Keywords
Postpartum
Pregnancy
HIV/AIDS
Antiretroviral therapy
How to Cite
Abstract
Introduction: HIV-related maternal mortality remains high in many low-resource settings despite global declines. Lifelong antiretroviral therapy (ART) improves maternal and child outcomes, yet ART initiation, retention, and adherence remain suboptimal during pregnancy and postpartum. Socioeconomic, behavioral, and structural determinants influence linkage to care and viral suppression, but evidence describing their impact across the perinatal continuum remains fragmented. This review will synthesize these determinants through an equity lens using the PROGRESS-Plus framework, and reporting will follow PRISMA-E 2012 guidelines.
Methods and Analysis: This protocol follows PRISMA-E 2012 guidelines and is registered with PROSPERO (CRD420250650979). A comprehensive search will be conducted across multiple databases for studies published from January 2012 to May 2025. Eligible designs will include quantitative, qualitative, and mixed-methods studies evaluating HIV testing, ART initiation, retention in care, and viral suppression in relation to socio-cultural, economic, behavioral, or health system factors. The PECO framework will be used (Population: pregnant/postpartum individuals with HIV ; Exposure: social/structural determinants; Comparator: not exposed; Outcomes: HIV care cascade indicators). Postpartum will be defined as up to 12 months after delivery, and adolescents aged 15–17 years will be included. Two independent reviewers will screen studies using Rayyan. Quality will be assessed using Joanna Briggs Institute tools. Random-effects meta-analysis will be conducted when feasible. Qualitative findings will undergo thematic synthesis; mixed-methods results will be integrated narratively.
Ethics and dissemination: Approval is not required as this review uses publicly available data. Findings will be submitted for publication, presented at guideline meetings, and shared at scientific conferences.
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