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Sasse SA, Harrington BJ, DiPrete BL, Chagomerana MB, Klyn LL, Wallie SD, Maliwichi M, Jumbe AN, Hoffman IF, Rosenberg NE, Tang JH, Hosseinipour MC. Factors associated with a history of treatment interruption among pregnant women living with HIV in Malawi: A cross-sectional study. PLoS One 2022; 17:e0267085. [PMID: 35439264 PMCID: PMC9017884 DOI: 10.1371/journal.pone.0267085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/02/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Long-term care engagement of women on antiretroviral therapy (ART) is essential to effective HIV public health measures. We sought to explore factors associated with a history of HIV treatment interruption among pregnant women living with HIV presenting to an antenatal clinic in Lilongwe, Malawi.
Methods
We performed a cross-sectional study of pregnant women living with HIV who had a history of ART interruption presenting for antenatal care. Women were categorized as either retained in HIV treatment or reinitiating care after loss-to-follow up (LTFU). To understand factors associated with treatment interruption, we surveyed socio-demographic and partner relationship characteristics. Crude and adjusted prevalence ratios (aPR) for factors associated with ART interruption were estimated using modified Poisson regression with robust variance. We additionally present patients’ reasons for ART interruption.
Results
We enrolled 541 pregnant women living with HIV (391 retained and 150 reinitiating). The median age was 30 years (interquartile range (IQR): 25–34). Factors associated with a history of LTFU were age <30 years (aPR 1.46; 95% CI: 1.33–1.63), less than a primary school education (aPR 1.25; CI: 1.08–1.46), initiation of ART during pregnancy or breastfeeding (aPR 1.49, CI: 1.37–1.65), nondisclosure of HIV serostatus to their partner (aPR 1.39, CI: 1.24–1.58), lack of awareness of partner’s HIV status (aPR 1.41, CI: 1.27–1.60), and no contraception use at conception (aPR 1.60, CI 1.40–1.98). Access to care challenges were the most common reasons reported by women for treatment interruption (e.g., relocation, transport costs, or misplacing health documentation).
Conclusions
Interventions that simplify the ART clinic transfer process, facilitate partner disclosure, and provide counseling about the importance of lifelong ART beyond pregnancy and breastfeeding should be further evaluated for improving retention in ART treatment of women living with HIV in Malawi.
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Affiliation(s)
- Simone A. Sasse
- Department of Obstetrics and Gynecology, New York University, New York, New York, United States of America
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- * E-mail:
| | - Bryna J. Harrington
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Bethany L. DiPrete
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | | | - Laura Limarzi Klyn
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Shaphil D. Wallie
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Madalitso Maliwichi
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Allan N. Jumbe
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Irving F. Hoffman
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Nora E. Rosenberg
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Jennifer H. Tang
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Mina C. Hosseinipour
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, United States of America
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McTigue G, Swartz A, Brittain K, Rini Z, Colvin CJ, Harrison A, Myer L, Pellowski J. Contraceptive trajectories postpartum: A longitudinal qualitative study of women living with HIV in Cape Town, South Africa. Soc Sci Med 2022; 292:114555. [PMID: 34776286 PMCID: PMC8748387 DOI: 10.1016/j.socscimed.2021.114555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 06/28/2021] [Accepted: 11/05/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Supporting the ability of women living with HIV (WLWH) to avoid unintended pregnancy during the postpartum period decreases the number of new pediatric HIV infections, reduces pregnancy-related morbidity and mortality, and is a cost-effective strategy for the elimination of mother-to-child transmission. However, little is currently known about the contraceptive intentions and experiences of reinitiating family planning use among mothers living with HIV as they transition from pregnancy into postpartum. STUDY OBJECTIVES To (1) understand the contraceptive trajectories of women living with HIV during pregnancy and postpartum