This project builds and validates a national cohort of pregnant women in HIV care and their infants to reveal how health systems, mobility and individual risk factors shape continuity of care and long-term HIV outcomes.

Project Principal Investigator(s):

Dr Mhairi Maskew and Dr Kate Clouse

Project duration:

2020 – 2025

Funding source:

NIH R01-HD103466 (2020-2025)

Meet the

Team

The South African National HIV Pregnancy Cohort project team has benefitted from the skills and expertise of a dynamic and diverse collection of researchers, epidemiologists, clinicians, health economists, public health specialists, data scientists and implementers.

  • Mhairi Maskew

    South Africa HE2RO team

  • Cornelius Nattey

    South Africa HE2RO team

  • Nkosinathi Ncgobo

    South Africa HE2RO team

  • Nelly Jinga

    South Africa HE2RO team

  • Kate Clouse

    University of North Carolina Greensboro

  • Jacob Bor

    Boston University

  • Babatyi Malope-Kgokong

    NHLS

  • Maanda Mudau

    NHLS

  • Prof Karl Technau

    ESRU-EMMCH

  • Mukesh Dheda

    KZN DoH

  • Otty Mhlongo

    KZN DoH

  • Prof Gayle Sherman

    NICD - WITS

  • Candice Hwang

    Northwestern University

  • Evelyn Lauren

    Boston University

  • Lucien De Voux

    Palindrome Data

  • Sbonga Dlamini

    Palindrome Data

  • Shantelle Smith

    Palindrome Data

  • Dr Laura Rossouw

    South Africa HE2RO team

  • Kamban Hirasen

    South Africa HE2RO team

Project

Objectives

This unique longitudinal cohort of pregnant women living with HIV and their HIV-exposed infants consists of routinely-collected NHLS laboratory records linked to maternal antenatal record data.

The project aims to generate high-quality, representative evidence on maternal and child health, continuity of care, and mobility within the context of the South African HIV epidemic over the past decade to support better health outcomes for women and children.

Introduction to the broader initiative linking cohort data across institutions:

The South African National HIV Pregnancy Cohort was built on the assumption that entry to antenatal care can be observed through laboratory tests conducted at the first visit. We used all HIV- and pregnancy-related laboratory results in the NHLS records since 2004 and linked these to carefully selected validation cohorts from leading South African research institutions. Through barcode-enabled data linkages, we are able to connect laboratory data to gold-standard prospective maternal and child health cohorts with established dates of antenatal care entry and delivery, enabling us to validate imputed pregnancy status and estimate continuity of care across facilities and over time.

This cross-institutional effort enhances the value of existing investments in research and data systems, reduces reliance on costly and time-intensive birth cohorts, and allows for robust analysis of maternal-infant health outcomes on a national scale.

Parent award specific aims were to:

  1. Develop and validate a novel national cohort of pregnant women accessing HIV care
  2. Measure the effect of system-wide factors impacting continuity of care among pregnant women:
    • Policies for expanded treatment access
    • Assess mobility and its effect on continuity of care both during and after pregnancy
  3. Identify individual-level risk factors for loss from HIV care

Supplement award specific aims were to:

  1. Describe long-term outcomes among HIV exposed and uninfected infants in the RMMCH cohort:
    • Continuity of care and HIV outcomes among maternal-infant pairs
    • Infant and maternal mobility within the first year of life
  2. Validation of infant HIV testing barcodes within the national HIV cohort in preparation for examining infant outcomes nationwide

Key Findings

And Impacts

By creating a nationally representative maternal and infant HIV laboratory cohort, and augmenting a linked clinical maternal cohort with longitudinal laboratory data, this project offers a transformative resource for:

Public health policy:

Providing policymakers with evidence on continuity of care, infant testing, mobility, and treatment outcomes to inform national HIV and maternal-child health programmes.

Research:

Enabling unprecedented analyses of HIV-exposed, uninfected infants and maternal-infant pairs, producing insights that would otherwise require costly prospective studies.

Data systems strengthening:

Demonstrating the power of leveraging routine laboratory data and cross-institutional linkages to create sustainable, scalable research resources that can track health outcomes across the life course.

Resources

Manuscripts

  • Lauren, E., Technau, K., Clouse, K., van Dongen, N., Wise, A., Ferreira, T., Rossouw, L., Bor, J. and Maskew, M., 2025. Postpartum continuity of care for women with HIV: Option B+ policy impact and limitations in South Africa. medRxiv, pp.2025-07. Link: https://www.medrxiv.org/content/medrxiv/early/2025/07/21/2025.07.19.25331807.full.pdf

  • Jinga N, Technau KG, Clouse K, Ngcobo NB, Nattey C, Hwang C, Grimsrud A, Wise A, Van Dongen N, Ferreira T, Mudau M, Maskew M. Uptake and Timing of Viral Load Testing and Frequency of Viraemic Episodes During Pregnancy in South Africa. HIV AIDS (Auckl). 2026;18:1-13 https://doi.org/10.2147/HIV.S560792

