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Naicker N, Yende-Zuma N, Kharsany ABM, Shozi H, Nkosi D, Naidoo A, Garrett N, Abdool Karim SS. Pregnancy rates and outcomes in a longitudinal HIV cohort in the context of evolving antiretroviral treatment provision in South Africa. BMC Pregnancy Childbirth 2022; 22:596. [PMID: 35883114 PMCID: PMC9317085 DOI: 10.1186/s12884-022-04829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In South Africa, women continue to face a high burden of Human Immunodeficiency Virus (HIV) infection and the possible complications thereof during pregnancy. We assessed pregnancy incidence rates and outcomes in a longitudinal HIV cohort study over a 15-year period. METHODS We evaluated pregnancies among women ≥ 18 years between 2004 and 2019 in the CAPRISA 002 study. We analysed pregnancy rates following HIV acquisition, CD4 counts and HIV viral load dynamics and pregnancy outcomes. We used linear regression to assess if the mean CD4 and log10 viral load close to delivery increases or decreases linearly across three different timepoints. RESULTS In total 245 women enrolled into the HIV negative study phase, 225 into the HIV infection phase and 232 in the antiretroviral therapy (ART) phase. Median follow-up time was 2.0 years [Interquartile Range (IQR) 0.8-2.0] during the HIV negative phase, 2.6 years; (IQR) 1.2-4.8] during HIV infection and 3.7 years (IQR 1.8-5.0) on ART, with maximum follow-up time of 2, 10 and 6 years respectively. Overall, 169 pregnancies occurred in 140 women, of which 16 pregnancies were observed during acute or early HIV infection [Incidence Rate (IR) 8.0 per 100 women-years; 95% confidence interval (CI): 4.6-12.9], 48 during established infection [IR 9.3; (CI 6.8-12.3)] and 68 on ART [IR 8.9; (CI: 7.0 - 11.4)]. Birth outcomes from 155/169 (91.7%) pregnancies were 118 (76.1%) full term live births, 17 (10.9%) premature live births, 9 (5.8%) therapeutic/elective miscarriages, 8 (5.1%) spontaneous miscarriages and 3 (1.9%) spontaneous foetal deaths or stillbirths. Six mother-to-child transmission events occurred, with four documented prior to 2008. Over time, mean CD4 count in pregnant women increased from 395 cells/µL (2004-2009) to 543 cells/µL (2010-2014) and to 696 cells/µL (2015-2019), p < 0.001. Conversely, the viral load declined from 4.2 log10 copies/ml to 2.5 log10 copies/ml and to 1.2 log10 copies/ml (p < 0.001) for the corresponding periods. CONCLUSIONS Pregnancy rates following HIV acquisition were high, emphasising a need for timeous ART provision and contraception counselling in women recently diagnosed with HIV. CD4 count and HIV viral load trajectories reflect improvements in treatment guidance for pregnant women over time.
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Affiliation(s)
- Nivashnee Naicker
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
- School of Laboratory Medicine and Medical Science, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Hlengiwe Shozi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Duduzile Nkosi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Anushka Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, NY 10032, USA
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Association between viral suppression during the third trimester of pregnancy and unintended pregnancy among women on antiretroviral therapy: Results from the 2019 antenatal HIV Sentinel Survey, South Africa. PLoS One 2022; 17:e0265124. [PMID: 35298503 PMCID: PMC8929576 DOI: 10.1371/journal.pone.0265124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives About half of the pregnancies among women living with HIV (WLWH) receiving antiretroviral therapy (ART) in sub-Saharan African countries are reported to be unintended. Unintended pregnancy is associated with late initiation of antenatal care (ANC), and may delay provision of viral load monitoring services, antenatal adherence counselling and support, and other services that promote sustained viral suppression throughout pregnancy. This study examines the association between unsuppressed viral load during the third trimester of pregnancy and unintended pregnancy among women who initiated ART before pregnancy. Methods This was an analysis of data from a national antenatal survey conducted at 1 589 public health facilities in South Africa between 1 October and 15 November 2019. Consenting pregnant women aged 15–49 years attending ANC during the survey period were enrolled. Demographic and clinical data were collected through interview and medical record review. Pregnancy intention was assessed using two questions from the London Measure of Unplanned Pregnancy, and responses were categorized as “unintended,” “undecided,” and “intended.” Blood specimens were collected from all women and tested for HIV; and if positive, a viral load test was performed. A survey domain-based poisson regression model examined the association between unsuppressed viral load during the third trimester of pregnancy and unintended pregnancy among women who initiated ART before pregnancy. Viral suppression was defined as viral load <50 copies/mL. Results Of 10 901 WLWH with viral load data available, 63.3% (95% confidence interval (CI): 62.4%-64.1%) were virally suppressed. Among the 2 681 women (representing 24.1% of all WLWH with viral load data) who initiated ART before pregnancy and were in their third trimester at the time of enrolment, 74.4% (95% CI: 73.0%-75.8%) were virally suppressed. In the same population, the proportion virally suppressed was lower among women whose current pregnancies were unintended (72.1%, 95% CI: 70.1%-74.1%) compared to women whose pregnancies were intended (78.3%, 95% CI: 75.9%-80.5%). In multivariable analyses adjusted for age, gravity, marital status, education, location of facility and syphilis status, unintended pregnancy was associated with unsuppressed viral load during the third trimester (adjusted relative risk: 1.3, 95% CI: 1.1–1.4) among women who initiated ART before pregnancy. Conclusion The identified association between unsuppressed viral load and unintended pregnancy among pregnant women who initiated ART before pregnancy highlights the need to strengthen routine assessment of fertility preferences and provision of contraceptive services to reproductive age WLWH receiving ART.