in Cape Town, South Africa, and (2) identify factors shaping differing contraceptive trajectories during the postpartum period. METHODS Thirty pregnant WLWH were interviewed during their eighth month of pregnancy and completed follow-up interviews at 6-8 weeks and 9-12 months postpartum (n = 81 total interviews). Interview topics included postpartum contraception intentions, contraceptive use, and experiences accessing family planning services. Trajectory analysis of contraceptive intentions was applied after initial thematic coding. RESULTS While nearly half of women interviewed during pregnancy expressed an intention to utilize a non-injectable contraceptive option after childbirth (e.g. implant, IUD, sterilization, oral contraceptive pills), all women interviewed at one year postpartum had received at least one injection. Three main contraceptive trajectories were identified. (1) realization of contraceptive intentions postpartum; (2) unrealized contraceptive intentions postpartum; and (3) change in contraceptive intention over time. Provider influence, coordination of services, and low contraceptive inventory were identified as potential factors shaping the contraceptive trajectories of participants enrolled in the study. CONCLUSION Disparities between contraceptive method intentions articulated by WLWH during pregnancy and methods attained postpartum suggest that significant barriers remain for women who are unsatisfied with injectable contraception. Failing to provide postpartum mothers living with HIV their intended family planning method undermines efforts to prevent unintended pregnancy, a key pillar of elimination of mother-to-child transmission.
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Affiliation(s)
- Georgiana McTigue
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA
| | - Alison Swartz
- Division of Social and Behavioural Sciences, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Kirsty Brittain
- Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Zanele Rini
- Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Christopher J Colvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA; Division of Social and Behavioural Sciences, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa; Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Jennifer Pellowski
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA; Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa.
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3
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Hachfeld A, Atkinson A, Calmy A, de Tejada BM, Hasse B, Paioni P, Kahlert CR, Boillat-Blanco N, Stoeckle M, Aebi-Popp K. Decrease of condom use in heterosexual couples and its impact on pregnancy rates: the Swiss HIV Cohort Study (SHCS). HIV Med 2021; 23:60-69. [PMID: 34476886 PMCID: PMC9290944 DOI: 10.1111/hiv.13152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
Introduction Following the ‘Swiss statement’ in 2008 it became an option to omit the use of condoms in serodiscordant couples and to conceive naturally. We analysed its impact on condom use and pregnancy events. Methods In all, 3023 women (aged 18–49 years) participating in the Swiss HIV Cohort Study were included. Observation time was divided into pre‐ and post‐Swiss statement phases (July 2005–December 2008 and January 2009–December 2019). We used descriptive statistics, Poisson interrupted time series analysis for pregnancy incidence, and logistic regression to identify predictors of live births, spontaneous and induced abortions. Results Condomless sex in sexually active women increased from 25% in 2005 to 75% in 2019, while pregnancy incidence did not. Women after 2008 experienced higher spontaneous abortion rates (12.1% vs. 17.2%, p = 0.02) while induced abortion and live birth rates did not change significantly. Spontaneous abortions were more common in older women [adjusted odds ratio (aOR) = 1.4, 95% CI: 1.2–1.7, p < 0.001], in women consuming alcohol (aOR = 2.8, 95% CI: 1.9–4.1, p < 0.001) and in those with non‐suppressed viral load (aOR = 0.2, 95% CI: 0.1–0.4, p ≤ 0.001). Induced abortions were more likely in women with depression (aOR = 3.4, 95% CI: 1.8–6.3, p < 0.001) and non‐suppressed viral load (aOR = 0.3, 95% CI: 0.2–0.7, p = 0.003). Conclusions The publication of the Swiss statement resulted in more condomless sex in heterosexual women, but this did not result in a higher incidence of pregnancy. Maternal age and spontaneous abortion rates increased over time, while induced abortion rates were not significantly affected. Women living with HIV in Switzerland have an unmet need regarding family planning counselling.
