Impact of antiretroviral therapy on fertility desires among HIV-infected persons in rural Uganda

Reproductive Health

Tom Rubaale²  Arif Alibhai¹  Gian S Jhangri¹  Jennifer Heys¹  Walter Kipp¹ 

[1] Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada;Kabarole District Health Department, P.O. Box 27, Fort Portal, Uganda

关键词: Uganda;    resource-limited setting;    peri-natal transmission;    mother-to-child-transmission;    knowledge;    HIV/AIDS;    family planning;    fertility desires;    highly active antiretroviral therapy;   

Others  :  821789
DOI  :  10.1186/1742-4755-8-27

 received in 2011-06-20, accepted in 2011-10-06,  发布年份 2011

【 摘 要 】

Background

Little is known about the fertility desires of HIV infected individuals on highly active antiretroviral therapy (HAART). In order to contribute more knowledge to this topic we conducted a study to determine if HIV-infected persons on HAART have different fertility desires compared to persons not on HAART, and if the knowledge about HIV transmission from mother-to-child is different in the two groups.

Methods

The study was a cross-sectional survey comparing two groups of HIV-positive participants: those who were on HAART and those who were not. Semi-structured interviews were conducted with 199 HIV patients living in a rural area of western Uganda. The desire for future children was measured by the question in the questionnaire "Do you want more children in future." The respondents' HAART status was derived from the interviews and verified using health records. Descriptive, bivariate and multivariate methods were used to analyze the relationship between HAART treatment status and the desire for future children.

Results

Results from the multivariate logistic regression model indicated an adjusted odds ratio (OR) of 1.08 (95% CI 0.40-2.90) for those on HAART wanting more children (crude OR 1.86, 95% CI 0.82-4.21). Statistically significant predictors for desiring more children were younger age, having a higher number of living children and male sex. Knowledge of the risks for mother-to-child-transmission of HIV was similar in both groups.

Conclusions

The conclusions from this study are that the HAART treatment status of HIV patients did not influence the desire for children. The non-significant association between the desire for more children and the HAART treatment status could be caused by a lack of knowledge in HIV-infected persons/couples about the positive impact of HAART in reducing HIV transmission from mother-to-child. We recommend that the health care system ensures proper training of staff and appropriate communication to those living with HIV as well as to the general community.