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Millar HC, Keter AK, Musick BS, Apondi E, Wachira J, MacDonald KR, Spitzer RF, Braitstein P. Decreasing incidence of pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya between 2005 and 2017: a retrospective cohort study. Reprod Health 2020; 17:191. [PMID: 33267899 PMCID: PMC7709285 DOI: 10.1186/s12978-020-01031-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to estimate the prevalence, incidence and risk factors for pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya. METHODS The Academic Model Providing Access to Healthcare (AMPATH) program is a partnership between Moi University, Moi Teaching and Referral Hospital and a consortium of 11 North American academic institutions. AMPATH currently provides care to 85,000 HIV-positive individuals in western Kenya. Included in this analysis were adolescents aged 10-19 enrolled in AMPATH between January 2005 and February 2017. Socio-demographic, behavioural, and clinical data at baseline and time-updated antiretroviral treatment (ART) data were extracted from the electronic medical records and summarized using descriptive statistics. Follow up time was defined as time of inclusion in the cohort until the date of first pregnancy or age 20, loss to follow up, death, or administrative censoring. Adolescent pregnancy rates and associated risk factors were determined. RESULTS There were 8565 adolescents eligible for analysis. Median age at enrolment in HIV care was 14.0 years. Only 17.7% had electricity at home and 14.4% had piped water, both indicators of a high level of poverty. 12.9% (1104) were pregnant at study inclusion. Of those not pregnant at enrolment, 5.6% (448) became pregnant at least once during follow-up. Another 1.0% (78) were pregnant at inclusion and became pregnant again during follow-up. The overall pregnancy incidence rate was 21.9 per 1000 woman years or 55.8 pregnancies per 1000 women. Between 2005 and 2017, pregnancy rates have decreased. Adolescents who became pregnant in follow-up were more likely to be older, to be married or living with a partner and to have at least one child already and less likely to be using family planning. CONCLUSIONS A considerable number of these HIV-positive adolescents presented at enrolment into HIV care as pregnant and many became pregnant as adolescents during follow-up. Pregnancy rates remain high but have decreased from 2005 to 2017. Adolescent-focused sexual and reproductive health and ante/postnatal care programs may have the potential to improve maternal and neonatal outcomes as well as further decrease pregnancy rates in this high-risk group.
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Affiliation(s)
- Heather C Millar
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya. .,Section of Gynaecology, Division of Endocrinology, SickKids Hospital, 555 University Avenue, 7th Floor, Black Wing, Toronto, ON, M5G 1X8, Canada. .,Department of Obstetrics and Gynaecology, University of Toronto Faculty of Medicine, 123 Edward Street, Suite 1200, Toronto, ON, M5G 1E2, Canada.
| | - Alfred K Keter
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya
| | - Beverly S Musick
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, Suite 3000, Indianapolis, IN, 46202, USA
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Moi Teaching and Referral Hospital, Nandi Road, Uasin Gishu County, PO Box 3-30100, Eldoret, Kenya
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Department of Behavioral Sciences, Moi University, College of Health Sciences, PO Box 4606, Eldoret, 30100, Kenya
| | - Katherine R MacDonald
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Riley Hospital 5900, Indianapolis, IN, 46202, USA
| | - Rachel F Spitzer
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Section of Gynaecology, Division of Endocrinology, SickKids Hospital, 555 University Avenue, 7th Floor, Black Wing, Toronto, ON, M5G 1X8, Canada.,Department of Obstetrics and Gynaecology, University of Toronto Faculty of Medicine, 123 Edward Street, Suite 1200, Toronto, ON, M5G 1E2, Canada
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), PO Box 4606, Eldoret, 30100, Kenya.,Department of Epidemiology, University of Toronto Dalla Lana School of Public Health, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.,Moi University, College of Health Sciences, School of Medicine, PO Box 4606, Eldoret, 30100, Kenya
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Elliver M, Hallström I, Jerene D. Pregnancy in women diagnosed with HIV on antiretroviral therapy in Ethiopia: a retrospective cohort study. Pan Afr Med J 2020; 37:101. [PMID: 33425134 PMCID: PMC7757312 DOI: 10.11604/pamj.2020.37.101.23035] [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: 04/23/2020] [Accepted: 09/14/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction due to increasing coverage of antiretroviral therapy (ART), more women living with HIV have improved health condition which also increases their chances of getting pregnant. However, the knowledge about pregnancy among women receiving ART in resource-constrained settings, like Ethiopia, is limited. The aim was to assess factors associated with pregnancy among women living with HIV in Ethiopia. Methods a retrospective cohort study from 2005 through 2013 including a total of 809 women aged 15-49 years on ART was used. The study was conducted in eight hospitals and health centers in two regions of Ethiopia. The data was collected between March and June of 2014 from patients´ pre-ART and ART registers by trained nurses, assisted by data entry clerks and supervised by senior physicians. Kaplan-Meier survival analysis and Cox regression analysis were used to examine the probability of becoming pregnant. Factors associated with pregnancy were presented with hazard ratios with 95% Confidence Interval (CI). Results a total of 809 women were included in this analysis, their median age was 27 years, 90% were urban residents and 40.6% were married. Four hundred eighty three (60.6%) were in WHO stage III at initiation of ART. The median CD4 count was 162.5 cell/μl at initiation of ART. Eighty-one women became pregnant during 3069 person-years of observation. The overall incidence of pregnancy was 26.4 pregnancies per 1000 person-years of observation. Women under the age of 24, those in less advanced disease stage, women with no education and those with college education had higher rates of pregnancy. Conclusion the results highlight that younger women, those in less advanced disease stage, either uneducated or highly educated ones have higher probability of becoming pregnant during HIV treatment. This suggests the need for integrating reproductive health services into HIV care services to meet the needs of women on ART.
