Impact of Availability and Use of ART/PMTCT Services on Fertility Desires of Previously Pregnant Women in Rakai, Uganda: A Retrospective Cohort Study
Journal of Acquired Immune Deficiency Syndromes
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
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