Original Paper

AIDS and Behavior

, Volume 17, Issue 2, pp 471-478

First online:

Incidence of Pregnancy Among Women Accessing Antiretroviral Therapy in Urban Malawi: A Retrospective Cohort Study

  • Hannock TweyaAffiliated withThe International Union Against Tuberculosis and Lung DiseaseThe Lighthouse Trust Email author 
  • , Caryl FeldackerAffiliated withThe Lighthouse TrustInternational Training and Education Center for Health (I-TECH)University of Washington
  • , Elizabeth BreezeAffiliated withLondon School of Hygiene and Tropical Medicine
  • , Andreas JahnAffiliated withInternational Training and Education Center for Health (I-TECH)University of WashingtonCMED/Department for HIV and AIDS, Ministry of Health
  • , Lisa Blake HaddadAffiliated withDepartment of Obstetrics and Gynecology, Emory University
  • , Anne Ben-SmithAffiliated withMaame Akua
  • , Thom ChawezaAffiliated withThe Lighthouse Trust
  • , Sam PhiriAffiliated withThe Lighthouse Trust

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Although previous studies investigated pregnancy rates among women on antiretroviral therapy (ART), incidence of, and factors associated with pregnancy among these women remain poorly understood. We, therefore, conducted a retrospective cohort study at a large public HIV clinic in Lilongwe, Malawi, between July 2007 and December 2010. At each clinic visit, pregnancy status was assessed. Time to event analysis was conducted using Poisson regression. Among 4,738 women, 589 pregnancies were observed. Pregnancy incidence was 9.3/100 person-years. After 6 months on ART, women on ART had similar total fertility rates to women in the urban population. In multivariable analysis, increasing age and advanced WHO clinical stage were associated with decreased probability of becoming pregnant while higher body mass index and longer time on ART were associated with increased probability of becoming pregnant. We recommend that ART clinics integrate comprehensive family planning services to address reproductive health needs among women on ART.


Antiretroviral therapy Pregnancy rate Family planning Malawi