Meta-analyses of fertility desires of people living with HIV

BMC Public Health

Asres Berhan¹  Yifru Berhan¹ 

[1] Hawassa University College of medicine and health sciences, Hawassa, Ethiopia

关键词: Sensitivity analysis;    HIV positive;    Meta-analysis;    Fertility desire;    ART;   

Others  :  1162272
DOI  :  10.1186/1471-2458-13-409

 received in 2012-07-19, accepted in 2013-04-26,  发布年份 2013

【 摘 要 】

Background

Literature review has shown that some years back the fertility desires of people living with HIV was low but in the recent years, it was reported as increasing. However, little is known about the strength of association of fertility desire of HIV positive people with antiretroviral therapy (ART) experience, age, sex, education level, and number of children.

Methods

In these meta-analyses, twenty studies from different parts of the world were included. The odds ratios of fertility desires were determined using the random-effects model. Heterogeneity among the studies was assessed by computing values for Tau², Chi-square (Q), I² and P-value. Sensitivity analysis and funnel plot were done to assess the stability of pooled values to outliers and publication bias, respectively.

Results

The pooled analysis demonstrated that fertility desires of study participants had no association with ART. Similarly, the overall odds ratio did not show statistically significant association of fertility desires with sex and educational attainment of study participants although forest plots of some studies fall on increased and some others on decreased sides of fertility desires. The two variables that demonstrated a strong association with fertility desires were age less than 30 years and being childless. The lowest heterogeneity was found in a meta-analysis comparing ART experienced and ART naïve HIV positive people. In all meta-analyses, the sensitivity analyses showed the stability of the pooled odds ratios; and the funnel plots did not show publication or disclosure bias.

Conclusion

Although the fertility desires among childless and younger age group was very strong, we realized that quite a significant segment of HIV-infected people have desire for fertility. Therefore, including fertility issue as integral part of HIV patient care may help several of them in their reproductive decision making (letting them know the risks and methods of prevention while anticipating pregnancy).