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Affiliation(s)
| | | | - Degu Jerene
- Koninklijke Centrale Vereeniging (KNCV) Tuberculosis Foundation, The Hague, Netherlands
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Mageda K, Mohamed M, Kulemba K. Incidence and determinants of pregnancy among women receiving HAART in Simiyu region: 14-year retrospective follow-up. TROPICAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2020. [DOI: 10.4103/tjog.tjog_92_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cernigliaro D, Barrington C, Donastorg Y, Perez M, Kerrigan D. Patient-provider communication about pregnancy and HIV among female sex workers living with HIV in Santo Domingo, Dominican Republic. BMC Pregnancy Childbirth 2019; 19:427. [PMID: 31752743 PMCID: PMC6868801 DOI: 10.1186/s12884-019-2482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/28/2019] [Indexed: 12/02/2022] Open
Abstract
Background Health providers can play an important role in communication about pregnancy, particularly for women at increased risk for pregnancy complications, including female sex workers (FSWs) living with HIV. This study explored factors related to patient-provider communication about pregnancy among 253 FSWs living with HIV of reproductive age in Santo Domingo, Dominican Republic. Methods A cross-sectional design was employed including structured socio-behavioral surveys. Data were analyzed utilizing bivariate and multivariate logistic regression. Results Of the 253 FSWs living with HIV in this study, 95.7% had been pregnant at least once (median: 4; IQR: 3,6), 28.0% wanted more children and 36% reported a pregnancy after HIV diagnosis. Over half of participants (58.0%) reported having ever spoken to a health provider about pregnancy while living with HIV. Multivariate logistic regression found significant associations between having spoken to a health provider about HIV in pregnancy and a more positive perception of their provider (AOR: 2.0; 95% CI: 1.0, 2.5) and years since HIV diagnosis (AOR: 1.1; 95% CI: 1.0, 1.1). Participants were less likely to speak with a provider if they had a history of drug use (AOR: 0.4; 95% CI: 0.2, 0.9) or current alcohol use (AOR: 0.5; 95% CI: 0.3, 0.9). Conclusion Findings highlight the importance of non-judgmental and tailored provider-initiated conversations surrounding pregnancy. Future research is needed to better understand how and when pregnancy communication is initiated, as well as the content of clinical care conversations, to address the reproductive health of FSWs living with HIV.
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Affiliation(s)
- Dana Cernigliaro
- The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway HH 257, Baltimore, MD, 21205, USA
| | - Clare Barrington
- The University of North Carolina Gillings School of Global Public Health, Rosenau Hall 319B, CB#7440, Chapel Hill, NC, 27599, USA
| | - Yeycy Donastorg
- Instituto Dermatologico y Cirugia de la Piel, Albert Thomas, 66, Santo Domingo, Dominican Republic
| | - Martha Perez
- Instituto Dermatologico y Cirugia de la Piel, Albert Thomas, 66, Santo Domingo, Dominican Republic
| | - Deanna Kerrigan
- The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway HH 257, Baltimore, MD, 21205, USA. .,Center on Health, Risk & Society, American University, 4400 Massachusetts Avenue, Washington, DC, NW, 20016, USA.
