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

Angela Kaida, Lynn T. Matthews, Steve Kanters, Jerome Kabakyenga, Conrad Muzoora, A. Rain Mocello, Jeffrey N. Martin, Peter Hunt, Jessica Haberer, Robert S. Hogg, David Bangsberg

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective:Many people living with HIV in sub-Saharan Africa desire biological children. Implementation of HIV prevention strategies that support the reproductive goals of people living with HIV while minimizing HIV transmission risk to sexual partners and future children requires a comprehensive understanding of pregnancy in this population. We analyzed prospective cohort data to determine pregnancy incidence and predictors among HIV-positive women initiating antiretroviral therapy (ART) in a setting with high HIV prevalence and fertility.Methods:Participants were enrolled in the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort of HIV-positive individuals initiating ART in Mbarara. Bloodwork (including CD4 cells/mm3, HIV viral load) and questionnaires (including socio-demographics, health status, sexual behavior, partner dynamics, HIV history, and self-reported pregnancy) were completed at baseline and quarterly. Our analysis includes 351 HIV-positive women (18-49 years) who enrolled between 2005-2011. We measured pregnancy incidence by proximal and distal time relative to ART initiation and used multivariable Cox proportional hazards regression analysis (with repeated events) to identify baseline and time-dependent predictors of pregnancy post-ART initiation.Results:At baseline (pre-ART initiation), median age was 33 years [IQR: 27-37] and median prior livebirths was four [IQR: 2-6]. 38% were married with 61% reporting HIV-positive spouses. 73% of women had disclosed HIV status to a primary sexual partner. Median baseline CD4 was 137 cells/mm3 [IQR: 81-207]. At enrolment, 9.1% (31/342) reported current pregnancy. After ART initiation, 84 women experienced 105 pregnancies over 3.8 median years of follow-up, yielding a pregnancy incidence of 9.40 per 100 WYs. Three years post-ART initiation, cumulative probability of at least one pregnancy was 28% and independently associated with younger age (Adjusted Hazard Ratio (AHR): 0.89/year increase; 95%CI: 0.86-0.92) and HIV serostatus disclosure to primary sexual partner (AHR: 2.45; 95%CI: 1.29-4.63).Conclusions:Nearly one-third of women became pregnant within three years of initiating ART, highlighting the need for integrated services to prevent unintended pregnancies and reduce periconception-related risks for HIV-infected women choosing to conceive. Association with younger age and disclosure suggests a role for early and couples-based safer conception counselling.

Original languageEnglish (US)
Article numbere63411
JournalPLoS One
Volume8
Issue number5
DOIs
StatePublished - May 21 2013
Externally publishedYes

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Uganda
Hazards
HIV
pregnancy
incidence
Pregnancy
therapeutics
Incidence
Sexual Partners
Regression analysis
Therapeutics
Health
Disclosure
spouses
counseling
sexual behavior
pregnant women
Sub-Saharan Africa
viral load
health status

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Incidence and Predictors of Pregnancy among a Cohort of HIV-Positive Women Initiating Antiretroviral Therapy in Mbarara, Uganda. / Kaida, Angela; Matthews, Lynn T.; Kanters, Steve; Kabakyenga, Jerome; Muzoora, Conrad; Mocello, A. Rain; Martin, Jeffrey N.; Hunt, Peter; Haberer, Jessica; Hogg, Robert S.; Bangsberg, David.

In: PLoS One, Vol. 8, No. 5, e63411, 21.05.2013.

