AIDS and Behavior

, Volume 17, Issue 2, pp 471–478 | Cite as

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

  • Hannock Tweya
  • Caryl Feldacker
  • Elizabeth Breeze
  • Andreas Jahn
  • Lisa Blake Haddad
  • Anne Ben-Smith
  • Thom Chaweza
  • Sam Phiri
Original Paper


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 



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.


  1. 1.
    UNAIDS. 2010 report on global AIDS epidemic. Geneva, Switzerland.Google Scholar
  2. 2.
    UNAIDS. 2008 report on global AIDS epidemic. Geneva, Switzerland.Google Scholar
  3. 3.
    World Health Organisation. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. Geneva. 2010.Google Scholar
  4. 4.
    Malawi Ministry of Health, HIV Department. Antiretroviral therapy programme in Malawi. Quarterly report—up to 30th September 2010. Lilongwe, Malawi. 2010.Google Scholar
  5. 5.
    Malawi Ministry of Health, HIV Department. Antiretroviral therapy programme in Malawi. Quarterly report—up to December 2010. Lilongwe, Malawi. 2010.Google Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.Google Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.Google Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 11.
    World Bank. World development indicators. Available on Accessed 25 June 2010.
  12. 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.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. 22.
    Malawi National Statistical Office & ORC Macro. Malawi demographic and health survey 2004. Zomba, Malawi and Calverton. 2004.Google Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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. 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.PubMedCrossRefGoogle Scholar
  29. 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. 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. 31.
    Guthrie BL, Choi RY, Bosire R, et al. Predicting pregnancy in HIV-1-discordant couples. AIDS Behav. 2010;14(5):1066–71.PubMedCrossRefGoogle Scholar
  32. 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.PubMedCrossRefGoogle Scholar
  33. 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.PubMedCrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.PubMedCrossRefGoogle Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. 37.
    White MK, Gorrill TS, Khalili K. Reciprocal transactivation between HIV-1 and other human viruses. Virology. 2006;352(1):1–13.PubMedCrossRefGoogle Scholar
  38. 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.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Hannock Tweya
    • 1
    • 2
  • Caryl Feldacker
    • 2
    • 3
    • 4
  • Elizabeth Breeze
    • 5
  • Andreas Jahn
    • 3
    • 4
    • 6
  • Lisa Blake Haddad
    • 7
  • Anne Ben-Smith
    • 8
  • Thom Chaweza
    • 2
  • Sam Phiri
    • 2
  1. 1.The International Union Against Tuberculosis and Lung DiseaseParisFrance
  2. 2.The Lighthouse TrustLilongweMalawi
  3. 3.International Training and Education Center for Health (I-TECH)LilongweMalawi
  4. 4.University of WashingtonSeattleUSA
  5. 5.London School of Hygiene and Tropical MedicineLondonUK
  6. 6.CMED/Department for HIV and AIDSMinistry of HealthLilongweMalawi
  7. 7.Department of Obstetrics and GynecologyEmory UniversityAtlantaUSA
  8. 8.Maame AkuaLilongweMalawi

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