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Van Ommen CE, Albert AYK, Piske M, Money DM, Cote HCF, Lima VD, Maan EJ, Alimenti A, van Schalkwyk J, Pick N, Murray MCM. Exploring the live birth rates of women living with HIV in British Columbia, Canada. PLoS One 2019; 14:e0211434. [PMID: 30726263 PMCID: PMC6364910 DOI: 10.1371/journal.pone.0211434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/14/2019] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the birth rates of women living with HIV (WLWH) compared to the general population in British Columbia (BC), Canada. Methods We retrospectively reviewed clinical and population level surveillance data from 1997 to 2015. Live birth rates from 1997 to 2015 among WLWH aged 15–49 years were compared with those of all BC women. Next, the number of live births among WLWH with a live birth between 1997–2012 and HIV-negative controls matched 1:3 by geocode were compared. Results WLWH had a lower birth rate compared to all BC women [31.4 (95%CI, 28.6–34.3) vs. 40.0 (39.3–40.1)/1000 person years]. Stratified by age, WLWH aged 15–24 years had a higher birth rate while WLWH aged 25–49 years had a lower birth rate than BC women (p<0.01). Between 1997 and 2015, birth rates for both populations decreased among women aged 15–24 years, and increased among women aged 25–49 years, most strikingly among WLWH 35–49 years (p<0.01). When comparing WLWH with a live birth to HIV-negative geocode matched controls, WLWH aged 15–24 years (p = 0.03) and aged 25–34 years (p<0.01) had more live births than controls while WLWH aged 35–49 years did not (p = 0.06). Conclusions On a population level, WLWH have lower birth rates than the general population. However, this is not observed among WLWH who have ever given birth compared with matched controls, suggesting that sociodemographic factors may play an important role. WLWH are increasingly giving birth in their later reproductive years. Taken together, our data supports the integration of reproductive health and HIV care.
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Affiliation(s)
- Clara E. Van Ommen
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arianne Y. K. Albert
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Micah Piske
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Deborah M. Money
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
| | - Hélène C. F. Cote
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Viviane D. Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evelyn J. Maan
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
| | - Ariane Alimenti
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Division of Infectious and Immunologic Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julianne van Schalkwyk
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
| | - Neora Pick
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melanie C. M. Murray
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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Brittain K, Remien RH, Mellins CA, Phillips TK, Zerbe A, Abrams EJ, Myer L. Determinants of suboptimal adherence and elevated HIV viral load in pregnant women already on antiretroviral therapy when entering antenatal care in Cape Town, South Africa. AIDS Care 2018; 30:1517-1523. [PMID: 30047287 DOI: 10.1080/09540121.2018.1503637] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Across sub-Saharan Africa, prevention of mother-to-child transmission services are encountering increasing numbers of women already established on antiretroviral therapy (ART) when entering antenatal care. However, there are few data examining ART adherence and HIV viral load in this group. We used multivariable logistic regression models to examine self-reported suboptimal adherence (defined as missed ART doses on ≥2 days during the preceding 30 days), elevated viral load (≥1000 copies/mL), and factors associated with each among women entering antenatal care on ART. Participants were recruited from one primary care clinic in Gugulethu, Cape Town, as part of a larger study of HIV-positive pregnant and postpartum women. Among 482 pregnant women established on ART and enrolled between May 2013 and June 2014 (median age: 31 years; median duration of ART use: 3 years), 15% reported suboptimal adherence and 12% had elevated viral load. After adjustment for age, suboptimal adherence was significantly more common among women who were not married/cohabiting and women who reported a higher level of concern about taking ART; a higher level of adherence self-efficacy was associated with a reduced odds of suboptimal adherence. In a multivariable model, elevated viral load was significantly associated with previous discontinuation of ART, a higher level of concern about taking ART, and report of an unintended pregnancy. Suboptimal adherence and elevated viral load are common among women entering antenatal care already on ART. Our findings highlight specific beliefs and concerns about ART use during pregnancy that should be addressed in counselling messaging, and suggest that family planning should be more effectively integrated into HIV care. Including adherence and viral load monitoring as part of pregnancy planning for women on ART may be important to achieve safer conception and promote healthy pregnancies.
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Affiliation(s)
- Kirsty Brittain
- a Division of Epidemiology & Biostatistics , School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa.,b Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa
| | - Robert H Remien
- c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute, Columbia University , New York , NY , USA
| | - Claude A Mellins
- c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute, Columbia University , New York , NY , USA
| | - Tamsin K Phillips
- a Division of Epidemiology & Biostatistics , School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa.,b Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa
| | - Allison Zerbe
- d ICAP , Columbia University, Mailman School of Public Health , New York , NY , USA
| | - Elaine J Abrams
- d ICAP , Columbia University, Mailman School of Public Health , New York , NY , USA.,e College of Physicians & Surgeons , Columbia University , New York , NY , USA
| | - Landon Myer