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Affiliation(s)
- Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.,Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Alexandra Calmy
- Department of Infectious Diseases, Geneva University Hospitals, HIV/AIDS Unit, Geneva, Switzerland
| | - Begoña Martinez de Tejada
- Obstetrics Division, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christian R Kahlert
- Children's Hospital of Eastern Switzerland and Cantonal Hospital, St. Gallen, Switzerland
| | | | - Marcel Stoeckle
- Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
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Tang JH, Davis NL, Corbett AH, Chinula L, Cottrell ML, Zia Y, Tegha G, Stanczyk FZ, Hurst S, Hosseinipour MC, Haddad LB, Kourtis AP. Effect of efavirenz on levonorgestrel concentrations among Malawian levonorgestrel implant users for up to 30 months of concomitant use: a subanalysis of a randomized clinical trial. Contracept X 2020; 2:100027. [PMID: 33364598 PMCID: PMC7752709 DOI: 10.1016/j.conx.2020.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives Our primary objective was to compare geometric mean levonorgestrel concentrations between levonorgestrel implant users who were or were not taking the antiretroviral efavirenz, for up to 30 months after implant initiation. Our secondary objective was to evaluate the pregnancy rate among levonorgestrel implant users on efavirenz. Study design We performed a subanalysis of 42 Malawian women randomized to initiate the levonorgestrel implant as part of a parent randomized clinical trial. Our subset included 30 HIV-infected women taking efavirenz and 12 HIV-uninfected women not taking efavirenz. They underwent urine pregnancy testing every 3 months and serum levonorgestrel testing at day 3 and months 1, 3, 6, 12, 18, 24, 27 and 30 after implant initiation. Geometric mean levonorgestrel concentrations were calculated for efavirenz users and non-efavirenz users at each time point. Results The geometric mean levonorgestrel concentrations were lower for efavirenz users than non-efavirenz users at every time point; the geometric mean ratio for efavirenz users:non-efavirenz users ranged from 0.60 [90% confidence interval (CI) 0.46–0.79] at 1 month to 0.27 (90% CI 0.12–0.61) at 30 months after implant insertion. No pregnancies occurred over 60 woman-years of concomitant levonorgestrel implant and efavirenz use, although 11 women had levonorgestrel concentrations < 180 pg/mL (the previously suggested minimum threshold concentration for efficacy). Conclusions Efavirenz users had lower levonorgestrel concentrations than non-efavirenz users, and one third of our concomitant efavirenz and levonorgestrel implant users had concentrations < 180 pg/mL. Continued evaluation of the contraceptive efficacy of the levonorgestrel implant may be needed for efavirenz users. Implications Among 42 Malawian women using the levonorgestrel implant for contraception, women who were taking the antiretroviral efavirenz had lower serum levonorgestrel concentrations than women who were not taking efavirenz. However, none of the women who were taking efavirenz became pregnant over 60 women-years of follow-up.
