplinary support strategies extending beyond the obstetric period. Given the impact of psychiatric and neurological comorbidities, integrated care is essential for this aging population. Furthermore, findings demand tailored retention interventions for younger patients and foreign-born women, as psychosocial and cultural challenges, rather than diagnosis timing, are the primary drivers of treatment interruption. In conclusion, clinical management must shift toward long-term, patient-centered models prioritizing the postpartum transition. Targeted strategies are imperative to ensure sustained viral suppression and safeguard maternal health.Abstract P73 Table 1–3",
  "authors": [
    {
      "affiliations": [
        "University of Ferrara, Ferrara, Italy",
        "Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy"
      ],
      "name": "D Segala"
    },
    {
      "affiliations": [
        "University of Ferrara, Ferrara, Italy"
      ],
      "name": "G Amaddeo"
    },
    {
      "affiliations": [
        "Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy"
      ],
      "name": "P Mori"
    },
    {
      "affiliations": [
        "University of Ferrara, Ferrara, Italy",
        "Azienda Unità Sanitaria Locale di Ferrara, Ferrara, Italy"
      ],
      "name": "R Cultrera"
    }
  ],
  "title": "P73 Longitudinal ART adherence and clinical retention in women living with HIV: a 32-year retrospective study on the postpartum transition and long-term maternal outcomes",
  "uid": "3ff2d0d5-22a0-5fad-bca2-bb9a7ad190d6"
}