Housing Instability and Antiretroviral Therapy Adherence: A Cohort Study of Pregnant and Postpartum Women in Durban, 2006

Housing instability is a recognised social determinant of health. Its specific impact on engagement with HIV care for pregnant and postpartum women in high-prevalence urban African settings requires clearer quantification. This life stage is critical for maternal health and the prevention of vertical transmission of HIV. This study analyses the association between housing stability and antiretroviral therapy (ART) adherence and retention in care among pregnant and postpartum women living with HIV in inner-city Durban, South Africa. A prospective cohort study was undertaken. Pregnant women initiating ART were enrolled from a public clinic and followed through the postpartum period. Housing instability was measured using a structured questionnaire at enrolment and follow-up. Primary outcomes were self-reported ART adherence and clinic attendance, verified against medical records. Associations were analysed using multivariate logistic regression. Preliminary analysis indicates a strong negative association between housing instability and optimal ART adherence. Women experiencing housing instability were approximately 40% less likely to report perfect adherence at six months postpartum compared to those with stable housing. Instability was also linked to a higher likelihood of missed clinic visits. Housing instability presents a significant barrier to sustained ART adherence and retention in HIV care for pregnant and postpartum women in this urban South African setting. Mitigating this social determinant may be crucial for improving maternal and infant health outcomes. Routine screening for housing instability should be integrated into antenatal and postnatal HIV care services. Targeted interventions, such as strengthened partnerships with social services to provide housing support, should be developed and evaluated as part of a comprehensive care package for this population. HIV, antiretroviral therapy, adherence, housing instability, social determinants of health, maternal health, postpartum period, South Africa This working paper provides preliminary empirical evidence on the magnitude of association between housing instability and ART adherence in a key population, highlighting a specific social barrier that requires intervention within prevention of vertical transmission programmes.