Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. UNAIDS. 2010 report on global AIDS epidemic. Geneva, Switzerland.

  2. UNAIDS. 2008 report on global AIDS epidemic. Geneva, Switzerland.

  3. World Health Organisation. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. Geneva. 2010.

  4. Malawi Ministry of Health, HIV Department. Antiretroviral therapy programme in Malawi. Quarterly report—up to 30th September 2010. Lilongwe, Malawi. 2010.

  5. Malawi Ministry of Health, HIV Department. Antiretroviral therapy programme in Malawi. Quarterly report—up to December 2010. Lilongwe, Malawi. 2010.

  6. Myer L, Carter RJ, Katyal M, Toro P, El-Sadr WM, Abrams EJ. Impact of antiretroviral therapy on incidence of pregnancy among HIV-infected women in sub-Saharan Africa: a cohort study. PLoS Med. 2009;7(2):e1000229.

    Article  Google Scholar 

  7. Makumbi FE, NaKigozo G, Reynolds JS, et al. Association between HIV Antiretroviral therapy and prevalence and incidence of pregnancy in Rakai, Uganda. Hindawi, Nov 2011; 2011.

  8. Ekouevi DK, Coffie PA, Becquet R, et al. Antiretroviral therapy in pregnant women with advanced HIV disease and pregnancy outcomes in Abidjan, Cote d’Ivoire. AIDS. 2008;22(14):1815–20.

    Article  PubMed  CAS  Google Scholar 

  9. Jennifer Chen HR, Ogwu A, Svab P, Wester C, Tumbare E, Moffat H, Makhema J, Essex M, and Shapiro R. Risk factors for adverse pregnancy outcomes among hiv-infected women in Gaborone. In: Proceedings of 16th conference of retroviruses and opportunistic infections. 2009. Accessed 4 Jan 2012.

  10. Marazzi MC, Palombi L, Nielsen-Saines K, et al. Extended antenatal use of triple antiretroviral therapy for prevention of mother-to-child transmission of HIV-1 correlates with favorable pregnancy outcomes. AIDS. 2011;25(13):1611–8.

    Article  PubMed  CAS  Google Scholar 

  11. World Bank. World development indicators. Available on http://data.worldbank.org/indicator. Accessed 25 June 2010.

  12. Myer L, Morroni C, Rebe K. Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS Patient Care STDS. 2007;21(4):278–85.

    Article  PubMed  Google Scholar 

  13. Cooper D, Moodley J, Zweigenthal V, Bekker LG, Shah I, Myer L. 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. 2009;13(Suppl 1):38–46.

    Article  PubMed  Google Scholar 

  14. Nakayiwa S, Abang B, Packel L, et al. Desire for children and pregnancy risk behavior among HIV-infected men and women in Uganda. AIDS Behav. 2006;10(4 Suppl):S95–104.

    Article  PubMed  Google Scholar 

  15. Homsy J, Bunnell R, Moore D, et al. Reproductive intentions and outcomes among women on antiretroviral therapy in rural Uganda: a prospective cohort study. PLoS One. 2009;4(1):e4149.

    Article  PubMed  Google Scholar 

  16. Taulo F, Berry M, Tsui A, et al. Fertility intentions of HIV-1 infected and uninfected women in Malawi: a longitudinal study. AIDS Behav. 2009;13(Suppl 1):20–7.

    Article  PubMed  Google Scholar 

  17. Hoffman IF, Martinson FE, Powers KA, et al. The year-long effect of HIV-positive test results on pregnancy intentions, contraceptive use, and pregnancy incidence among Malawian women. J Acquir Immune Defic Syndr. 2008;47(4):477–83.

    Article  PubMed  Google Scholar 

  18. Nebie Y, Meda N, Leroy V, et al. Sexual and reproductive life of women informed of their HIV seropositivity: a prospective cohort study in Burkina Faso. J Acquir Immune Defic Syndr. 2001;28(4):367–72.

    PubMed  CAS  Google Scholar 

  19. Hunter SC, Isingo R, Boerma JT, Urassa M, Mwaluko GM, Zaba B. The association between HIV and fertility in a cohort study in rural Tanzania. J Biosoc Sci. 2003;35(2):189–99.

    Article  PubMed  Google Scholar 

  20. Gray RH, Wawer MJ, Serwadda D, et al. Population-based study of fertility in women with HIV-1 infection in Uganda. Lancet. 1998;351(9096):98–103.

    Article  PubMed  CAS  Google Scholar 

  21. Douglas GP, Gadabu OJ, Joukes S, et al. Using touchscreen electronic medical record systems to support and monitor national scale-up of antiretroviral therapy in Malawi. PLoS Med. 2010;7(8):e1000319.

    Article  PubMed  Google Scholar 

  22. Malawi National Statistical Office & ORC Macro. Malawi demographic and health survey 2004. Zomba, Malawi and Calverton. 2004.

  23. Ross A, Van der Paal L, Lubega R, Mayanja BN, Shafer LA, Whitworth J. HIV-1 disease progression and fertility: the incidence of recognized pregnancy and pregnancy outcome in Uganda. AIDS. 2004;18(5):799–804.