  • Nattey, C., Maskew, M., Jinga, N., Rossouw, L,, Wise, A., van Dongen, N., Brizido, T.F., Mudau, M., Technau, K.G. and Clouse, K. The impact of expanded access to antiretroviral treatment on engagement in HIV care and viral suppression among pregnant women living with HIV in South Africa. PLoSONE, 2026. In press

  • Rossouw, L., Ngcobo, N., Clouse, K., Nattey, C., Technau, K.G. and Maskew, M., 2025. Augmenting maternal clinical cohort data with administrative laboratory dataset linkages: a validation study. Discover Health Systems, 4(1), pp.1-8. Link: https://link.springer.com/article/10.1007/s44250-025-00298-4

  • Technau, K.G., Maskew, M., Nattey, C., Hwang, C., van Dongen, N., Brizido, T.F. and Wise, A., 2024. Cohort profile: Rahima Moosa Mother and Child Hospital maternal HIV cohort, Johannesburg, South Africa. BMJ open, 14(9), p.e085082. Link: https://bmjopen.bmj.com/content/bmjopen/14/9/e085082.full.pdf

  • Nelly Jinga, MPhil1; Candice Hwang, MD1,2; Kate Clouse, PhD, MPH1,3,4, Cornelius Nattey, MSc1; Bernard Mbwele, MD, MSc5; Nkosinathi Ngcobo, MSc1; Molly Beestrum, MLIS6; Mark D. Huffman, MD, MPH7,8,9; Matthew P. Fox, DSc, MPH1,10,11; Mhairi Maskew, MBBCh, PhD1. 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. Under review BMJ Open.

  • Candice Hwang, Nelly Jinga, Mukesh Dheda, Otty Mhlongo, Pinky Phungula, Kate Clouse, Mark D. Huffman, Matthew P. Fox, Mhairi Maskew. Engagement in antenatal and HIV care among pregnant women before and after Option B+ policy implementation in South Africa. South African Medical Journal (SAMJ), 2026. In press

  • Maskew M, Technau K, Davies MA, Vreeman R, Fox MP. Adolescent retention in HIV care within differentiated service-delivery models in sub-Saharan Africa. Lancet HIV. 2022 Oct;9(10):e726-e734. https://doi.org/10.1016/S2352-3018(22)00137-0. Epub 2022 Sep 8. PMID: 36088915.

  • Clouse, K., Malope-Kgokong, B., Bor, J. et al. The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV. BMC Public Health 20, 1662 (2020). https://doi.org/10.1186/s12889-020-09679-1

Resources

Conference presentations

  • Nelly Jinga, Karl-G Technau, Nkosinathi Ngcobo, Cornelius Nattey, Candice Hwang, Kate Clouse, Amy Wise, Nicola van Dongen, Thalia Ferreira, Mhairi Maskew. Uptake of viral load testing and viraemic episodes during pregnancy. Poster presentation at The 25th International Workshop on HIV and Hepatitis Observational Databases, 23-25 March 2023, Athens, Greece.

  • Cornelius Nattey, Nelly Jinga, Kate Clouse, Amy Wise, Nicola van Dongen, Thalia Ferreira, Babatyi Malope-Kgopong, Maanda Mudau, Karl-G Technau, Mhairi Maskew. Understanding engagement in HIV care among pregnant women accessing antenatal services in Johannesburg, South Africa. Poster presentation at the 25th International Workshop on HIV and Hepatitis Observational Databases, 23-25 March 2023, Athens, Greece.

  • Nelly Jinga, Karl-G Technau, Nkosinathi Ngcobo, Cornelius Nattey, Candice Hwang, Kate Clouse, Amy Wise, Nicola van Dongen, Thalia Ferreira, Mhairi Maskew. Uptake of viral load testing and viraemic episodes during pregnancy. Oral presentation at The PathReD Congress 2023 workshop, 31 August – 03 September 2023, Johannesburg, South Africa.

  • Cornelius Nattey, Nelly Jinga, Kate Clouse, Amy Wise, Nicola van Dongen, Thalia Ferreira, Babatyi Malope-Kgopong, Maanda Mudau, Karl-G Technau, Mhairi Maskew. Understanding engagement in HIV care among pregnant women accessing antenatal services in Johannesburg, South Africa. Oral presentation at The PathReD Congress 2023 workshop, 31 August – 03 September 2023, Johannesburg, South Africa.

  • Nelly Jinga, Kate Clouse, Cornelius Nattey, Karl-Günter Technau, Nkosinathi Ngcobo, Nicola van Dongen, Amy Wise, Thalia Ferreira, Mhairi Maskew. Viral load suppression and viraemic episodes at 12- and 24-months postpartum among women in Johannesburg, South Africa. Abstract accepted for poster presentation at the 26th International Workshop on HIV and Hepatitis Observational Databases (IWHOD), Vilamoura, Portugal, 21st-23rd March 2024.