- a Division of Epidemiology & Biostatistics , School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa.,b Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town , Cape Town , South Africa
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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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Arikawa S, Eboua T, Kouakou K, N'Gbeche MS, Amorissani-Folquet M, Moh C, Amoussou-Bouah UB, Coffie PA, Becquet R, Leroy V. Pregnancy incidence and associated factors among HIV-infected female adolescents in HIV care in urban Côte d'Ivoire, 2009-2013. Glob Health Action 2016; 9:31622. [PMID: 27527503 PMCID: PMC4985616 DOI: 10.3402/gha.v9.31622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Adolescents living with HIV are sexually active and engaged in risky sexual behaviors. Knowledge on how and to what extent adolescents in HIV care are affected by pregnancy is needed so as to adopt better preventive services. We estimated 4-year pregnancy incidence and correlates among HIV-infected female adolescents in HIV care in urban Côte d'Ivoire. DESIGN We conducted retrospective analysis of a pediatric prospective cohort of the International epidemiological Databases to Evaluate AIDS (IeDEA) West Africa Collaboration. Female patients with confirmed HIV infection aged 10-19 years, having at least one clinical visit in 2009 to health facilities participating in the pediatric IeDEA West African cohort in Abidjan, Côte d'Ivoire, were included. Data on incident pregnancies were obtained through medical records and interviews with health professionals. Pregnancy incidence rate was estimated per 100 person-years (PY). Poisson regression models were used to identify factors associated with the first pregnancy and provided incidence rate ratios (IRR) with 95% confidence intervals (CI). RESULTS In 2009, 266 female adolescents were included, with a median age of 12.8 years (interquartile range, IQR: 10.0-15.0), CD4 cell counts of 506 cells/mm(3) (IQR: 302-737), and 80% on antiretroviral treatment. At the 48th month, 17 new pregnancies were reported after 938 PY of follow-up: 13 girls had one pregnancy while 2 had two pregnancies. Overall incidence rate of pregnancy was 1.8/100 PY (95% CI: 1.1-2.9). High incidence was observed among those aged 15-19 years: 3.6/100 PY (95% CI: 2.2-5.9). Role of maternal death in the risk of pregnancy was at the limit of statistical significance (adjusted IRR: 3.1, 95% CI: 0.9-11.0; ref. non-maternal orphans). CONCLUSIONS Incidence of pregnancy among HIV-infected adolescents in care aged 15-19 years reached a level observed in adult cohorts in Sub-Saharan Africa. Health personnel in pediatric care have to intensify their efforts to provide more realistic and age-adapted reproductive health services to meet the needs of adolescent patients already confronting issues of sexuality. Vulnerability of maternal orphans merits further investigation.
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Affiliation(s)
- Shino Arikawa
- Inserm, Centre de recherche Inserm U1219, Bordeaux, France.,Institut de Santé Publique Epidémiologie Développement (ISPED), Université Bordeaux, Bordeaux, France;
| | - Tanoh Eboua
- Centre Hospitalier Universitaire Yopougon, Abidjan, Côte d'Ivoire
| | - Kouadio Kouakou
- Centre Intégré de Recherches Biocliniques, Abidjan, Côte d'Ivoire
| | | | | | - Corinne Moh
- Centre de Prise en charge de Recherche et de Formation, Abidjan, Côte d'Ivoire
| | | | - Patrick Ahuatchi Coffie
- Programme PACCI, Abidjan, Côte d'Ivoire.,Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Renaud Becquet
- Inserm, Centre de recherche Inserm U1219, Bordeaux, France.,Institut de Santé Publique Epidémiologie Développement (ISPED), Université Bordeaux, Bordeaux, France
| | - Valériane Leroy
- Inserm, Centre de recherche Inserm U1027, Université Paul Sabatier Toulouse 3, Toulouse, France
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Poda A, Hema A, Konaté A, Kaboré F, Zoungrana J, Kamboulé E, Soré I, Bado G, Ouédraogo AS, Ouédraogo M, Meda N, Sawadogo AB. Pregnancy rate and birth outcomes among women receiving antiretroviral therapy in Burkina Faso: a retrospective cohort study. Pan Afr Med J 2016; 23:105. [PMID: 27222692 PMCID: PMC4867182 DOI: 10.11604/pamj.2016.23.105.7372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 02/10/2016] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION In Sub-Saharan Africa, few studies reported pregnancy incidence and outcomes in women taking antiretroviral therapy (ART). This survey aims to estimate the incidence and outcomes of pregnancy in a cohort of HIV positive women initiating ART in Bobo-Dioulasso, Burkina Faso. METHODS We carried out a retrospective cohort study. We selected women in childbearing age initiating ART and followed up in Bobo-Dioulasso teaching hospital between January 2005 and June 2011. The incidence of pregnancies during follow-up was calculated. Childbirth was defined by the expulsion of a fetus after 22 weeks of amenorrhea. Before this term, it is an abortion. Childbirth is said premature if it occurs before 37 weeks of gestation, to term if it occurs between the 38th and the 42nd week. The annual age-standardized fertility rates were calculated using the baseline population from the 2010 demographic and health survey (DHS) in Burkina Faso. RESULTS A total of 1,763 women of childbearing age under ART were included in the study. They ranged between 18 and 48 years old with a median of 35 years old. A total of 222 pregnancies were observed during 4639 women-years of follow-up, corresponding to an incidence density of 5 pregnancies for 100 women-years (95% CI: 4.2-5.5). Among the 222 pregnancies recorded, 9(4.0%) ended with abortion, 205(92.4%) with childbirth (including 15 premature childbirths); the outcome of 8(3.6%) pregnancies were unknown abortion. Live birth and stillborn rates were 94.0% (193/205) and 6.0% respectively. The standard fertility rate in our cohort was 45 live births for 1,000 women-years. The general decrease in fertility rates was 66.0% among women infected with HIV compared to the overall population. CONCLUSION This study shows a low pregnancy incidence among women initiating ART as compared to their peers from the general population. Pregnancies that occurred during ART generally end with live births. Care packages for HIV infected women of childbearing age must include reproductive health services to better address this issue.
