Reproductive Intentions and Outcomes among Women on Antiretroviral Therapy in Rural Uganda: A Prospective Cohort Study

Abstract

BackgroundAntiretroviral therapy (ART) may influence the biological, social and behavioral determinants of pregnancy in HIV-infected women. However, there are limited longitudinal data on the reproductive intentions and outcomes among women on ART in Africa.Methodology /Principal FindingsUsing a prospective cohort design, we analyzed trends in desire for children and predictors of pregnancy among a cohort of 733 HIV-infected women in rural Uganda who initiated ART between May 2003 and May 2004 and were followed up in their homes until June 2006. Women answered in-depth social and behavioral questionnaires administered every quarter in year 1 after initiating ART, and every 6 to 12 months thereafter. Use of family planning methods was assessed at 18 and 24 months after starting ART. We tested for non-constant pregnancy incidence by using a shape parameter test from the Weibull distribution. We modeled repeated measurements of all variables related to the women's desire for children over time using a generalized estimating equation (GEE) extension to the logistic regression model. Risk factors for pregnancy were examined using Cox proportional hazards model. 711 women eligible for the study were followed-up for a median time of 2.4 years after starting ART. During this time, less than 7% of women reported wanting more children at any time point yet 120 (16.9%) women experienced 140 pregnancies and pregnancy incidence increased from 3.46 per 100 women-years (WY) in the first quarter to 9.5 per 100 WY at 24 months (p<0.0001). This was paralleled by an increase in the proportion of women reporting sexual activity in the past 3 months, from 24.4% at baseline to 32.5% over 24 months of follow-up (p = 0.001). Only 14% of women used permanent or semi-permanent family planning methods by their second year on ART. In the multivariate model, younger age (HR = 2.71 per 10-year decrease, 95% CI: 2.95–3.78), having a BMI>18.5 (HR = 1.09, CI: 1.01–1.18) and not having used condoms consistently in the last 3 months (HR = 1.79, CI: 1.02–3.13) were independently associated with pregnancy.Conclusion/SignificanceWomen on ART and their partners should be consistently counseled on the effects of ART in restoring fertility, and offered regularly free and comprehensive family planning services as part of their standard package of care.

Modern Contraceptive Utilization and Associated Factors among HIV Positive Women on Antiretroviral Therapy in Mizan-Tepi Teaching and Referral Hospital, South-West Ethiopia

“…Despite the risk of mother to child transmission of HIV, significant proportion of parents living with HIV continued to desire to have children [5][6][7][8]. Studies also revealed that HIV-positive women encountered unintended pregnancies with associated risk of mother to child transmission of HIV [9][10][11]. The experience of repeated untended pregnancy among HIV positive women particularly adolescents is partially due to inconsistence use of contraceptives [12].…”

HIV/AIDS and contraceptive use: factors associated with contraceptive use among sexually active HIV-positive women in Kenya

“…[17,18,3] In particular, a multi-country analysis of Demographic and Health Survey (DHS) data from nine countries revealed lower contraceptive uptake among HIV-positive women with prior knowledge of their status than counterparts who were HIV-negative in three of the countries included in the study: Zimbabwe, Kenya, and Malawi. [16] The apparent disconnect between fertility desire and contraceptive uptake among HIV-positive women has been attributed to diverse factors ranging from social desirability or stigma surrounding childbearing for HIV-positive individuals [19] to low contraceptive use among HIV-positive women based on the perception that they and their partners were infertile due to HIV infection [20]. Despite the general association between HIV-positive status and low fertility intention, perceived risk or uncertainly about HIV status have both been linked to desires to accelerate childbearing.…”

Disclosure, Knowledge of Partner Status, and Condom Use Among HIV-Positive Patients Attending Clinical Care in Tanzania, Kenya, and Namibia

“…25,26 While rates of consistent condom use among couples who are aware of their status are higher, unprotected sex among these couples is still common 27,28 and has been shown to be associated with desire for pregnancy 29 and alcohol use. 30 PLHIV who inconsistently use condoms and who simultaneously have higher viral loads due to non-adherence to antiretroviral treatment (ART) or because they are not yet eligible for ART are at high risk for transmitting HIV to negative sex partners.…”