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Affiliation(s)
- Jennifer H Tang
- University of North Carolina at Chapel Hill, 111 Mason Farm Road, CB #7577; Chapel Hill, NC, 27599-7577, USA.,UNC Project Malawi, 100 Mzimba Drive, Private Bag A104, Lilongwe, Malawi
| | - Nicole L Davis
- US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Amanda H Corbett
- University of North Carolina at Chapel Hill, 111 Mason Farm Road, CB #7577; Chapel Hill, NC, 27599-7577, USA
| | - Lameck Chinula
- University of North Carolina at Chapel Hill, 111 Mason Farm Road, CB #7577; Chapel Hill, NC, 27599-7577, USA.,UNC Project Malawi, 100 Mzimba Drive, Private Bag A104, Lilongwe, Malawi
| | - Mackenzie L Cottrell
- University of North Carolina at Chapel Hill, 111 Mason Farm Road, CB #7577; Chapel Hill, NC, 27599-7577, USA
| | - Yasaman Zia
- US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Gerald Tegha
- UNC Project Malawi, 100 Mzimba Drive, Private Bag A104, Lilongwe, Malawi
| | - Frank Z Stanczyk
- University of Southern California, Keck School of Medicine, Reproductive Endocrine Research Laboratory, 1321 N. Mission Road, Los Angeles, CA, 90033, USA
| | - Stacey Hurst
- US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Mina C Hosseinipour
- University of North Carolina at Chapel Hill, 111 Mason Farm Road, CB #7577; Chapel Hill, NC, 27599-7577, USA.,UNC Project Malawi, 100 Mzimba Drive, Private Bag A104, Lilongwe, Malawi
| | - Lisa B Haddad
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Athena P Kourtis
- US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
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McGinn EK, Irani L. Provider-Initiated Family Planning Within HIV Services in Malawi: Did Policy Make It into Practice? GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:540-550. [PMID: 31791976 PMCID: PMC6927829 DOI: 10.9745/ghsp-d-19-00192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022]
Abstract
Four years after Malawi embraced a policy of provider-initiated family planning (PIFP) within its HIV Clinical Guidelines, this policy remained largely unimplemented at the health facility level. Strengthening PIFP in Malawi’s public and private health facilities will require targeted and comprehensive systems changes. Malawi’s guidelines for Clinical Management of HIV in Children and Adults promote the practice of provider-initiated family planning (PIFP) for all clients over the age of 15. The guidelines recommend that providers should offer all clients condoms, offer injectables to female clients, and refer clients to another provider or site if clients prefer another family planning method. This study assessed to what extent family planning services had been integrated into HIV services among 41 facilities in Malawi (hospitals, health posts, health centers; public and nonprofit private) and how the reproductive rights of people living with HIV were being addressed. Data were collected through facility audits (N=41), provider interviews (N=122), client exit interviews (N=425), and mystery client visits (N=58). This study found that contrary to clinical protocols, only 14% of clients at the antiretroviral therapy (ART) clinic had reported being asked about their family planning/fertility intentions during the visit that day. Only 24% of providers at the facility had received training on family planning-HIV integration, and 21% had no family planning training at all. Overwhelmingly, ART clients relied on condoms to meet their family planning needs. Only 24% of ART clinics had injectables available, and only 15% of ART clinics had a full range of family planning methods (short- and long-acting, hormonal and non-hormonal) available to clients. These findings suggest that Malawi’s strong national policies on family planning-HIV integration, and specifically PIFP, are not being implemented in practice and thus not adequately addressing the family planning needs of clients with HIV. To improve PIFP, Malawi requires targeted systems changes. Facilities need to broaden their family planning method mix offerings. Furthermore, providers need more training on family planning and the importance of HIV clients having access to family planning services, and referral services need to be strengthened so providers can ensure clients have access to their method of choice in a timely manner.
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Feyissa TR, Harris ML, Melka AS, Loxton D. Unintended Pregnancy in Women Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-analysis. AIDS Behav 2019; 23:1431-1451. [PMID: 30467712 DOI: 10.1007/s10461-018-2346-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In 2014, about 1.5 million pregnancies occurred among HIV-positive women in low and middle-income countries. To pool magnitude and factors associated with unintended pregnancy in women living with HIV in sub-Saharan Africa, a systematic search of electronic databases was undertaken in November 2016. Pooling the magnitude of unintended pregnancy reported by 14 studies yielded a crude summary prevalence of 55.9%. The magnitude of unwanted pregnancy and mistimed pregnancy in six studies ranged from 14 to 59 and 9 to 47.2%, respectively. Contraceptive failure was an important factor for many unintended pregnancies. The magnitude of unintended pregnancy was significantly higher in HIV-positive women than for HIV-negative women in three out of six studies. The available evidence suggests that there is a high magnitude of unintended pregnancy in this population. Improving effective contraceptive utilization is thus a priority to address unintended pregnancies and to prevent mother to child transmission of HIV. PROSPERO Number: CRD42016051310.
