Improving Perinatal HIV Care During the COVID-19 Pandemic: Implementing a Mobile Integrated Health Program to Close the Gap

Background: Pregnant people with HIV (PWH) often experience loss to follow-up and viral nonsuppression after delivery, contributing to morbidity and HIV transmission. The COVID-19 pandemic disrupted health systems and exacerbated health disparities, including for PWH and their infants. To improve perinatal HIV outcomes, we implemented a perinatal care program in September 2020 that offered multidisciplinary home visits through a mobile integrated health (MIH) unit within a large, safety-net health care system in Atlanta, GA. Methods: We analyzed data collected from PWH who delivered 1 year before (August 31, 2019–August 31, 2020; pre-implementation) to 6 months after (September 1, 2020–February 28, 2021; post-implementation) MIH implementation to compare HIV clinical outcomes. We evaluated barriers, facilitators, and patient preferences through exit surveys with MIH program participants. Results: Overall, 32 (53%) delivered before and 28 (47%) PWH delivered after MIH implementation; most were non-Hispanic Black. Three-fourths who delivered post-MIH used MIH, mostly (62%) for postpartum obstetric visits. HIV visit attendance within 3 months and retention in care at 6 months of delivery were significantly higher post-implementation (P = 0.04). Participants noted that the MIH program significantly improved appointment scheduling and access to health care services during the pandemic (P< 0.05). Participants highly rated the preferability, convenience, safety, and use of the MIH program for future pregnancies. Conclusions: Implementation of a perinatal MIH program for PWH and their infants led to significant improvement in engagement in HIV care after delivery. Our findings demonstrate that novel, interdisciplinary programming can fill critical gaps in care delivery, including during periods of health care disruption.