【 授权许可】

   
2013 Berhan and Berhan; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

【 参考文献 】

• [1]Yeatman S: HIV infection and fertility preference in rural Malawi. Stud Fam Plann 2009, 40(4):261-276.
• [2]Ross A, ven der Paarl L, Lubega R, Mayanja BN, Shafer LA, Whitworth J: HIV-1 disease progression and fertility: the incidence of recognized pregnancy and pregnancy outcome in Uganda. AIDS 2004, 18(5):799-804.
• [3]Desgrees du Lou A, Msellati P, Yao A: Impaired fertility in HIV-1 infected pregnant women; a clinic based survey in Abidjan. AIDS 1999, 13(4):517-521.
• [4]Berhan Y: Attitude of people living with HIV/AIDS to be a biological parent and their knowledge on MTCT reduction methods. Ethiop Med J 2008, 46(4):335-347.
• [5]Marcellin F, Protopopescu C, Abe C, Boyer S, Blanche J, Ongolo-Zogo P, Koulla-Shiro S, Moatti JP, Carrieri MP, Spire B: Desire for a child among HIV-infected women receiving antiretroviral therapy in Cameroon: results from the national survey, EVAL study. AIDS Care 2010, 22(4):441-451.
• [6]Hofman IF, Martinson FE, Powers KA, Chilongozi DA, Msiska ED, Kachipapa EI: The year-long effect of HIV-positive test results on pregnancy intentions, contraceptive use, and pregnancy incidence among Malawian women. J Acquire Immune Defic Syndr 2008, 47(4):477-483.
• [7]Nakayiwa S, Abang B, Packel L, Lifshay J, Purcell DW, King R, Ezati E, Mermin J, Coutinho A, Bunnel R: Desire for children and pregnancy risk behavior among HIV-infected men and women in Uganda. AIDS Behav 2006, 10:S95-S104.
• [8]Oladapo OT, Daniel OJ, Odusoga OL, Ayoola-Sotubo O: Fertility desires and intentions of HIV positive patients at a suburban specialist center. J Natl Med Assoc 2005, 97(12):1672-1681.
• [9]Kanniappan S, Jeyapaul MJ, Kalyanwala S: Desire for motherhood: Exploring HIV-positive women’s desire, intentions and decision-making in attaining motherhood. AIDS Care 2008, 20(6):625-630.
• [10]Mair M, Andia I, Emenyonu N, Guzman D, Kaida A, Pepper L, Hogg R, Bangsberg DR: Antiretroviral therapy is associated with increased fertility desire, but not pregnancy or live birth, among HIV positive women in an early HIV treatment program in rural Uganda. AIDS Behav 2009, 13(1):28-37.
• [11]Ogilive GS, Palepu A, Remple VP, Maan E, Heath K: Fertility intentions of women of reproductive age living with HIV in British Columbia, Canada. AIDS 2007, 21:S83-S88.
• [12]Loutfy MR, Hart TA, Mohammed SS, Su D, Ralph ED: Fertility desires and intentions of HIV-positive women of reproductive age in Ontan Canada: a cross sectional study. PLoS One 2009, 4(12):e7925. http://www.plosone.org webcite
• [13]Siegel K, Schrimshaw EW: Reasons and justifications for considering pregnancy among women living with HIV/AIDS. Psychol Women Quart 2001, 25(2):112-123.
• [14]Ndlovu V: Considering childbearing in the age of highly active antiretroviral therapy (HAART): Views of HIV-positive couples. Journal of Social Aspects of HIV/AIDS 2009, 6(2):58-68.
• [15]Cooper D, Harris J, Myer L, Orner P, Braacken H: “Life is still going on”: reproductive intentions among HIV-positive women and men in South Africa. Soc Sci Med 2007, 65(2):274-283.
• [16]Aska ML, Chompikul J, Keiwkarnka B: Determinants of fertility desires among HIV positive women living in the Western highlands province of Papua New Guinea. World J AIDS 2011, 1(4):198-207.
• [17]McClellan MK, Patel R, Kadzirange G, Chipato T, Katzenstein D: Fertility desires and condom use among HIV-positive women at an antiretroviral roll-out program in Zimbabwe. Afr J Reprod Health 2010, 14(2):27-35.
• [18]Barbara Nattabi B, Li J, Sandra C, Thompson SC, Orach CG, Earnest J: A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav 2009, 13(5):949-968.
• [19]Wallace BC, Schmid CH, Lau J, Trikalinos TA: Meta-analyst: software for meta-analysis of binary, continuous and diagnostic data. BMC Med Res Methodol 2009., 9(1) 80+. http://www.biomedcentral.com/1471-2288/9/80 webcite
• [20]Paiva V, Santos N, Francia-Junior I, Filipe E, Ayres JR, Segurado A: Desire to have children: gender and reproductive rights of men and women living with HIV: a challenge to health care in Brazil. AIDS Patient Care STDS 2007, 21(4):268-277.
• [21]Alemayehu B, Aregay A: Desire to procreate among people living with HIV/AIDS: Determinants in Ethiopia: a cross-sectional study. J AIDS HIV Res 2012, 4(5):128-135.
• [22]Cooper D, Moodley J, Zweigenthal V, Bekker L-G, Shah I, Myer L: Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: implications for integrating reproductive health and HIV care services. AIDS Behav 2009, 13:S38-S46.