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Abstract
PURPOSE OF REVIEW Contraception is a vital component of medical care for women with HIV or at high risk of acquiring HIV. Over the last several years, there has been emerging evidence regarding the safety and effectiveness of various contraceptive methods, ultimately leading to a revision in the WHO Medical Eligibility Criteria for contraceptive use. RECENT FINDINGS Progestogen-only injectables may be associated with an increased risk of HIV acquisition and its use has been revised to category 2 from category 1. Etonogestrel and levonorgestrel levels are lower in women who concurrently use contraceptive implant and efavirenz-based antiretroviral therapy. Multipurpose technology, aimed at providing antiretroviral medication and contraception, is an area of ongoing research but is not yet clinically available. SUMMARY It is important for providers who care for women with HIV or at high risk of HIV to inquire about pregnancy intentions. If contraception is desired, these women should be offered all available methods, with counseling regarding possible risks of contraceptive failure or HIV acquisition.
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Kopp DM, Bula A, Maman S, Chinula L, Tsidya M, Mwale M, Tang JH. Influences on birth spacing intentions and desired interventions among women who have experienced a poor obstetric outcome in Lilongwe Malawi: a qualitative study. BMC Pregnancy Childbirth 2018; 18:197. [PMID: 29855296 PMCID: PMC5984328 DOI: 10.1186/s12884-018-1835-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 05/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stillbirth and neonatal mortality are very high in many low-income countries, including Malawi. Use of family planning to encourage birth spacing may optimize outcomes for subsequent pregnancies. However, reproductive desires and influences on birth spacing preferences of women who have experienced a stillbirth or neonatal death in low-resource settings are not well understood. METHODS We conducted a qualitative study using 20 in-depth interviews and four focus group discussions with women who had experienced a stillborn baby or early neonatal death to explore attitudes surrounding birth spacing and potential interventions to promote family planning in this population. Qualitative data were analyzed for recurrent patterns and themes and central ideas were extracted to identify their core meanings. RESULTS Forty-six women participated in the study. After experiencing a stillbirth or neonatal death, most women wanted to wait to become pregnant again but women with living children wished to wait for longer periods of time than those with no living children. Most women preferred birth spacing interventions led by clinical providers and inclusion of their spouses. CONCLUSIONS Many influences on family size and birth spacing were noted in this population, with the most significant influencing factor being the spouse. Interventions to promote birth spacing and improve maternal and neonatal health in this population need to involve male partners and knowledgeable health care providers to be effective. TRIAL REGISTRATION Clinicaltrials.gov NCT02674542 Registered February 1, 2016 (retrospectively registered).
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Affiliation(s)
- Dawn M Kopp
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi. .,UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA. .,Kamuzu Central Hospital, Lilongwe, Malawi.
