Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

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

TitleImpact of Availability and Use of ART/PMTCT Services on Fertility Desires of Previously Pregnant Women in Rakai, Uganda: A Retrospective Cohort Study
Publication TypeJournal Article
Year of Publication2015
AuthorsLitwin, LE, Makumbi, FE, Gray, R, Wawer, M, Kigozi, G, Kagaayi, J, Nakigozi, G, Lutalo, T, Serwada, D, Brahmbhatt, H
JournalJ Acquir Immune Defic Syndr
Date PublishedJul 1
ISBN Number1525-4135
Accession Number25835605
KeywordsAdolescent, Adult, Anti-HIV Agents/*therapeutic use, attitude to health, Cohort Studies, Female, Fertility, Health Knowledge, Attitudes, Practice, HIV Infections/*drug therapy/epidemiology/prevention & control/transmission, Humans, Infectious Disease Transmission, Vertical/*prevention & control, Longitudinal Studies, Middle Aged, Pregnancy, Pregnancy Complications, Infectious/epidemiology/prevention & control, Retrospective Studies, Sexual and Reproductive Health, Uganda/epidemiology, Young Adult

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 chi. "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.