Candice Hwang

All Publications

• Uptake and retention in HIV care among pregnant and postpartum women living with HIV under different eras of vertical transmission prevention policies in sub-Saharan Africa: a systematic review and meta-analysis. medRxiv : the preprint server for health sciences Jinga, N., Hwang, C., Rossouw, L., Clouse, K., Nattey, C., Mbwele, B., Ngcobo, N., Beestrum, M., Huffman, M. D., Fox, M. P., Maskew, M. 2026

  Abstract

  This systematic review and meta-analysis (2010-2025) examines changes in uptake and retention rates among pregnant and postpartum women with HIV in sub-Saharan Africa as countries adopted Option B+ for preventing vertical transmission.We searched PubMed, Embase, Cochrane Library, Scopus, and African Index Medicus from 10/2021-05/2025 for eligible studies that measured HIV care uptake or retention for pregnant/postpartum women under prevention policies before or during Option B+. Study designs were limited to cohort, case-control, cross-sectional, or interventional studies. Exclusions were white papers, commentaries, modeling, cost-effectiveness, and qualitative studies.Outcomes were (i) HIV care uptake defined as initiation of ART during pregnancy or prior to initial antenatal care (ANC) visit and (ii) proportion of women retained in HIV care as defined by study authors after ART initiation (or entry to antenatal care). These were synthesized in meta-analyses stratified by policy era (pre-Option B+ vs. Option B+) at different times for different countries. Comparisons between policy eras were made using relative risk with a 95% confidence interval. Pooled retention estimates at 6- and 12-months post ART initiation used crude relative risks (RR) with 95% confidence intervals (CI).Among 4,752 articles, 82 from 17 countries were included; 60 reported HIV care uptake, 31 reported retention outcomes. Pooled HIV uptake rose by 8% (RR=1.08; 95% CI:1.06-1.09) and pooled retention in HIV care rose by 46% (RR=1.46; 95% CI:1.41-1.51) after Option B+ implementation. Pooled estimates of retention in care were 36.9% (95% CI: 13.9%, 59.9%) at 6 months post ART initiation before the implementation of Option B+ and 72.7% (95% CI: 66.3%, 79.1%) after implementation.HIV care uptake and retention improved after Option B+ implementation in 15 countries reporting results, but retention remains suboptimal for meeting UNAIDS 95-95-95 targets.

  View details for DOI 10.64898/2026.04.02.26350030

  View details for PubMedID 42006775

  View details for PubMedCentralID PMC13086076

• Engagement in antenatal and HIV care among pregnant women before and after Option B plus policy implementation in South Africa SAMJ SOUTH AFRICAN MEDICAL JOURNAL Hwang, C., Jinga, N., Dheda, M., Mhlongo, O., Phungula, P., Clouse, K., Huffman, M. D., Fox, M. P., Maskew, M. 2026; 116 (1)

  View details for DOI 10.7196/SAMJ.2025.v116i1.2304

  View details for Web of Science ID 001697398900002

• Engagement in antenatal and HIV care among pregnant women before and after Option B+ policy implementation in South Africa. medRxiv : the preprint server for health sciences Hwang, C., Jinga, N., Dheda, M., Mhlongo, O., Phungula, P., Clouse, K., Huffman, M. D., Fox, M. P., Maskew, M. 2024

  Abstract

  Background: Substantial gains have been made in South Africa in the prevention of vertical transmission of HIV over the past decade.Objectives: to determine whether engagement in antenatal and HIV care among pregnant Women Living with HIV (WLWH) differed after Option B+ implementation.Methods: We analysed cohort data from a pregnancy and birth defects surveillance system in KwaZulu-Natal (KZN). We report on two co-primary outcomes related to engagement in HIV care: 1) timing and number of ANC visits during the pregnancy period; and 2) timing of ART initiation (both self-reported ART use in interviews and observed initiation of treatment in maternal records). The association of policy era on the timing of ANC presentation was assessed using log-binomial regression modelling. We also report proportions initiating ART before or during pregnancy stratified by policy era.Results: Data from 40,357 women, including 16,016 (40%) WLWH were analysed. During the Option B+ era, 24% of pregnant WLWH attended their first antenatal care visit during the first trimester, compared to 16% during the Option B era (RR=1.52;95%CI=1.41-1.64). The proportion of women living with HIV who initiated ART prior to pregnancy was also higher during the Option B+ era compared to the Option B era, though this result was limited by missingness in the data.Conclusions: Engagement in antenatal and HIV care improved after Option B+ implementation. In the Option B+ era, South Africa has made significant progress towards the goal of eliminating mother-to-child transmission of HIV.

  View details for DOI 10.1101/2024.10.31.24316487

  View details for PubMedID 39574851

• Cohort profile: Rahima Moosa Mother and Child Hospital maternal HIV cohort, Johannesburg, South Africa BMJ OPEN Technau, K., Maskew, M., Nattey, C., Hwang, C., van Dongen, N., Brizido, T., Wise, A. 2024; 14 (9): e085082

  Abstract

  The Rahima Moosa Mother and Child Hospital (RMMCH) maternal HIV cohort originated from data systems that were developed to support HIV-related birth care and track outcomes of a complete birth cohort of HIV-exposed infants at Rahima Moosa Hospital and their mothers living with HIV.Supported by the Empilweni Services and Research Unit, maternal and infant data from 13 654 pregnant women living with HIV who delivered their infants (and a subset also attended antenatal care) were collected at RMMCH in Johannesburg, South Africa since 2013. Maternal data were collected using counsellor-administered interviews and the 2013-2018 subset of this cohort was linked to the National Health Laboratory Services (NHLS) national HIV cohort-a longitudinal cohort of people living with HIV accessing care in the public sector antiretroviral therapy programme in South Africa that can observe national access to HIV care through laboratory testing data.Topics addressed by the cohort include antenatal care history, HIV treatment exposure, delivery/birth management, prophylaxis and maternal blood results relevant to HIV captured at delivery. The cohort was also one of the first to describe implementation of early infant diagnosis procedures in South Africa including evaluations of novel point-of-care testing strategies demonstrating improvements in uptake of HIV care among infants accessing point-of-care services.Annual linkage of infant delivery and testing data to longitudinal laboratory test data in the NHLS national HIV cohort is planned to allow for analysis of both infant continuity of care outcomes and as well as evaluation of maternal-infant pair treatment and mobility outcomes in the post partum and later period.

  View details for DOI 10.1136/bmjopen-2024-085082

  View details for Web of Science ID 001322570700001

  View details for PubMedID 39306359

  View details for PubMedCentralID PMC11418577