Fertility Intentions and Clinical Care Attendance Among Women Living with HIV in South Africa

Abstract

Poor HIV care retention impedes optimal treatment outcomes in persons living with HIV. Women trying to become pregnant may be motivated by periconception horizontal and vertical transmission concerns and thus more likely to attend HIV care visits than women not trying to conceive. We estimated the effect of fertility intentions on HIV care attendance over 12 months among non-pregnant, HIV-positive women aged 18–35 years who were on or initiating antiretroviral therapy in Johannesburg, South Africa. The percentage of women attending an HIV care visit decreased from 93.4% in the first quarter to 82.8% in the fourth quarter. Fertility intentions were not strongly associated with care attendance in this cohort of reproductive-aged women; however, attendance declined over time irrespective of childbearing plans. These findings suggest a need for reinforced efforts to support care engagement and risk reduction, including safer conception practices for women wishing to conceive.

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Acknowledgements

We offer our gratitude to the participants, clinic staff and study team for their contributions and support of the study. KR, SS, KP, BP, BC and AP contributed to the conception and the design of the analysis. VB and HR were involved in data collection, study management and the design of the original parent study. All authors contributed to the drafting and editing of the manuscript, interpretation of the data, approval of the final version and are accountable for all aspects of the work presented here.

Funding

This study received funding from the United States Centers for Disease Control and Prevention (CDC) public health dissertation grant 1R36PS001584-01. The research was conducted in clinics supported by PEPFAR (President’s Emergency Plan For AIDS Relief) and the United States Agency for International Development. KR was supported by National Institutes of Health (2T32AI102623-06) and an award through the Society of Family Planning Research Fund; BC was supported by the National Institutes of Health (5K24AI12079-03). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Correspondence to Katherine B. Rucinski.

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Rucinski, K.B., Schwartz, S.R., Powers, K.A. et al. Fertility Intentions and Clinical Care Attendance Among Women Living with HIV in South Africa. AIDS Behav 24, 1585–1591 (2020). https://doi.org/10.1007/s10461-019-02564-y

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Keywords

  • Fertility intentions
  • Antiretroviral therapy
  • Retention
  • Engagement in care
  • Safer conception