  • Cornelius Nattey, Mhairi Maskew, Nelly Jinga, Amy Wise, Nicola van Dongen, Thalia Ferreira, Karl-G Technau, Kate Clouse. Predictors of postpartum continuity in HIV care among women living with HIV in South Africa. Abstract accepted for poster presentation at the 26th International Workshop on HIV and Hepatitis Observational Databases (IWHOD), Vilamoura, Portugal, 21st-23rd March 2024.

  • Hwang C., Huffman, M.D., Fox, M., Clouse, K., & Maskew, M.  Engagement in antenatal care among pregnant women before and after Option B+ policy implementation in South Africa. Stellenbosch University – Consortium of Universities for Global Health Conference; 2022 October; Stellenbosch, South Africa

  • Hwang C, Ngcobo N, Huffman, M.D., Fox, M., Clouse, K., & Maskew, M. Uptake and retention in HIV care among pregnant women living with HIV before and after Option B+ policy implementation in South Africa. University of the Witwatersrand Faculty of Health Sciences Biennial Research Day 2022; 2022 September; Johannesburg, South Africa.

    *Awarded Best Staff Poster in Communicable Diseases

  • Hwang C, Nattey C, Ngcobo N, Mbwele B. Uptake and retention in HIV care among pregnant and postpartum women living with HIV under different eras of prevention of mother-to-child transmission (PMTCT) policies in sub-Saharan Africa: a systematic review and meta-analysis. Northwestern University Global Health Day; 2021 December; Chicago, IL.

  • Evelyn Lauren, Karl Technau, Kate Clouse, Nicola van Dongen, Amy Wise, Thalia Ferreira, Jacob Bor, Mhairi Maskew. Postpartum continuity of care for women with HIV: impact of Option B+ in South Africa. Poster presentation at the World Congress on Epidemiology; 2024 September; Cape Town, South Africa.

  • Kamban Hirasen, Mhairi Maskew, Kate Clouse, Malose Lebelo, Amy Wise, Nicola van Dongen, Laura Rossouw, Nelly Jinga, Karl-Günter Technau. Birth Order and Clinical Outcomes Among HIV-Exposed Infants in South Africa: Evidence from Observational and Sibling Cohorts. Poster presentation at the 28th International Workshop on HIV and Hepatitis Observational Databases (IWHOD), Thessaloniki, Greece, 26-28 March 2026.

  • Mhairi Maskew, Jacob Bor, Evelyn Lauren, Trevor Graham Bell, Karl Technau, Babatyi Malope-Kgokong, Laura Rossouw, Nelly Jinga, Kamban Hirasen, Kate Clouse. Constructing the South Africa National HIV Pregnancy Cohort using routine laboratory data. Poster presentation at the 28th International Workshop on HIV and Hepatitis Observational Databases (IWHOD), Thessaloniki, Greece, 26-28 March 2026.

  • Kate Clouse, Evelyn Lauren, Babatyi Malope-Kgokong, Jacob Bor, Gayle Sherman, Mhairi Maskew. Engagement in HIV care and mobility among postpartum women in the South African National HIV Pregnancy Cohort. Oral presentation at the 28th International Workshop on HIV and Hepatitis Observational Databases (IWHOD), Thessaloniki, Greece, 26-28 March 2026.

  • Laura Rossouw, Kate Clouse, Karl Technau, Babatyi Malope-Kgokong, Malose Lebelo, Puleng Gabela, Lethokuhle Mtshali, Amy Wise, Thalia Ferreira Brizido, Nicola van Dongen, Nelly Jinga, Mhairi Maskew.. Monitoring HIV viral load testing among mother–infant pairs living with HIV in the Rahima Moosa Mother and Child Hospital Cohort in Johannesburg, South Africa. Poster presentation at the 28th International Workshop on HIV and Hepatitis Observational Databases (IWHOD), Thessaloniki, Greece, 26-28 March 2026.

  • Nelly Jinga, Karl-Günter Technau, Kate Clouse, Laura Rossouw, Kamban Hirasen, Malose Lebelo, Amy Wise, Nicola van Dongen, Mhairi Maskew. Association between maternal HIV viraemia and vertical transmission among mother-infant pairs in Johannesburg 2013-2018. Poster presentation at the 28th International Workshop on HIV and Hepatitis Observational Databases (IWHOD), Thessaloniki, Greece, 26-28 March 2026.

  • Laura Rossouw, Shantelle Parrott, Kieran Sharpey-Schafer, Lucien de Voux, Kate Clouse, Karl Technau, Malose Lebelo, Puleng Gabela, Lethokuhle Mtshali, Amy Wise, Thalia Ferreira Brizido, Nicola van Dongen, Nelly Jinga, Mhairi Maskew. Harnessing Longitudinal Cohort Data to Identify Patterns of Engagement in Maternal HIV Care Using Unsupervised Machine Learning: A Case Study from Johannesburg, South Africa. Oral presentation at the 28th International Workshop on HIV and Hepatitis Observational Databases (IWHOD), Thessaloniki, Greece, 26-28 March 2026.