Abstract
BackgroundThe objective of this study was to estimate the prevalence, incidence and risk factors for pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya.MethodsThe Academic Model Providing Access to Healthcare (AMPATH) program is a partnership between Moi University, Moi Teaching and Referral Hospital and a consortium of 11 North American academic institutions. AMPATH currently provides care to 85,000 HIV-positive individuals in western Kenya. Included in this analysis were adolescents aged 10–19 enrolled in AMPATH between January 2005 and February 2017. Socio-demographic, behavioural, and clinical data at baseline and time-updated antiretroviral treatment (ART) data were extracted from the electronic medical records and summarized using descriptive statistics. Follow up time was defined as time of inclusion in the cohort until the date of first pregnancy or age 20, loss to follow up, death, or administrative censoring. Adolescent pregnancy rates and associated risk factors were determined.ResultsThere were 8565 adolescents eligible for analysis. Median age at enrolment in HIV care was 14.0 years. Only 17.7% had electricity at home and 14.4% had piped water, both indicators of a high level of poverty. 12.9% (1104) were pregnant at study inclusion. Of those not pregnant at enrolment, 5.6% (448) became pregnant at least once during follow-up. Another 1.0% (78) were pregnant at inclusion and became pregnant again during follow-up. The overall pregnancy incidence rate was 21.9 per 1000 woman years or 55.8 pregnancies per 1000 women. Between 2005 and 2017, pregnancy rates have decreased. Adolescents who became pregnant in follow-up were more likely to be older, to be married or living with a partner and to have at least one child already and less likely to be using family planning.ConclusionsA considerable number of these HIV-positive adolescents presented at enrolment into HIV care as pregnant and many became pregnant as adolescents during follow-up. Pregnancy rates remain high but have decreased from 2005 to 2017. Adolescent-focused sexual and reproductive health and ante/postnatal care programs may have the potential to improve maternal and neonatal outcomes as well as further decrease pregnancy rates in this high-risk group.
Highlights
The objective of this study was to estimate the prevalence, incidence and risk factors for pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya
Plain English summary In this study we looked at how many HIV positive adolescent girls in a large HIV treatment program in western Kenya became pregnant from 2005 to 2017
17.7% of these girls had electricity at home and 14.4% had piped water, which told us that many of these girls were poor. 12.9% of these girls were pregnant when they joined the care program. Of those who were not pregnant when they started in our HIV care program, 5.6% became pregnant later. 1.0% of the girls were pregnant when they joined the care program and became pregnant again another time while they were still under the age of 20 years
Summary
The objective of this study was to estimate the prevalence, incidence and risk factors for pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya. In Kenya, where 47% of women have begun child-bearing by age 20, recent estimates suggest an increase in adolescent pregnancy rates from 96 births per 1000 women aged 15–19 in 2008 to 121 births per 1000 women aged 15–19 in 2014 [3, 4]. This is despite the release of a national Adolescent Reproductive Health and Development Policy in 2003, which called for the development of adolescent-focused health services and targeted a reduction in the proportion of women below age 20 with a first birth from 45% in 1998 to 22% by 2015 [5]. It has important negative consequences, for the individual woman and her child, and, for the future health and well-being of communities and countries [6]
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