Research output: Contribution to journalArticle

Kaida, A, Matthews, LT, Kanters, S, Kabakyenga, J, Muzoora, C, Mocello, AR, Martin, JN, Hunt, P, Haberer, J, Hogg, RS & Bangsberg, D 2013, 'Incidence and Predictors of Pregnancy among a Cohort of HIV-Positive Women Initiating Antiretroviral Therapy in Mbarara, Uganda', PLoS One, vol. 8, no. 5, e63411. https://doi.org/10.1371/journal.pone.0063411
Kaida, Angela ; Matthews, Lynn T. ; Kanters, Steve ; Kabakyenga, Jerome ; Muzoora, Conrad ; Mocello, A. Rain ; Martin, Jeffrey N. ; Hunt, Peter ; Haberer, Jessica ; Hogg, Robert S. ; Bangsberg, David. / Incidence and Predictors of Pregnancy among a Cohort of HIV-Positive Women Initiating Antiretroviral Therapy in Mbarara, Uganda. In: PLoS One. 2013 ; Vol. 8, No. 5.
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abstract = "Objective:Many people living with HIV in sub-Saharan Africa desire biological children. Implementation of HIV prevention strategies that support the reproductive goals of people living with HIV while minimizing HIV transmission risk to sexual partners and future children requires a comprehensive understanding of pregnancy in this population. We analyzed prospective cohort data to determine pregnancy incidence and predictors among HIV-positive women initiating antiretroviral therapy (ART) in a setting with high HIV prevalence and fertility.Methods:Participants were enrolled in the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort of HIV-positive individuals initiating ART in Mbarara. Bloodwork (including CD4 cells/mm3, HIV viral load) and questionnaires (including socio-demographics, health status, sexual behavior, partner dynamics, HIV history, and self-reported pregnancy) were completed at baseline and quarterly. Our analysis includes 351 HIV-positive women (18-49 years) who enrolled between 2005-2011. We measured pregnancy incidence by proximal and distal time relative to ART initiation and used multivariable Cox proportional hazards regression analysis (with repeated events) to identify baseline and time-dependent predictors of pregnancy post-ART initiation.Results:At baseline (pre-ART initiation), median age was 33 years [IQR: 27-37] and median prior livebirths was four [IQR: 2-6]. 38{\%} were married with 61{\%} reporting HIV-positive spouses. 73{\%} of women had disclosed HIV status to a primary sexual partner. Median baseline CD4 was 137 cells/mm3 [IQR: 81-207]. At enrolment, 9.1{\%} (31/342) reported current pregnancy. After ART initiation, 84 women experienced 105 pregnancies over 3.8 median years of follow-up, yielding a pregnancy incidence of 9.40 per 100 WYs. Three years post-ART initiation, cumulative probability of at least one pregnancy was 28{\%} and independently associated with younger age (Adjusted Hazard Ratio (AHR): 0.89/year increase; 95{\%}CI: 0.86-0.92) and HIV serostatus disclosure to primary sexual partner (AHR: 2.45; 95{\%}CI: 1.29-4.63).Conclusions:Nearly one-third of women became pregnant within three years of initiating ART, highlighting the need for integrated services to prevent unintended pregnancies and reduce periconception-related risks for HIV-infected women choosing to conceive. Association with younger age and disclosure suggests a role for early and couples-based safer conception counselling.",
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AU - Kanters, Steve

AU - Kabakyenga, Jerome

AU - Muzoora, Conrad

AU - Mocello, A. Rain

AU - Martin, Jeffrey N.

AU - Hunt, Peter

AU - Haberer, Jessica

AU - Hogg, Robert S.

AU - Bangsberg, David

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N2 - Objective:Many people living with HIV in sub-Saharan Africa desire biological children. Implementation of HIV prevention strategies that support the reproductive goals of people living with HIV while minimizing HIV transmission risk to sexual partners and future children requires a comprehensive understanding of pregnancy in this population. We analyzed prospective cohort data to determine pregnancy incidence and predictors among HIV-positive women initiating antiretroviral therapy (ART) in a setting with high HIV prevalence and fertility.Methods:Participants were enrolled in the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort of HIV-positive individuals initiating ART in Mbarara. Bloodwork (including CD4 cells/mm3, HIV viral load) and questionnaires (including socio-demographics, health status, sexual behavior, partner dynamics, HIV history, and self-reported pregnancy) were completed at baseline and quarterly. Our analysis includes 351 HIV-positive women (18-49 years) who enrolled between 2005-2011. We measured pregnancy incidence by proximal and distal time relative to ART initiation and used multivariable Cox proportional hazards regression analysis (with repeated events) to identify baseline and time-dependent predictors of pregnancy post-ART initiation.Results:At baseline (pre-ART initiation), median age was 33 years [IQR: 27-37] and median prior livebirths was four [IQR: 2-6]. 38% were married with 61% reporting HIV-positive spouses. 73% of women had disclosed HIV status to a primary sexual partner. Median baseline CD4 was 137 cells/mm3 [IQR: 81-207]. At enrolment, 9.1% (31/342) reported current pregnancy. After ART initiation, 84 women experienced 105 pregnancies over 3.8 median years of follow-up, yielding a pregnancy incidence of 9.40 per 100 WYs. Three years post-ART initiation, cumulative probability of at least one pregnancy was 28% and independently associated with younger age (Adjusted Hazard Ratio (AHR): 0.89/year increase; 95%CI: 0.86-0.92) and HIV serostatus disclosure to primary sexual partner (AHR: 2.45; 95%CI: 1.29-4.63).Conclusions:Nearly one-third of women became pregnant within three years of initiating ART, highlighting the need for integrated services to prevent unintended pregnancies and reduce periconception-related risks for HIV-infected women choosing to conceive. Association with younger age and disclosure suggests a role for early and couples-based safer conception counselling.

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