【 授权许可】

   
2011 Kipp et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Newell ML, Brahmbhatt H, Ghys PD: Child mortality and HIV infection in Africa: a review. AIDS 2004, 18(Suppl):27-34.
• [2]Gregson S, Zhuwau T, Anderson RM, Chandiwana SK: Is there evidence for behaviour change in response to AIDS in rural Zimbabwe? Soc Sci Med 1998, 46:321-330.
• [3]Feldman R, Maposhere C: Safer sex and reproductive choice: findings from "positive women: voices and choices" in Zimbabwe. Reprod Health Matters 2003, 11:162-173.
• [4]Lutalo T, Kidugavu M, Wawer MJ, Serwadda D, Zabin LS, Gray RH: Trends and determinants of contraceptive use in Rakai District, Uganda, 1995-98. Stud Fam Plann 2000, 31:217-227.
• [5]Caldwell C, Caldwell P: The cultural context of high fertility in Africa. Population Develop Rev 1987, 13(3):409-437.
• [6]Rasmussen MB, Rasmussen JB, Nielsen VR, Herlin T, Fisker N, Horntstrup MK: Prevention of vertical transmission of HIV in Denmark. Ugeskrift for Laeger 2008, 170(34):2567-2570.
• [7]Goetghebuer T, Haelterman E, Marvillet I, Barlow P, Hainaut M, Salameh A: Vertical transmission of HIV in Belgium: a 1986-2002 retrospective analysis. Eur J Pediatr 2009, 168:79-85.
• [8]Ciaranello AL, Seage GR, Freedberg KA, Weinstein MC, Lockman S, Walensky RP: Antiretroviral drugs for preventing mother-to-child transmission of HIV in sub-Saharan Africa: balancing efficacy and infant toxicity. AIDS 2008, 22(17):2359-2369.
• [9]Stover J, Fidzani B, Molomo BC, Moeti T, Musuka G: Estimated HIV trends and program effects in Botswana. PLoS One 2008., 3(11) epub 2008 Nov 14
• [10]Leroy V, Ekouevi DK, Becquet R, Viho I, Dequae-Merchadou L, Tonwe-Gold B: 18-months effectiveness of short course antiretroviral regimens combined with alternatives to breastfeeding to prevent HIV mother-to-child transmission. PLoS One 2008, 3(2):e1645.
• [11]Allen S, Serufilira A, Gruber V, Kegeles S, Van de Perre P, Carael M: Pregnancy and contraception use among urban Rwandan women after HIV testing and counseling. Am J Pub Health 1993, 83:705-710.
• [12]Grieser M, Gittelsohn J, Shankar AV, Koppenhaver T, Legrand TK, Marindo R: Reproductive decision making and the HIV/AIDS epidemic in Zimbabwe. J South Afric Stud 2001, 27:225-243.
• [13]Baylies C: The impact of HIV on family size preference in Zambia. Reprod Health Matters 2000, 8:77-86.
• [14]Rutenberg N, Baek C, Review of Field Experiences: Integration of Family Planning and PMTCT Services. In Population Council. Washington, DC; 2004.
• [15]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 Pat Care STDs 2007, 21(4):278-285.
• [16]Myer L, Carter R, Katyal M, Toro P, El-Sadr W, Abrams E: Impact of antiretroviral therapy on incidence of pregnancy among HIV-infected women in sub-Saharan Africa: A cohort study. PLoS Med 2010, 7(2):e1000229.
• [17]Ndlovu V: Considering childbearing in the age of highly active antiretroviral therapy (HAART): Views of HIV-positive couples. Sahara J 2009, 6(2):58-68.
• [18]Maier M, Andia I, Emenyonu N, Guzman D, Kaida A, Pepper L: Antiretroviral therapy is associated with increased fertility desire, but not pregnancy and life births, among HIV + women in an early HIV treatment program in rural Uganda. AIDS Behav 2009, 13(Suppl 1):28-37.
• [19]Homsy J, Bunnell R, Moore D, King R, Malamba S, Nakityo R: Reproductive intentions and outcomes among women on antiretroviral therapy in rural Uganda: a prospective cohort study. PLoS One 2009, 4(1):e4149.
• [20]Snow R, Mutumba M, Powers G, Evans L, Rukundo E, Abesiga L, Kabasindi J, Ford T, Mugyenyi G: The impact of HIV on fertility aspirations in Uganda. Population Study Center 11(740):19.
• [21]Andia I, Kaida A, Maier M, Guzman D, Emenyonu N, Pepper L, Bangsberg D, Hogg R: Highyl active antiretroviral therapy and increased use of contraceptives among HIV-positive women during expanding access to antiretroviral therapy in Mbarara, Uganda. Am J Pub Health 2009, 99:340-347.
• [22]Makumbi F, Nakigozi G, Reynolds S, Ndyanabo A, Lutalo T, Serwada D, Nalugoda F, Wawer M, Gray R: Associations between HIV anti retroviral therapy and the prevalence and incidence of pregnancy in Rakai, Uganda. AIDS Res Treatm 2010. 2011
• [23]Maja TM: Involvement of males in promoting reproductive health. Curationis 2007, 30(1):71-76.
• [24]Odu OO, Ijadunola KT, Komolafe JO, Adebimpe WT: Men's knowledge and attitude with respect to family planning in a suburban Nigerian community. Niger J Med 2006, 15(3):260-265.
• [25]Kaida A, Kipp W, Hessel P, Konde-Lule J: Male participation in family planning; Results from a qualitative study in Mpigi district, Uganda. J Biosoc Sci 2005, 37(3):269-286.
• [26]Heys J, Kipp W, Jhangri G, Alibhai A, Rubaale T: Fertility desires and Infection with the Human Immunodeficiency Virus: Results from a survey in rural Uganda. AIDS 2009, 23(Suppl):37-45.
• [27]Uganda Bureau of Statistics, Macro International Inc: Uganda Demographic and Health Survey 2007; final report. Kampala, Uganda;
• [28]STATA Corporation, STATA Statistical Software College Station, Texas, United States of America; 2009. Release 11
• [29]Taulo F, Berry M, Tsui A, Makanani B, Kafulafula G, Li Q: Fertility intentions of HIV-1 infected and uninfected women in Malawi: A longitudinal study. AIDS Behav 2009, 13(Supp.1):20-27.
• [30]Laher F, Todd C, Stibich M, Phofa R, Behane X, Mohapi L: A qualitative assessment of decisions affecting contraceptive utilizations and fertility intentions among HIV-positive women in Soweto, South Africa. AIDS Behav 2009, 13(Supp.1):47-54.
• [31]National antiretroviral treatment and care guidelines for adults, adolescents and children [http://www.who.int/hiv/amds/Uganda_moh_treatment_guidelines.pdf] webciteMinistry of Health, 2003 Kampala, Uganda; 2001.
• [32]East African [http://allafrica.com/stories/20090803 1372.html] webcite 2009.
• [33]Haeri S, Shauer M, Dale M, Leslie J, Baker AM, Saddlemine S: Obstetric and newborn infant outcomes in human immunodeficiency virus-infected women who receive highly active antiretroviral therapy. Am J Obs Gynec 2009, 201(3):315. e1-5.
• [34]Olagbo BN, Ezeanochie MC, Ande AB, Oboro VO: Obstetric and perinatal outcome in HIV positive women receiving HAART in urban Nigeria. Archiv Gynec Obs 2009, in press.