Unplanned pregnancies and contraceptive use among HIV- positive women in care.
Unplanned pregnancies and contraceptive use among HIV- positive women in care.
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DOI：
10.1371/journal.pone.0197216
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Frazier EL
中科院分区：
文献类型：
--
作者：
Sutton MY;Zhou W;Frazier EL
在美国，有 230,360 名被诊断出艾滋病毒的女性中，每年约有 8,500 名女性生育，并且意外怀孕（与艾滋病毒阴性女性一样）很普遍。然而，艾滋病毒呈阳性的妇女的意外怀孕和避孕措施的使用尚未得到充分研究。为了检查 HIV 阳性女性的意外怀孕和避孕药具使用情况，我们使用了医疗监测项目 (MMP) 2013-2014 年的数据，该项目是一个 HIV 监测系统，对美国接受护理的 HIV 阳性成人进行全国估计（对于 2013-2014 年期间接受采访的这组女性来说，怀孕结果日期为 1986-2015 年；报告怀孕结果的中位年份为2003）。接受艾滋病毒护理并在 45 岁（生育年龄）之前被诊断出感染艾滋病毒的妇女也包括在内。我们以 95% 置信区间 (CI) 计算了计划外妊娠的调整后患病率 (aPR)。对于采访时年龄在 18-44 岁的女性，我们按方法计算了避孕药具使用率（前 12 个月）的加权流行率，包括永久性避孕药（即绝育）、短效避孕药（即避孕药、醋酸去孕酮 (DMPA)）、长效可逆避孕药 (LARC)（即植入物）和屏障避孕药（即避孕套）。六百七十一名妇女符合计划外怀孕分析的标准； HIV 诊断时的中位年龄 = 24.6 岁，78.1% (CI:74.5–81.7) 报告≥ 1 次意外怀孕。与西班牙裔相比，报告意外怀孕的女性更有可能是非西班牙裔白人 (aPR = 1.20; CI 1.05–1.38) 或非西班牙裔黑人 (aPR = 1.14; CI 1.01–1.28)，高于贫困线 (aPR = 1.09; CI 1.01–1.18)，并且没有接受过医疗机构的护理。访谈前一年的妇产科检查（aPR = 1.13；CI 1.04–1.22）。在 1,142 例妊娠总数中，有 795 例（69.6%）是活产婴儿； 70 人（7.8%）出生时艾滋病毒呈阳性； 42 名（60%）出生时艾滋病毒呈阳性的人是计划外怀孕。对于避孕药具分析（n = 957 名受访时年龄为 18-44 岁的女性），90.5% 的人报告使用至少一种避孕药具，其中 59.7% 的人报告在上一年使用屏障方法，29.9% 的人报告永久绝育，22.8% 的人报告使用短期方法。只有 5.3% 的女性使用 LARC。与 40-44 岁的女性相比，报告使用 LARC 或 DMPA 的女性更有可能年龄在 18-29 岁（aPR = 3.08；CI 1.61-5.89）或 30-39 岁（aPR = 2.86；CI 1.76-4.63）。意外怀孕很普遍，LARC 使用率很低；预防工作应在临床就诊期间加强艾滋病毒阳性妇女的怀孕计划和避孕意识。
Among 230,360 women with diagnosed HIV in the United States (U.S.), ~ 8,500 give birth annually, and unplanned pregnancies (as with HIV-negative women) are prevalent. However, unplanned pregnancies and contraceptive use among HIV-positive women have been understudied. To examine unplanned pregnancies and contraceptive use among HIV-positive women, we used 2013–2014 data from the Medical Monitoring Project (MMP), an HIV surveillance system that produces national estimates for HIV-positive adults in care in the U.S. (Pregnancy outcome dates were from years 1986–2015 for this cohort of women who were interviewed during 2013–2014; median year of reported pregnancy outcome was year 2003). Women in HIV care and diagnosed with HIV before age 45 (reproductive age) were included. We calculated adjusted prevalence ratios (aPR) of unplanned pregnancies with 95% confidence intervals (CI). For women who were aged 18–44 years at time of interview, we computed weighted prevalences of contraceptive use (previous 12 months) by method, including permanent (i.e., sterilization), short-acting (i.e., pills, depo-progesterone acetate (DMPA)), long-acting reversible contraceptives (LARC) (i.e., implants), and barriers (i.e., condoms). Six hundred seventy-one women met criteria for the unplanned pregnancy analysis; median age at HIV diagnosis = 24.6 years, and 78.1% (CI:74.5–81.7) reported ≥ 1 unplanned pregnancy. Women reporting unplanned pregnancies were more likely to be non-Hispanic white (aPR = 1.20; CI 1.05–1.38) or non-Hispanic black (aPR = 1.14; CI 1.01–1.28) than Hispanic, to be above the poverty level (aPR = 1.09; CI 1.01–1.18), and to have not received care from an OB/GYN in the year before interview (aPR = 1.13; CI 1.04–1.22). Among 1,142 total pregnancies, 795 (69.6%) were live births; 70 (7.8%) were born HIV-positive; 42 (60%) of those born HIV-positive were unplanned pregnancies. For the contraceptives analysis (n = 957 women who were aged 18–44 at time of interview), 90.5% reported using at least one contraceptive, including 59.7% reporting barrier methods, 29.9% reporting permanent sterilization, and 22.8% reporting short-term methods in the previous year. LARC was used by only 5.3% of women. Women who reported use of LARC or DMPA were more likely to be aged 18–29 years (aPR = 3.08; CI 1.61–5.89) or 30–39 years (aPR = 2.86; CI 1.76–4.63) compared with women aged 40–44 years. Unplanned pregnancies were prevalent and LARC use was low; prevention efforts should strengthen pregnancy planning and contraceptive awareness for HIV-positive women during clinical visits.
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