• [23]Ogilvie GS, Palepu A, Remple VR, Maan E, Heath K, MacDonald G, Christilaw J, Berkowitz J, Fisher WA, Burge DR: Fertility intentions of women of reproductive age living with HIV in British Columbia, Canada. AIDS 2007, 21(Suppl 1):S83-S88.
• [24]Andia I, Kaida A, Maier M, Guzman D, Emenyonu N, Pepper L, Bangsberg DR, Hogg RS: Highly active antiretroviral therapy and increased use of contraceptives among HIV-positive women during expanding access to antiretroviral therapy in Mbarara, Uganda. Am J Public Health 2009, 99(2):340-347.
• [25]Kipp W, Heys J, Jhangri G, Alibhai A, Rubaale T: Impact of antiretroviral therapy on fertility desires among HIV-infected persons in rural Uganda. Reproductive Health 2011, 8:e27. http://www.reproductive-health-journal.com webcite BioMed Central Full Text
• [26]Heard I, Sitta R, Lert F, and the VESPA study group: Reproductive choice in men and women living with HIV: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA study). AIDS 2007, 21(Suppl 1):S77-S82.
• [27]Iliyasu Z, Abubakar IS, Kabir M, Babashani M, Shuaib F, Aliyu MH: Correlates of fertility intentions among HIV/AIDS patients in Northern Nigeria. Afr J Reprod Health 2009, 13(3):71-83.
• [28]Nobrega AA, Oliveira FAS, Galvao MTG, Mota RS, Barbosa RM, Dourado I, Kendall C, Kerr-Pontes LRS: Desire for a child among women living with HIV/AIDS in Northeast Brazil. AIDS Patient Care STDS 2007, 21(4):261-267.
• [29]Kaida A, Laher F, Strathdee SA, Money D, Janssen PA, Hogg RS, Gray G: Contraceptive use and method preference among women in Soweto, South Africa. The influence of expanding access to HIV and treatment services. PLoS One 2010, 5(11):E13868. http://www.plosone.org webcite
• [30]Kaida A, Laher F, Strathdee SA, Money D, Janssen PA, Hogg RS, Gray G: Childbearing intentions of HIV-positive women of reproductive age in Soweto, South Africa: the influence of expanding access to HAART in an HIV hypeendemic setting. Am J Public Health 2011, 101(2):350-358.
• [31]Tesfaye L, Admasu M, Getachew A, Sharma HR: Fertility desires and family planning demand among HIV-positive clients in follow-up care at antiretroviral treatment unit in Gondar University hospital, Ethiopia. Vulnerable Child Youth Stud 2012, 7(1):20-35.
• [32]Stanwood NL, Cohn SE, Heiser JR, Pugliese MA: Contraception and fertility plans in a cohort of HIV-positive women in care. Contraception 2007, 75:294-298.
• [33]Getachew M, Alemseged F, Abera M, Deribew A: Factors affecting fertility decisions of married men and women living with HIV in South Wollo Zone, Northeast Ethiopia. Ethiop J Health Dev 2010, 24(3):214-220.
• [34]Tamene W, Fantahun M: Fertility desire and family-planning demand among HIV-positive women and men undergoing antiretroviral treatment in Addis Ababa. Afr J AIDS Res 2007, 6(3):223-227.
• [35]Myer L, Morroni C, Rebe K: Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS Patient Care STDS 2007, 21(4):278-285.
• [36]Erhabor O, Akani CI, Eyindah CE: Reproductive health options among HIV infected persons in the low-income Niger Delta of Nigeria. HIV/AIDS Res Palliat Care 2012, 4:29-35.
• [37]Finocchario-Kessler S, Sweat MD, Dariotis JK, Trent ME, Kerrigan DL, Keller JM, Anderson JR: Understanding high fertility desires and intentions among a sample urban women living with HIV in the United states. AIDS Behav 2010, 14(5):1106-1114.
• [38]Homsy J, Bunnel R, Moore D: Reproductive intentions and outcomes among women on antiretroviral therapy in rural Uganda: a prospective cohort study. PLoS One 2009, 4(1):e4149. http://www.plosone.org webcite
• [39]Kakire O, Osinde MO, Kaye DK: Factors that predict fertility desires for people living with HIV infection at a support and treatment center in Kabale, Uganda. Reprod Health 2010, 7:e27. http://www.reproductive-health-journal.com webcite BioMed Central Full Text
• [40]Gruskin S, Firestone R, MacCarthy S, Ferguson L: HIV and pregnancy intentions: do services adequately respond to women’s needs? Am J Public Health 2008, 98(4):1746-1750.
• [41]Lima VD, Hogg RS, Harrigan PR, Moore D, Yip B, Wood E: Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy. AIDS 2007, 21(6):685-692.
• [42]Zaba B, Gregson S: Measuring the impact of HIV on fertility in Africa. AIDS 1998, 12(Suppl 1):S41-S50.
• [43]Laher F, Todd CS, Stibich MA, Phofa R, Behane X, Mohapi L, Gray G: A qualitative assessment of decisions affecting contraceptive utilization and fertility intentions among HIV-positive women in Seweto, South Africa. AIDS Behav 2009, 13:S47-S54.
• [44]Joint United Nations Programme on HIV/AIDS (UNAIDS): Report on the global AIDS epidemic 2010. http://www.unaids.org webcite