    Article  PubMed  Google Scholar 

  24. Sedgh G, Larsen U, Spiegelman D, Msamanga G, Fawzi WW. HIV-1 disease progression and fertility in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr. 2005;39(4):439–45.

    Article  PubMed  Google Scholar 

  25. Tai JH, Udoji MA, Barkanic G, et al. Pregnancy and HIV disease progression during the era of highly active antiretroviral therapy. J Infect Dis. 2007;196(7):1044–52.

    Article  PubMed  Google Scholar 

  26. Kaida A, Gray G, Bastos FI, et al. The relationship between HAART use and sexual activity among HIV-positive women of reproductive age in Brazil, South Africa, and Uganda. AIDS Care. 2008;20(1):21–5.

    Article  PubMed  CAS  Google Scholar 

  27. Reid SE, Dai JY, Wang J, et al. Pregnancy, contraceptive use, and HIV acquisition in HPTN 039: relevance for HIV prevention trials among African women. J Acquir Immune Defic Syndr. 2011;53(5):606–13.

    Google Scholar 

  28. Massad LS, Springer G, Jacobson L, et al. Pregnancy rates and predictors of conception, miscarriage and abortion in US women with HIV. AIDS. 2004;18(2):281–6.

    Article  PubMed  Google Scholar 

  29. Haddad L, Cwiak C, Jamieson D, et al. Condom use among HIV-positive women desiring family planning in Lilongwe, Malawi. Contraception. 2011;84(3):324–5.

    Google Scholar 

  30. Malawi Ministry of Health. Clinical management of HIV in children and adults; integrated guidelines for providing HIV services. Lilongwe: Malawi Ministry of Health; 2011.

    Google Scholar 

  31. Guthrie BL, Choi RY, Bosire R, et al. Predicting pregnancy in HIV-1-discordant couples. AIDS Behav. 2010;14(5):1066–71.

    Article  PubMed  Google Scholar 

  32. Cooper D, Harries J, Myer L, Orner P, Bracken H, Zweigenthal V. “Life is still going on”: reproductive intentions among HIV-positive women and men in South Africa. Soc Sci Med. 2007;65(2):274–83.

    Article  PubMed  Google Scholar 

  33. Nattabi B, Li J, Thompson SC, Orach CG, Earnest J. A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav. 2009;13(5):949–68.

    Article  PubMed  Google Scholar 

  34. Matthews LT, Mukherjee JS. Strategies for harm reduction among HIV-affected couples who want to conceive. AIDS Behav. 2009;13(Suppl 1):5–11.

    Article  PubMed  Google Scholar 

  35. Donnell D, Baeten JM, Kiarie J, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet. 2010;375(9731):2092–8.

    Article  PubMed  Google Scholar 

  36. Buchacz K, Patel P, Taylor M, et al. Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections. AIDS. 2004;18(15):2075–9.

    Article  PubMed  Google Scholar 

  37. White MK, Gorrill TS, Khalili K. Reciprocal transactivation between HIV-1 and other human viruses. Virology. 2006;352(1):1–13.

    Article  PubMed  CAS  Google Scholar 

  38. Cohen M CY, McCauley M, Gamble T, Bollinger R, Bryson Y. Antiretroviral treatment to prevent the sexual transmission of HIV-1: results from the HPTN 052 multinational randomized controlled trial. 6th IAS conference on HIV pathogenesis, treatment and prevention. July 17–20, 2011. Rome. Abstract MOAX0102. 2011.

Download references

Acknowledgments

We are grateful to all the clinic staff at Martin Preuss Centre who collected data. We thank numerous donors supporting the Lighthouse and the Malawi national ART program. Hannock Tweya is supported as an Operational Research Fellow by the International Union Against Tuberculosis and Lung Disease, Paris, France.

Author information

Authors and Affiliations

  1. The International Union Against Tuberculosis and Lung Disease, Paris, France

    Hannock Tweya

  2. The Lighthouse Trust, P.O. Box 106, Lilongwe, Malawi

    Hannock Tweya, Caryl Feldacker, Thom Chaweza & Sam Phiri

  3. International Training and Education Center for Health (I-TECH), Lilongwe, Malawi

    Caryl Feldacker & Andreas Jahn

  4. University of Washington, Seattle, WA, USA

    Caryl Feldacker & Andreas Jahn

  5. London School of Hygiene and Tropical Medicine, London, UK

    Elizabeth Breeze

  6. CMED/Department for HIV and AIDS, Ministry of Health, Lilongwe, Malawi

    Andreas Jahn

  7. Department of Obstetrics and Gynecology, Emory University, Atlanta, GA, USA

    Lisa Blake Haddad

  8. Maame Akua, 43/2/391, Lilongwe, Malawi

    Anne Ben-Smith

Authors
  1. Hannock Tweya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caryl Feldacker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth Breeze
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andreas Jahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lisa Blake Haddad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anne Ben-Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thom Chaweza
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sam Phiri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hannock Tweya.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tweya, H., Feldacker, C., Breeze, E. et al. Incidence of Pregnancy Among Women Accessing Antiretroviral Therapy in Urban Malawi: A Retrospective Cohort Study. AIDS Behav 17, 471–478 (2013). https://doi.org/10.1007/s10461-012-0150-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-012-0150-0

Keywords

Search

Navigation