Incidence and Predictors of Pregnancy among a Cohort of HIV-Positive Women Initiating Antiretroviral Therapy in Mbarara, Uganda

PLoS ONE

Volumn 8, Issue 5, 2013, Pages

  Kaida, Angela ^a   Matthews, Lynn T ^b,c,d   Kanters, Steve ^e   Kabakyenga, Jerome ^f   Muzoora, Conrad ^f   Mocello, A Rain ^g   Martin, Jeffrey N ^g   Hunt, Peter ^g   Haberer, Jessica ^c,d   Hogg, Robert S ^a,h   Bangsberg, David R ^c,d,f  

^a SIMON FRASER UNIVERSITY   (Canada)

^b BETH ISRAEL DEACONESS MEDICAL CENTER   (United States)

^c HARVARD MEDICAL SCHOOL   (United States)

^d MASSACHUSETTS GENERAL HOSPITAL   (United States)

^e UNIVERSITY OF BRITISH COLUMBIA   (Canada)

^f MBARARA UNIVERSITY OF SCIENCE AND TECHNOLOGY   (Uganda)

^g UNIVERSITY OF CALIFORNIA   (United States)

^h BRITISH COLUMBIA CENTRE FOR EXCELLENCE IN HIV AIDS   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIRETROVIRUS AGENT;

ADULT; AGE DISTRIBUTION; ARTICLE; CD4 LYMPHOCYTE COUNT; COHORT ANALYSIS; CONTROLLED STUDY; DEMOGRAPHY; FEMALE; FEMALE FERTILITY; FOLLOW UP; HEALTH EDUCATION; HEALTH STATUS; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; HUMAN IMMUNODEFICIENCY VIRUS PREVALENCE; LIVE BIRTH; MAJOR CLINICAL STUDY; MARRIED WOMAN; MEDICAL HISTORY; PATIENT EDUCATION; PREGNANCY; PREGNANCY RATE; PROSPECTIVE STUDY; SELF REPORT; SEXUAL BEHAVIOR; SEXUAL COUNSELING; SPOUSE; TIME TO PREGNANCY; UGANDA; UNPLANNED PREGNANCY; VIRUS LOAD;

ADOLESCENT; ADULT; ANTIRETROVIRAL THERAPY, HIGHLY ACTIVE; COHORT STUDIES; FEMALE; HIV SEROPOSITIVITY; HUMANS; INCIDENCE; KAPLAN-MEIER ESTIMATE; MIDDLE AGED; PREGNANCY; PREVALENCE; PROPORTIONAL HAZARDS MODELS; TIME FACTORS; TREATMENT OUTCOME; UGANDA; YOUNG ADULT;

EID: 84877998235     PISSN: None     EISSN: 19326203     Source Type: Journal    
DOI: 10.1371/journal.pone.0063411     Document Type: Article

References (90)