| | - Agatha Bula
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi
| | - Suzanne Maman
- UNC Department of Health Behavior, Chapel Hill, NC, USA
| | - Lameck Chinula
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi.,UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA.,Kamuzu Central Hospital, Lilongwe, Malawi.,Malawi College of Medicine Department of Obstetrics & Gynaecology, Blantyre, Malawi
| | - Mercy Tsidya
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi
| | - Mwawi Mwale
- Bwaila Hospital, Lilongwe District Health Office, Lilongwe, Malawi
| | - Jennifer H Tang
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi.,UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA.,Kamuzu Central Hospital, Lilongwe, Malawi.,Malawi College of Medicine Department of Obstetrics & Gynaecology, Blantyre, Malawi
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Salters K, Loutfy M, de Pokomandy A, Money D, Pick N, Wang L, Jabbari S, Carter A, Webster K, Conway T, Dubuc D, O’Brien N, Proulx-Boucher K, Kaida A. Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada. PLoS One 2017; 12:e0180524. [PMID: 28727731 PMCID: PMC5519029 DOI: 10.1371/journal.pone.0180524] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/17/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pregnancy incidence rates among women living with HIV (WLWH) have increased over time due to longer life expectancy, improved health status, and improved access to and HIV prevention benefits of combination antiretroviral therapy (cART). However, it is unclear whether intended or unintended pregnancies are contributing to observed increases. METHODS We analyzed retrospective data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). Kaplan-Meier methods and GEE Poisson models were used to measure cumulative incidence and incidence rate of pregnancy after HIV diagnosis overall, and by pregnancy intention. We used multivariable logistic regression models to examine independent correlates of unintended pregnancy among the most recent/current pregnancy. RESULTS Of 1,165 WLWH included in this analysis, 278 (23.9%) women reported 492 pregnancies after HIV diagnosis, 60.8% of which were unintended. Unintended pregnancy incidence (24.6 per 1,000 Women-Years (WYs); 95% CI: 21.0, 28.7) was higher than intended pregnancy incidence (16.6 per 1,000 WYs; 95% CI: 13.8, 20.1) (Rate Ratio: 1.5, 95% CI: 1.2-1.8). Pregnancy incidence among WLWH who initiated cART before or during pregnancy (29.1 per 1000 WYs with 95% CI: 25.1, 33.8) was higher than among WLWH not on cART during pregnancy (11.9 per 1000 WYs; 95% CI: 9.5, 14.9) (Rate Ratio: 2.4, 95% CI: 2.0-3.0). Women with current or recent unintended pregnancy (vs. intended pregnancy) had higher adjusted odds of being single (AOR: 1.94; 95% CI: 1.10, 3.42), younger at time of conception (AOR: 0.95 per year increase, 95% CI: 0.90, 0.99), and being born in Canada (AOR: 2.76, 95% CI: 1.55, 4.92). CONCLUSION Nearly one-quarter of women reported pregnancy after HIV diagnosis, with 61% of all pregnancies reported as unintended. Integrated HIV and reproductive health care programming is required to better support WLWH to optimize pregnancy planning and outcomes and to prevent unintended pregnancy.
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Affiliation(s)
- Kate Salters
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Deborah Money
- Oak Tree Clinic, BC Women’s Hospital and Health Centre, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women’s Hospital and Health Centre, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Shahab Jabbari
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Tracey Conway
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniele Dubuc
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nadia O’Brien
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Karene Proulx-Boucher
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- * E-mail:
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Agadjanian V, Hayford SR. HIV status, fertility intentions, and contraception in the era of expanded access to antiretroviral therapy: A case study of rural Mozambique. Glob Public Health 2016; 13:582-596. [PMID: 28032523 DOI: 10.1080/17441692.2016.1268188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Provision of effective contraception to HIV-positive women of reproductive age is critical to effective management of HIV infection and prevention of both vertical and horizontal HIV transmission in developing countries. This exploratory retrospective study examines contraceptive use during the prolonged post-partum period in a sample of 285 HIV-positive and HIV-negative women who gave birth at four rural maternity clinics in a high HIV-prevalence region in Mozambique. Multivariate analyses show no significant variations by HIV status in contraceptive timing (mean time to first contraceptive use of 7.1 months) or prevalence (31% at time of survey) but detect a moderating effect of fertility intentions: while HIV status makes no difference for women wishing to stop childbearing, among women who want to continue having children, or are unsure about their reproductive plans, HIV-positive status is associated with higher likelihood of contraceptive use. Regardless of HIV status, virtually no condom use is reported. These results are situated within the context of a rapidly widening access to post-partum antiretroviral therapy in the study site and similar sub-Saharan settings.
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Affiliation(s)
- Victor Agadjanian
- a Department of Sociology , University of Kansas , Lawrence , KS , USA
| | - Sarah R Hayford
- b Department of Sociology and Institute for Population Research , Ohio State University , Columbus , OH , USA
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