High incidence of unplanned pregnancy after antiretroviral therapy initiation: findings from a prospective cohort study in South Africa.
High incidence of unplanned pregnancy after antiretroviral therapy initiation: findings from a prospective cohort study in South Africa.
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DOI：
10.1371/journal.pone.0036039
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Black V
中科院分区：
文献类型：
--
作者：
Schwartz SR;Rees H;Mehta S;Venter WD;Taha TE;Black V
Increased fertility rates in HIV-infected women receiving antiretroviral therapy (ART) have been attributed to improved immunological function; it is unknown to what extent the rise in pregnancy rates is due to unintended pregnancies. Non-pregnant women ages 18–35 from four public-sector ART clinics in Johannesburg, South Africa, were enrolled into a prospective cohort and followed from August 2009–March 2011. Fertility intentions, contraception and pregnancy status were measured longitudinally at participants' routine ART clinic visits. Of the 850 women enrolled, 822 (97%) had at least one follow-up visit and contributed 745.2 person-years (PY) at-risk for incident pregnancy. Overall, 170 pregnancies were detected in 161 women (incidence rate [IR]: 21.6/100 PY [95% confidence interval (CI): 18.5–25.2]). Of the 170 pregnancies, 105 (62%) were unplanned. Unmet need for contraception was 50% higher in women initiating ART in the past year as compared to women on ART>1 year (prevalence ratio 1.5 [95% CI: 1.1–2.0]); by two years post-ART initiation, nearly one quarter of women had at least one unplanned pregnancy. Cumulative incidence of pregnancy was equally high among recent ART initiators and ART experienced participants: 23.9% [95% CI: 16.4–34.1], 15.9% [12.0–20.8], and 21.0% [16.8–26.1] for women on ART 0–1 yr, >1 yr–2 yrs, and >2 yrs respectively (log-rank, p = 0.54). Eight hormonal contraceptive failures were detected [IR: 4.4 [95% CI: 2.2–8.9], 7/8 among women using injectable methods. Overall 47% (80/170) of pregnancies were not carried to term. Rates of unintended pregnancies among women on ART are high, including women recently initiating ART with lower CD4 counts and higher viral loads. A substantial burden of pregnancy loss was observed. Integration of contraceptive services and counselling into ART care is necessary to reduce maternal and child health risks related to mistimed and unwanted pregnancies. Further research into injectable contraceptive failures on ART is warranted.
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DOI：
10.1097/qad.0b013e32834541d9
发表时间：
2011-04-24
期刊：
AIDS (London, England)
影响因子：
--
作者：
Abdool Karim SS;Richardson BA;Ramjee G;Hoffman IF;Chirenje ZM;Taha T;Kapina M;Maslankowski L;Coletti A;Profy A;Moench TR;Piwowar-Manning E;Mâsse B;Hillier SL;Soto-Torres L;HIV Prevention Trials Network (HPTN) 035 Study Team
通讯作者：
HIV Prevention Trials Network (HPTN) 035 Study Team
DOI：
10.1080/13625180701829952
发表时间：
2008-06-01
影响因子：
1.7
作者：
El-Ibiary, Shareen Y.;Cocohoba, Jennifer M.
通讯作者：
Cocohoba, Jennifer M.
影响因子：
15.8
作者：
Myer L;Carter RJ;Katyal M;Toro P;El-Sadr WM;Abrams EJ
通讯作者：
Abrams EJ
影响因子：
4.4
作者：
Cooper, Diane;Moodley, Jennifer;Myer, Landon
通讯作者：
Myer, Landon
影响因子：
9.8
作者：
Stringer, Elizabeth M.;Kaseba, Christine;Stringer, Jeffrey A.
通讯作者：
Stringer, Jeffrey A.