1. UNAIDS (2010) Global Report: UNAIDS Report on the global AIDS epidemic 2010. Geneva: UNAIDS.
2. Chen JL, Philips KA, Kanouse DE, Collins RL, Miu A (2001) Fertility desires and intentions of HIV-positive men and women. Fam Plann Perspect 33: 144-152, 165.
3. Ogilvie GS, Palepu A, Remple VP, Maan E, Heath K, et al. (2007) Fertility intentions of women of reproductive age living with HIV in British Columbia, Canada. AIDS 21(Suppl 1): S83-88.
4. Frodsham LC, Boag F, Barton S, Gilling-Smith C, (2006) Human immunodeficiency virus infection and fertility care in the United Kingdom: demand and supply. Fertil Steril 85: 285-289.
5. Heard I, Sitta R, Lert F, (2007) Reproductive choice in men and women living with HIV: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA Study). AIDS 21(Suppl 1): S77-82.
6. Panozzo L, Battegay M, Friedl A, Vernazza PL, (2003) High risk behaviour and fertility desires among heterosexual HIV-positive patients with a serodiscordant partner-two challenging issues. Swiss Med Wkly 133: 124-127.
7. Beyeza-Kashesya J, Ekstrom AM, Kaharuza F, Mirembe F, Neema S, et al. (2010) My partner wants a child: a cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda. BMC Public Health 10: 247.
8. Brubaker SG, Bukusi EA, Odoyo J, Achando J, Okumu A, et al. (2011) Pregnancy and HIV transmission among HIV-discordant couples in a clinical trial in Kisumu, Kenya. HIV Med 12: 316-321.
9. Cooper D, Moodley J, Zweigenthal V, Bekker LG, Shah I, et al. (2009) Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: implications for integrating reproductive health and HIV care services. AIDS Behav 13(Suppl 1): 38-46.
10. Homsy J, Bunnell R, Moore D, King R, Malamba S, et al. (2009) Reproductive intentions and outcomes among women on antiretroviral therapy in rural Uganda: a prospective cohort study. PLoS ONE 4: e4149.
11. Kaida A, Laher F, Strathdee SA, Janssen PA, Money D, et al. (2011) Childbearing intentions of HIV-positive women of reproductive age in Soweto, South Africa: the influence of expanding access to HAART in an HIV hyperendemic setting. Am J Public Health 101: 350-358.
12. Maier M, Andia I, Emenyonu N, Guzman D, Kaida A, et al. (2009) Antiretroviral therapy is associated with increased fertility desire, but not pregnancy or live birth, among HIV+ women in an early HIV treatment program in rural Uganda. AIDS Behav 13(Suppl 1): 28-37.
13. Matthews LT, Crankshaw T, Giddy J, Kaida A, Smit JA, et al. (2013) Reproductive Decision-Making and Periconception Practices Among HIV-Positive Men and Women Attending HIV Services in Durban, South Africa. AIDS Behav 17: 461-470.
14. Myer L, Morroni C, Rebe K, (2007) Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS Patient Care STDS 21: 278-285.
15. Nakayiwa S, Abang B, Packel L, Lifshay J, Purcell DW, et al. (2006) Desire for children and pregnancy risk behavior among HIV-infected men and women in Uganda. AIDS Behav 10: S95-104.
16. Kharsany AB, Hancock N, Frohlich JA, Humphries HR, Abdool Karim SS, et al. (2010) Screening for 'window-period' acute HIV infection among pregnant women in rural South Africa. HIV Med 11: 661-665.
17. Moodley D, Esterhuizen TM, Pather T, Chetty V, Ngaleka L, (2009) High HIV incidence during pregnancy: compelling reason for repeat HIV testing. AIDS 23: 1255-1259.
18. Mugo NR, Heffron R, Donnell D, Wald A, Were EO, et al. (2011) Increased risk of HIV-1 transmission in pregnancy: a prospective study among African HIV-1-serodiscordant couples. AIDS 25: 1887-1895.
19. Chadwick RJ, Mantell JE, Moodley J, Harries J, Zweigenthal V, et al. (2011) Safer conception interventions for HIV-affected couples: implications for resource-constrained settings. Top Antivir Med 19: 148-155.
20. Matthews LT, Mukherjee JS, (2009) Strategies for harm reduction among HIV-affected couples who want to conceive. AIDS Behav 13(Suppl 1): 5-11.
21. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, et al. (2011) Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365: 493-505.
22. Abdool Karim Q, Abdool Karim SS, Frohlich JA, Grobler AC, Baxter C, et al. (2010) Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science 329: 1168-1174.
23. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, et al. (2012) Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 367: 399-410.
24. Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, et al. (2012) Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med 367: 423-434.
25. Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, et al. (2012) Preexposure prophylaxis for HIV infection among African women. N Engl J Med 367: 411-422.
26. Bujan L, Hollander L, Coudert M, Gilling-Smith C, Vucetich A, et al. (2007) Safety and efficacy of sperm washing in HIV-1-serodiscordant couples where the male is infected: results from the European CREAThE network. AIDS 21: 1909-1914.
27. Vitorino RL, Grinsztejn BG, de Andrade CA, Hokerberg YH, de Souza CT, et al. (2011) Systematic review of the effectiveness and safety of assisted reproduction techniques in couples serodiscordant for human immunodeficiency virus where the man is positive. Fertil Steril 95: 1684-1690.
28. Mmeje O, Cohen CR, Cohan D, (2012) Evaluating safer conception options for HIV-serodiscordant couples (HIV-infected female/HIV-uninfected male): a closer look at vaginal insemination. Infect Dis Obstet Gynecol 2012: 587651.
29. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, et al. (2005) Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med 2: e298.
30. Bailey RC, Moses S, Parker CB, Agot K, Maclean I, et al. (2007) Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 369: 643-656.
31. Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, et al. (2007) Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 369: 657-666.
32. Bekker L-G, Black V, Myer L, Rees H, Cooper D, et al. (2011) Guideline on safer conception in fertile HIV-infected individuals and couples. Southern African Journal of HIV Medicine 12: 31-44.
33. Matthews LT, Smit JA, Cu-Uvin S, Cohan D, (2012) Antiretrovirals and safer conception for HIV-serodiscordant couples. Curr Opin HIV AIDS 7: 569-578.
34. Farrell B (2007) Family planning-integrated HIV services: A framework for integrating family planning and antriretroviral therapy services. New York: EngenderHealth/The ACQUIRE Project.
35. Wilcher R, Cates W Jr, Gregson S, (2009) Family planning and HIV: strange bedfellows no longer. AIDS 23(Suppl 1): S1-6.
36. World Health Organization (WHO) (2005) Sexual and reproductive health and HIV/AIDS: A framework for priority linkages. Geneva: WHO.
37. Gruskin S, Ferguson L, O'Malley J, (2007) Ensuring sexual and reproductive health for people living with HIV: an overview of key human rights, policy and health systems issues. Reprod Health Matters 15: 4-26.
38. Kaida A, Bangsberg DR, Gray G, Hogg RS, King R, et al. (2009) Editorial: Introduction to the Supplement on HIV, HAART, and Fertility in sub-Saharan Africa. AIDS Behav 13(Suppl 1): 1-4.
39. Mantell JE, Smit JA, Stein ZA, (2009) The right to choose parenthood among HIV-infected women and men. J Public Health Policy 30: 367-378.
40. Myer L, Akugizibwe P, (2009) Impact of HIV treatment scale-up on women's reproductive health care and reproductive rights in Southern Africa. J Acquir Immune Defic Syndr 52(Suppl 1): S52-53.
41. Makumbi FE, Nakigozi G, Reynolds SJ, Ndyanabo A, Lutalo T, et al. (2011) Associations between HIV Antiretroviral Therapy and the Prevalence and Incidence of Pregnancy in Rakai, Uganda. AIDS Res Treat 2011: 519492.
42. Myer L, Carter RJ, Katyal M, Toro P, El-Sadr WM, et al. (2010) Impact of antiretroviral therapy on incidence of pregnancy among HIV-infected women in Sub-Saharan Africa: a cohort study. PLoS Med 7: e1000229.
43. Uganda Bureau of Statistics and Macro International Inc. (2007) Uganda Demographic and Health Survey 2006. Calverton: Uganda Bureau of Statistics and Macro International Inc.
44. World Health Organization (WHO) (2011) Global HIV/AIDS response: epidemic update and health sector progress towards universal access: Progress report 2011. Geneva: WHO.
45. Ministry of Health (Uganda) and ORC Macro (2006) Uganda HIV/AIDS Sero-behavioural survey 2004-2005. Calverton, MD: Ministry of Health (Uganda) and ORC Macro.
46. Geng EH, Bwana MB, Kabakyenga J, Muyindike W, Emenyonu NI, et al. (2010) Diminishing availability of publicly funded slots for antiretroviral initiation among HIV-infected ART-eligible patients in Uganda. PLoS ONE 5: e14098.
