The Impact of Antiretroviral Treatment Exposure on Incident Pregnancy Among HIV-infected Women in sub-Saharan Africa: Findings from Four Population-based HIV Impact Assessment Surveys, 2015-2017 公开
Levano, Samantha (Spring 2021)
Published
Abstract
Research has shown that HIV infection is associated with a reduced incidence of pregnancy in sub-Saharan Africa. As recommendations for universal treatment take precedence, further research is needed to understand the association between antiretroviral therapy (ART) and pregnancy incidence among women living with HIV. The Population-based HIV Impact Assessment (PHIA) Project has collected HIV-focused, cross-sectional, nationally representative data to measure the global impact of HIV. This study analyzed data from four countries where PHIA reports are publicly available: Zambia, Malawi, Tanzania, and Eswatini. Time-varying exposure and event categories were defined according to the HIV status, ART status, and pregnancy status of each observation at multiple points in a forty-five-month time series. Time to pregnancy was then modeled using Cox proportional hazards regressions, with follow-up censored at the pregnancy start date for women with a live birth in the last three years and at the survey date for women without a live birth. There were two primary models assessed, 1: comparing HIV-negative women to HIV-positive women not on ART and HIV-positive women on ART; 2: comparing HIV-positive women not on ART to HIV-positive women on ART <1 year and HIV-positive women on ART >1 year. In this analysis, we found that pregnancy incidence rates were lower in HIV-positive women not on ART and HIV-positive women on ART compared to HIV-negative women. These findings were consistent for all four countries, except for Eswatini, where pregnancy incidence was higher for HIV-positive women not on ART compared to HIV-negative women. Additionally, we concluded that HIV-positive women on ART >1 year were overall less likely to report a recent pregnancy than HIV-positive women not on ART in all countries except Malawi. Further, HIV-positive women on ART <1 year were overall more likely to report a recent pregnancy than HIV-positive women not on ART in all countries except for Tanzania. Our findings suggest that fertility differs by the duration of antiretroviral therapy with further qualitative and quantitative data needed to expand upon the biological, behavioral, and social effects of HIV and ART on pregnancy incidence in sub-Saharan Africa.
Table of Contents
Table of Contents
Introduction………………………………………………………………………………………..7
Methods…………………………………………………………………………………………..16
Results………………………………………………………………………………………..…..22
Discussion………………………………………………………………………………………..37
Conclusion……………………………………………………………………………………….43
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The Impact of Antiretroviral Treatment Exposure on Incident Pregnancy Among HIV-infected Women in sub-Saharan Africa: Findings from Four Population-based HIV Impact Assessment Surveys, 2015-2017 () | 2021-05-03 16:18:25 -0400 |
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