Abstract
Introductiondue to increasing coverage of antiretroviral therapy (ART), more women living with HIV have improved health condition which also increases their chances of getting pregnant. However, the knowledge about pregnancy among women receiving ART in resource-constrained settings, like Ethiopia, is limited. The aim was to assess factors associated with pregnancy among women living with HIV in Ethiopia.Methodsa retrospective cohort study from 2005 through 2013 including a total of 809 women aged 15-49 years on ART was used. The study was conducted in eight hospitals and health centers in two regions of Ethiopia. The data was collected between March and June of 2014 from patients´ pre-ART and ART registers by trained nurses, assisted by data entry clerks and supervised by senior physicians. Kaplan-Meier survival analysis and Cox regression analysis were used to examine the probability of becoming pregnant. Factors associated with pregnancy were presented with hazard ratios with 95% Confidence Interval (CI).Resultsa total of 809 women were included in this analysis, their median age was 27 years, 90% were urban residents and 40.6% were married. Four hundred eighty three (60.6%) were in WHO stage III at initiation of ART. The median CD4 count was 162.5 cell/μl at initiation of ART. Eighty-one women became pregnant during 3069 person-years of observation. The overall incidence of pregnancy was 26.4 pregnancies per 1000 person-years of observation. Women under the age of 24, those in less advanced disease stage, women with no education and those with college education had higher rates of pregnancy.Conclusionthe results highlight that younger women, those in less advanced disease stage, either uneducated or highly educated ones have higher probability of becoming pregnant during HIV treatment. This suggests the need for integrating reproductive health services into HIV care services to meet the needs of women on ART.
Highlights
Human Immunodeficiency Virus (HIV) is still a major global health issue - 36.9 million people are estimated to currently be living with HIV
The cumulative probability of surviving from pregnancy was lower among women under the age of 24 compared to women over the age of 24, with a mean survival time of 7.8 and 8.9 years, respectively
This study found that women on Antiretroviral therapy (ART) in SNNPR and Addis Ababa in Ethiopia had an overall incidence of pregnancy of 26.4 pregnancies per 1000 personyears of observation
Summary
Human Immunodeficiency Virus (HIV) is still a major global health issue - 36.9 million people are estimated to currently be living with HIV. The coverage of people receiving ART has increased significantly, today reaching 65% of women over the age of 15 living with HIV [1]. The desire to give birth among HIV infected women receiving ART in Tigray region, Finote Selam in Mirab Gojjam zone in Amhara region, Addis Ababa and South Wollo zone was 45.5%, 28.8%, 44% and 15.7%, respectively [5,6,7,8]. The fertility desire among both men and women living with HIV and being treated with ART in Fiche and Addis Ababa was 39.1% and 54.6%, respectively [9,10]. A meta-analysis consisting of twenty studies from Ethiopia, Uganda, South Africa, Nigeria, USA, France, Brazil and Canada showed that age less than 30 years and not having children were strongly associated with fertility desire among HIV positive women [11]
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