47. Uganda Ministry of Health (2009) National Antiretroviral Treatment Guidelines for Adults, Adolescents, and Children, 3rd edition. Kampala: Uganda Ministry of Health.
48. Uganda Ministry of Health (2008) National Antiretroviral Treatment and Care Guidelines for Adults, Adolescents, and Children, 2nd edition. Kampala: Uganda Ministry of Health.
49. Uganda Ministry of Health (2003) National Antiretroviral Treatment and Care Guidelines for Adults and Children, 1st edition. Kampala: Uganda Ministry of Health.
50. Awiti Ujiji O, Ekstrom AM, Ilako F, Indalo D, Rubenson B, (2010) "I will not let my HIV status stand in the way." Decisions on motherhood among women on ART in a slum in Kenya- a qualitative study. BMC Womens Health 10: 13.
51. Blair JM, Hanson DL, Jones JL, Dworkin MS, (2004) Trends in pregnancy rates among women with human immunodeficiency virus. Obstet Gynecol 103: 663-668.
52. Desgrees-Du-Lou A, Msellati P, Viho I, Yao A, Yapi D, et al. (2002) Contraceptive use, protected sexual intercourse and incidence of pregnancies among African HIV-infected women. DITRAME ANRS 049 Project, Abidjan 1995-2000. Int J STD AIDS 13: 462-468.
53. Guthrie BL, Choi RY, Bosire R, Kiarie JN, Mackelprang RD, et al. (2010) Predicting pregnancy in HIV-1-discordant couples. AIDS Behav 14: 1066-1071.
54. Sharma A, Feldman JG, Golub ET, Schmidt J, Silver S, et al. (2007) Live birth patterns among human immunodeficiency virus-infected women before and after the availability of highly active antiretroviral therapy. Am J Obstet Gynecol 196: 541 e541-546.
55. Simbayi LC, Kalichman SC, Strebel A, Cloete A, Henda N, et al. (2007) Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa. Sex Transm Infect 83: 29-34.
56. Bolton P, Ndogoni L (2001) Cross-cultural assessment of trauma-related mental illness (Phase II): A report of research conducted by World Vision Uganda and The Johns Hopkins University. US Agency for International Development, The Johns Hopkins University, and World Vision International.
57. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L, (1974) The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci 19: 1-15.
58. Martinez P, Andia I, Emenyonu N, Hahn JA, Hauff E, et al. (2008) Alcohol use, depressive symptoms and the receipt of antiretroviral therapy in southwest Uganda. AIDS Behav 12: 605-612.
59. Revicki DA, Sorensen S, Wu AW, (1998) Reliability and validity of physical and mental health summary scores from the Medical Outcomes Study HIV Health Survey. Med Care 36: 126-137.
60. Wu AW (1999) MOS-HIV Health Survey Users' Manual. Baltimore: Johns Hopkins Bloomberg School of Public Health.
61. Lin DY, Wei LJ, (1989) The robust inference for the Cox proportional hazards model. Journal of the American Statistical Association 84: 1074-1078.
62. Akaike H, (1974) A new look at the statistical model identification. IEEE Transactions on Automatic Control 19: 716-723.
63. The SAS Institute (2011) SAS version 9.3. Cary: NC: The SAS Institute.
64. Bussmann H, Wester CW, Wester CN, Lekoko B, Okezie O, et al. (2007) Pregnancy rates and birth outcomes among women on efavirenz-containing highly active antiretroviral therapy in Botswana. J Acquir Immune Defic Syndr 45: 269-273.
65. Tweya H, Feldacker C, Breeze E, Jahn A, Haddad LB, et al. (2012) Incidence of pregnancy among women accessing Antiretroviral therapy in urban Malawi: A retrospective cohort study. AIDS Behav.
66. Gibb DM, Kizito H, Russell EC, Chidziva E, Zalwango E, et al. (2012) Pregnancy and infant outcomes among HIV-infected women taking long-term ART with and without tenofovir in the DART trial. PLoS Med 9: e1001217.
67. Schwartz SR, Mehta SH, Taha TE, Rees HV, Venter F, et al. (2012) High pregnancy intentions and missed opportunities for patient-provider communication about fertility in a South African cohort of HIV-positive women on antiretroviral therapy. AIDS Behav 16: 69-78.
68. Kabami J, Bajunirwe F (2011) Incidence and predictors of pregnancy among women receiving HIV care and treatment at a large urban facility in Western Uganda. 6th International AIDS Society (IAS) conference on HIV Pathogenesis, Treatment and Prevention Rome, Italy.