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Affiliation(s)
- Armel Poda
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso; Institut Supérieur des Sciences de la Santé (INSSA), Université Polytechnique de Bobo Dioulasso (UPB), Bobo Dioulasso, Burkina Faso
| | - Arsène Hema
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Aina Konaté
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Firmin Kaboré
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Jacques Zoungrana
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Euloges Kamboulé
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Ibrahim Soré
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Guillaume Bado
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Abdoul-Salam Ouédraogo
- Institut Supérieur des Sciences de la Santé (INSSA), Université Polytechnique de Bobo Dioulasso (UPB), Bobo Dioulasso, Burkina Faso; Service de Bactériologie Virologie, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Macaire Ouédraogo
- Institut Supérieur des Sciences de la Santé (INSSA), Université Polytechnique de Bobo Dioulasso (UPB), Bobo Dioulasso, Burkina Faso; Service de Médecine Interne, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Nicolas Meda
- Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso; Centre Muraz, Bobo Dioulasso, Burkina Faso
| | - Adrien Bruno Sawadogo
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso; Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
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12
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Akelo V, McLellan-Lemal E, Toledo L, Girde S, Borkowf CB, Ward L, Ondenge K, Ndivo R, Lecher SL, Mills LA, Thomas TK. Determinants and Experiences of Repeat Pregnancy among HIV-Positive Kenyan Women--A Mixed-Methods Analysis. PLoS One 2015; 10:e0131163. [PMID: 26120846 PMCID: PMC4488283 DOI: 10.1371/journal.pone.0131163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 05/31/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To identify factors associated with repeat pregnancy subsequent to an index pregnancy among women living with HIV (WLWH) in western Kenya who were enrolled in a 24-month phase-II clinical trial of triple-ART prophylaxis for prevention of mother-to-child transmission, and to contextualize social and cultural influences on WLWH's reproductive decision making. METHODS A mixed-methods approach was used to examine repeat pregnancy within a 24 month period after birth. Counselor-administered questionnaires were collected from 500 WLWH. Forty women (22 with a repeat pregnancy; 18 with no repeat pregnancy) were purposively selected for a qualitative interview (QI). Simple and multiple logistic regression analyses were performed for quantitative data. Thematic coding and saliency analysis were undertaken for qualitative data. RESULTS Eighty-eight (17.6%) women had a repeat pregnancy. Median maternal age was 23 years (range 15-43 years) and median gestational age at enrollment was 34 weeks. In multiple logistic regression analyses, living in the same compound with a husband (adjusted odds ratio (AOR): 2.33; 95% confidence interval (CI): 1.14, 4.75) was associated with increased odds of repeat pregnancy (p ≤ 0.05). Being in the 30-43 age group (AOR: 0.25; 95% CI: 0.07, 0.87), having talked to a partner about family planning (FP) use (AOR: 0.53; 95% CI: 0.29, 0.98), and prior usage of FP (AOR: 0.45; 95% CI: 0.25, 0.82) were associated with a decrease in odds of repeat pregnancy. QI findings centered on concerns about modern contraception methods (side effects and views that they 'ruined the womb') and a desire to have the right number of children. Religious leaders, family, and the broader community were viewed as reinforcing cultural expectations for married women to have children. Repeat pregnancy was commonly attributed to contraception failure or to lack of knowledge about post-delivery fertility. CONCLUSIONS In addition to cultural context, reproductive health programs for WLWH may need to address issues related to living circumstances and the possibility that reproductive-decision making may extend beyond the woman and her partner.
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Affiliation(s)
- Victor Akelo
- Kenya Medical Research Institute, Kisumu, Kenya
- * E-mail:
| | | | - Lauren Toledo
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- ICF International, Atlanta, GA, United States of America
| | - Sonali Girde
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- ICF International, Atlanta, GA, United States of America
| | - Craig B. Borkowf
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Laura Ward
- Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | | | | | - Shirley L. Lecher
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Lisa A. Mills
- Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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Henegar CE, Westreich DJ, Maskew M, Miller WC, Brookhart MA, Van Rie A. Effect of pregnancy and the postpartum period on adherence to antiretroviral therapy among HIV-infected women established on treatment. J Acquir Immune Defic Syndr 2015; 68:477-80. [PMID: 25559590 PMCID: PMC4374144 DOI: 10.1097/qai.0000000000000501] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
: Among women who become pregnant after initiating highly active antiretroviral therapy (HAART), few data describe the effect of pregnancy and postpartum on adherence. We conducted a retrospective clinical cohort study among therapy-naive women (age, 18-45 years) initiating HAART in Johannesburg, South Africa. Among 7510 women in our analysis, 896 experienced a pregnancy after starting HAART. Compared with nonpregnant periods of follow-up, there was an increased risk of nonadherence during the postpartum period (weighted risk ratio: 1.46, 95% confidence interval: 1.17 to 1.82) but not during pregnancy itself (weighted risk ratio: 0.95, 95% confidence interval: 0.78 to 1.17).
