Litwin L.E., Makumbi F.E., Gray R., Wawer M., Kigozi G., Kagaayi J., Nakigozi G., Lutalo T., Serwada D., Brahmbhatt H.
Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E4010, Baltimore, MD, United States; Jhpiego Corporation, Baltimore, MD, United States; Makerere University School of Public Health, Kampala, Uganda; Rakai Health Sciences Program, Entebbe, Uganda
Litwin, L.E., Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E4010, Baltimore, MD, United States, Jhpiego Corporation, Baltimore, MD, United States; Makumbi, F.E., Makerere University School of Public Health, Kampala, Uganda, Rakai Health Sciences Program, Entebbe, Uganda; Gray, R., Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E4010, Baltimore, MD, United States; Wawer, M., Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E4010, Baltimore, MD, United States; Kigozi, G., Rakai Health Sciences Program, Entebbe, Uganda; Kagaayi, J., Rakai Health Sciences Program, Entebbe, Uganda; Nakigozi, G., Rakai Health Sciences Program, Entebbe, Uganda; Lutalo, T., Rakai Health Sciences Program, Entebbe, Uganda; Serwada, D., Makerere University School of Public Health, Kampala, Uganda; Brahmbhatt, H., Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E4010, Baltimore, MD, United States
Objective: To assess fertility desires by availability and use of antiretroviral therapy and prevention of mother-to-child transmission (ART/PMTCT) services in Rakai, Uganda. Design: Retrospective analyses of longitudinal data from the Rakai Community Cohort Study. Methods: Study participants were retrospectively identified and categorized by HIV status. Availability of ART/PMTCT services in Rakai was defined in three periods: (1) pre-ART/PMTCT (<2005), (2) ART/PMTCT rollout (2005-2006), and (3) universal ART/PMTCT (>2006); and use of ART/PMTCT was coded as yes if the woman received services. Trends in fertility desires were assessed by x2. "Modified" Poisson regression was performed using generalized linear models with a log link and Poisson family to estimate prevalence rate ratios (PRRs) and 95% confidence intervals (CIs) of desire for another child among previously and currently pregnant women; PRRs were adjusted for demographic and behavioral factors. Results: A total of 4227 sexually active women in Rakai, including 436 HIV+ women, contributed 13,970 observations over 5 survey rounds. Fertility desires increased in the population in the ART/PMTCT rollout [adjusted (adj.) PRR: 1.08, 95% CI: 1.04 to 1.13] and the universal availability periods (adj. PRR: 1.11, 95% CI: 1.08 to 1.14) compared with pre-ART/PMTCT period. A total of 862 woman observations used ART/PMTCT services. Fertility desires were similar among ART/PMTCT service users and nonusers in cross-sectional analysis (adj. PRR: 0.84, 95% CI: 0.62 to 1.14) and 1 year after ART/PMTCT use (adj. PRR: 1.27, 95% CI: 0.83 to 1.94). Conclusions: Availability of ART/PMTCT may increase fertility desires of previously pregnant women in Rakai, Uganda. Use of ART/PMTCT services was not correlated with fertility desires of previously or current pregnant women. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
adolescent; adult; antiretroviral therapy and prevention of mother to child transmission; antiviral therapy; Article; cohort analysis; condom use; contraceptive behavior; controlled study; female; female fertility; groups by age; health care availability; human; Human immunodeficiency virus infection; major clinical study; married person; pregnancy; preventive health service; priority journal; retrospective study; rural population; vertical transmission; attitude to health; fertility; HIV Infections; longitudinal study; middle aged; Pregnancy Complications, Infectious; prevention and control; transmission; Uganda; young adult; anti human immunodeficiency virus agent; Adolescent; Adult; Anti-HIV Agents; Attitude to Health; Cohort Studies; Female; Fertility; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Longitudinal Studies; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Retrospective Studies; Uganda; Young Adult
1UO1AI075115-O1A1, National Institutes of Health; 22006.03, National Institutes of Health; NINR: 5R01NR011474-03, NIH, National Institutes of Health; U1AI51171, National Institutes of Health