69. Heffron R, Were E, Celum C, Mugo N, Ngure K, et al. (2010) A prospective study of contraceptive use among African women in HIV-1 serodiscordant partnerships. Sex Transm Dis 37: 621-628.
70. Taulo F, Berry M, Tsui A, Makanani B, Kafulafula G, et al. (2009) Fertility intentions of HIV-1 infected and uninfected women in Malawi: a longitudinal study. AIDS Behav 13Suppl 1: 20-27.
71. Schwartz SR, Rees H, Mehta S, Venter WD, Taha TE, et al. (2012) High incidence of unplanned pregnancy after antiretroviral therapy initiation: findings from a prospective cohort study in South Africa. PLoS ONE 7: e36039.
72. US Census Bureau International Programs (2008) Global Population Profile (2008) International Data Base: Age-Specific Fertility Rates and Selected Derived Measures: US Census Bureau.
73. Lewis JJ, Ronsmans C, Ezeh A, Gregson S, (2004) The population impact of HIV on fertility in sub-Saharan Africa. AIDS 18(Suppl 2): S35-43.
74. Linas BS, Minkoff H, Cohen MH, Karim R, Cohan D, et al. (2011) Relative time to pregnancy among HIV-infected and uninfected women in the Women's Interagency HIV Study, 2002-2009. AIDS 25: 707-711.
75. Zaba B, Gregson S, (1998) Measuring the impact of HIV on fertility in Africa. AIDS 12(Suppl 1): S41-50.
76. Snow RC, Mutumba M, Resnicow K, Mugyenyi G, (2013) The social legacy of AIDS: Fertility aspirations among HIV-affected women in Uganda. Am J Public Health 103: 278-285.
77. Muyindike W, Fatch R, Steinfield R, Matthews LT, Musinguzi N, et al. (2012) Contraceptive Use and Associated Factors among Women Enrolling into HIV Care in Southwestern Uganda. Infect Dis Obstet Gynecol 2012: 340782.
78. Polis CB, Gray RH, Lutalo T, Nalugoda F, Kagaayi J, et al. (2011) Trends and correlates of hormonal contraceptive use among HIV-infected women in Rakai, Uganda, 1994-2006. Contraception 83: 549-555.
79. Agangi A, Thorne C, Newell ML, (2005) Increasing likelihood of further live births in HIV-infected women in recent years. BJOG 112: 881-888.
80. van Benthem BH, de Vincenzi I, Delmas MC, Larsen C, van den Hoek A, et al. (2000) Pregnancies before and after HIV diagnosis in a european cohort of HIV-infected women. European Study on the Natural History of HIV Infection in Women. AIDS 14: 2171-2178.
81. Cooper D, Harries J, Myer L, Orner P, Bracken H, et al. (2007) "Life is still going on": reproductive intentions among HIV-positive women and men in South Africa. Soc Sci Med 65: 274-283.
82. Andia I, Kaida A, Maier M, Guzman D, Emenyonu N, et al. (2009) Highly active antiretroviral therapy and increased use of contraceptives among HIV-positive women during expanding access to antiretroviral therapy in Mbarara, Uganda. Am J Public Health 99: 340-347.
83. Matthews L, Crankshaw T, Giddy J, Kaida A, Psaros C, et al. (2012) Reproductive counseling by clinic healthcare workers in Durban, South Africa: perspectives from HIV-positive men and women reporting serodiscordant partners. Infectious Diseases in Obstetrics and Gynecology 2012: 9.
84. Myer L, Rebe K, Morroni C, (2007) Missed opportunities to address reproductive health care needs among HIV-infected women in antiretroviral therapy programmes. Trop Med Int Health 12: 1484-1489.
85. DeCherney AH, Berkowitz GS, (1982) Female fecundity and age. N Engl J Med 306: 424-426.
86. United Nations Population Division (2009) World Fertility Data 2008. Geneva.
87. Kisakye P, Akena WO, Kaye DK, (2010) Pregnancy decisions among HIV-positive pregnant women in Mulago Hospital, Uganda. Cult Health Sex 12: 445-454.
88. King R, Katuntu D, Lifshay J, Packel L, Batamwita R, et al. (2008) Processes and outcomes of HIV serostatus disclosure to sexual partners among people living with HIV in Uganda. AIDS Behav 12: 232-243.
89. Kastner J, Erikson S, Matthews LT, Berry N, Ninsiima F, et al. (2013) Tracing multi-level factors that influence pregnancy desires of HIV-positive women on ART in south-western Uganda (Abstract no. 31). Afri-Can Forum. Entebbe, Uganda (January 17-19, 2013).
90. King R, Khana K, Nakayiwa S, Katuntu D, Homsy J, et al. (2011) 'Pregnancy comes accidentally-like it did with me': reproductive decisions among women on ART and their partners in rural Uganda. BMC Public Health 11: 530.