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Affiliation(s)
- Cassidy E Henegar
- *Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC; †Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and ‡Division of Infectious Diseases, Department of Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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14
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Burgos-Soto J, Balestre E, Minga A, Ajayi S, Sawadogo A, Zannou MD, Leroy V, Ekouevi DK, Dabis F, Becquet R. Incidence of pregnancy after antiretroviral therapy initiation and associated factors in 8 West African countries. J Acquir Immune Defic Syndr 2014; 67:e45-54. [PMID: 25216079 PMCID: PMC4166575 DOI: 10.1097/qai.0000000000000279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION This study aimed at estimating the incidence of pregnancy after antiretroviral therapy (ART) initiation in 8 West African countries over a 10-year period. METHODS A retrospective analysis was conducted within the international database of the IeDEA West Africa Collaboration. All HIV-infected women aged <50 years and starting ART for their own health between 1998 and 2011 were eligible. Pregnancy after ART initiation was the main outcome and was based on clinical reporting. Poisson regression analysis accounting for country heterogeneity was computed to estimate first pregnancy incidence post-ART and to identify its associated factors. Pregnancy incidence rate ratios were adjusted on country, baseline CD4 count and clinical stage, hemoglobin, age, first ART regimen, and calendar year. RESULTS Overall, 29,425 HIV-infected women aged 33 years in median (interquartile range, 28-38) contributed for 84,870 women-years of follow-up to this analysis. The crude incidence of first pregnancy (2304 events) was 2.9 per 100 women-years [95% confidence interval (CI): 2.7 to 3.0], the highest rate being reported among women aged 25-29 years: 4.7 per 100 women-years; 95% CI: 4.3 to 5.1. The overall Kaplan-Meier probability of pregnancy occurrence by the fourth year on ART was 10.9% (95% CI: 10.4 to 11.4) and as high as 28.4% (95% CI: 26.3 to 30.6) among women aged 20-29 years at ART initiation. CONCLUSIONS The rate of pregnancy occurrence after ART initiation among HIV-infected women living in the West Africa region was high. Family planning services tailored to procreation needs should be provided to all HIV-infected women initiating ART and health consequences carefully monitored in this part of the world.
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Affiliation(s)
- Juan Burgos-Soto
- Université de Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
| | - Eric Balestre
- Université de Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
| | - Albert Minga
- Centre Médical de Suivi de Donneurs de Sang (CMSDS), Abidjan, Côte d’Ivoire
| | - Samuel Ajayi
- University of Abuja Teaching Hospital (UATH), Abuja, Nigeria
| | - Adrien Sawadogo
- Hôpital de jour, CHU Souro Sanou, Bobo Dioulasso, Burkina-Faso
| | - Marcel D. Zannou
- Centre de Prise en Charge des Personnes vivant avec le VIH, CHNU, Cotonou, Benin
| | - Valériane Leroy
- Université de Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
| | - Didier K. Ekouevi
- Université de Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
- Département des sciences fondamentales et santé publique, faculté des sciences de la santé, université de Lomé, Lomé, Togo
| | - François Dabis
- Université de Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
| | - Renaud Becquet
- Université de Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
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Cook R, Hayden R, Weiss SM, Jones DL. Desire for fertility among HIV-seroconcordant and -discordant couples in Lusaka, Zambia. CULTURE, HEALTH & SEXUALITY 2014; 16:741-751. [PMID: 24815904 PMCID: PMC4090252 DOI: 10.1080/13691058.2014.902103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Pregnancy rates and the desire to conceive are increasing among women living with HIV in Africa. However, attempts to conceive may increase the risk of HIV transmission or reinfection. A better understanding of factors influencing fertility desires would significantly contribute to programmes to meet the reproductive needs of women living with HIV. Using a couples-based approach, this paper explored fertility desires among HIV-seroconcordant and -discordant couples in Lusaka, Zambia. Participants were 208 heterosexual couples recruited from community health clinics and their respective catchment areas. Couples completed assessments on demographics, condom use, relationship quality and communication. Desire for children was often shared among couple members, and the strongest predictor of participants' desire for children was having a partner who wanted children. Additionally, the number of children participants had, their own reports of positive communication, and their partner's HIV serostatus influenced reproductive desires. Results support the involvement of both couple members in pre-conception counselling and pregnancy planning interventions. The inclusion of both partners may be a more effective strategy to respond to the reproductive needs of couples affected by HIV, enabling them to safeguard the health of both partners and infants.
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Affiliation(s)
- Ryan Cook
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Florida, USA
| | - Robert Hayden
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Florida, USA
| | - Stephen M. Weiss
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Florida, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Florida, USA
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Westreich D, Jamal N, Smith JS, Schulze D, Williams S, Michelow P, Levin S, Firnhaber C. Injectable and oral contraception and the incidence and progression of cervical disease in HIV-infected women in South Africa. Contraception 2014; 89:286-91. [PMID: 24485095 DOI: 10.1016/j.contraception.2013.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 12/11/2013] [Accepted: 12/24/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few data exist regarding the effect of hormonal contraception (HC) on incidence and progression of cervical disease (e.g., cervical dysplasia, squamous intraepithelial lesions, cervical intraepithelial neoplasia) in HIV-infected African women. STUDY DESIGN We conducted an observational study of HIV-seropositive women in Johannesburg, South Africa. The effect of individual HC types on the incidence and progression of cervical disease was determined using Poisson regression to obtain adjusted incidence rate ratios. RESULTS We evaluated 594 HIV-infected women, with median follow-up time of 445 days; 75 of these women were receiving some form of HC (largely DMPA, NET-EN, or COCs) at baseline. Risks of incidence and progression of cervical disease were similar comparing women not receiving HCs to women receiving DMPA, NET-EN, or COCs both individually by HC-type and considering all HC together. CONCLUSIONS There was no statistically significant effect of particular HC methods or of HC use in general on rates of incidence or progression of cervical disease in this study. These results should reassure us that use of HC is unlikely to substantially increase risks of cervical disease among HIV-positive women.
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Affiliation(s)
- Daniel Westreich
- Department of Obstetrics and Gynecology and Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Naiomi Jamal
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Doreen Schulze
- Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Pam Michelow
- Cytology Unit, National Health Laboratory Service and Department of Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - Simon Levin
- Right to Care, Johannesburg, South Africa; Department of Obstetrics and Gynecology, Rahima Moosa Mother and Child Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Cynthia Firnhaber
- Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Right to Care, Johannesburg, South Africa
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Westreich D, Rosenberg M, Schwartz S, Swamy G. Representation of women and pregnant women in HIV research: a limited systematic review. PLoS One 2013; 8:e73398. [PMID: 24009750 PMCID: PMC3751870 DOI: 10.1371/journal.pone.0073398] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV-related outcomes may be affected by biological sex and by pregnancy. Including women in general and pregnant women in particular in HIV-related research is important for generalizability of findings. OBJECTIVE To characterize representation of pregnant and non-pregnant women in HIV-related research conducted in general populations. DATA SOURCES All HIV-related articles published in fifteen journals from January to March of 2011. We selected the top five journals by 2010 impact factor, in internal medicine, infectious diseases, and HIV/AIDS. STUDY ELIGIBILITY CRITERIA HIV-related studies reporting original research on questions applicable to both men and women of reproductive age were considered; studies were excluded if they did not include individual-level patient data. STUDY APPRAISAL AND SYNTHESIS METHODS Articles were doubly reviewed and abstracted; discrepancies were resolved through consensus. We recorded proportion of female study participants, whether pregnant women were included or excluded, and other key factors. RESULTS In total, 2014 articles were published during this period. After screening, 259 articles were included as original HIV-related research reporting individual-level data; of these, 226 were determined to be articles relevant to both men and women of reproductive age. In these articles, women were adequately represented within geographic region. The vast majority of published articles, 183/226 (81%), did not mention pregnancy (or related issues); still fewer included pregnant women (n=33), reported numbers of pregnant women (n=19), or analyzed using pregnancy status (n=9). LIMITATIONS Data were missing for some key variables, including pregnancy. The time period over which published works were evaluated was relatively short. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The under-reporting and inattention to pregnancy in the HIV literature may reduce policy-makers' ability to set evidence-based policy around HIV/AIDS care for pregnant women and women of child-bearing age.
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Affiliation(s)
- Daniel Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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19
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Incident pregnancy and time to death or AIDS among HIV-positive women receiving antiretroviral therapy. PLoS One 2013; 8:e58117. [PMID: 23520489 PMCID: PMC3592862 DOI: 10.1371/journal.pone.0058117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 02/03/2013] [Indexed: 02/02/2023] Open
Abstract
Background Little is known about the impact of pregnancy on response to highly active antiretroviral therapy (HAART) in sub-Saharan Africa. We examined the effect of incident pregnancy after HAART initiation on clinical response to HAART. Methods We evaluated a prospective clinical cohort of adult women initiating HAART in Johannesburg, South Africa between 1 April 2004 and 31 March 2011, and followed up until an event, transfer, drop-out, or administrative end of follow-up on 30 September 2011. Women over age 45 and women who were pregnant at HAART initiation were excluded from the study. Main exposure was having experienced pregnancy after HAART initiation; main outcome was death and (separately) death or new AIDS event. We calculated adjusted hazard ratios (HRs) and 95% confidence limits (CL) using marginal structural Cox proportional hazards models. Results The study included 7,534 women, and 20,813 person-years of follow-up; 918 women had at least one recognized pregnancy during follow-up. For death alone, the weighted (adjusted) HR was 0.84 (95% CL 0.44, 1.60). Sensitivity analyses confirmed main results, and results were similar for analysis of death or new AIDS event. Incident pregnancy was associated with a substantially reduced hazard of drop-out (HR = 0.62, 95% CL 0.51, 0.75). Conclusions Recognized incident pregnancy after HAART initiation was not associated with increases in hazard of clinical events, but was associated with a decreased hazard of drop-out. High rates of pregnancy after initiation of HAART may point to a need to better integrate family planning services into clinical care for HIV-infected women.
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