High Pregnancy Intentions and Missed Opportunities for Patient–Provider Communication About Fertility in a South African Cohort of HIV-Positive Women on Antiretroviral Therapy

Abstract

High fertility intentions amongst HIV-positive women have been reported elsewhere. Less is known about how clinical and HIV treatment characteristics correlate with fertility intentions. We use cross-sectional baseline data from a prospective cohort study to assess pregnancy intentions and patient-provider communication around fertility. Non-pregnant, HIV-positive women aged 18-35 on ART were recruited through convenience sampling at Johannesburg antiretroviral (ART) treatment facilities. Among the 850 women in this analysis, those on efavirenz had similar fertility intentions over the next year as women on nevirapine-based regimens (33% vs. 38%). In multivariate analysis, recent ART initiation was associated with higher current fertility intentions; there was no association with CD4 cell count. Forty-one percent of women had communicated with providers about future pregnancy options. Women on ART may choose to conceive at times that are sub-optimal for maternal, child and partner health outcomes and should be routinely counseled around safer pregnancy options.

Contraceptive knowledge and practice among HIV-positive women receiving antiretroviral therapy at a district hospital in KwaZulu-Natal

“…19 However, this finding was better than the reported rate in Uganda, where only 18% of sexually active women receiving ART used dual methods of contraception. 20 Further research is needed to assess the information that is provided to patients, barriers to the use of dual contraception methods and factors that influence the limited use of other contraceptive methods.…”

Safety, strength and simplicity of efavirenz in pregnancy

“…A small proportion (6.4%) said a provider had told them not to have more children, and 36% were unsure whether their provider had approved of them having children. 21 Furthermore, women on both EFV and NVP had similar pregnancy intentions -either trying to conceive or planning to do so. 21 …”

“…21 Furthermore, women on both EFV and NVP had similar pregnancy intentions -either trying to conceive or planning to do so. 21 …”

Antiretrovirals for safer conception for HIV-negative women and their HIV-1-infected male partners

“…Antiretroviral therapy has rendered HIV a treatable condition and people on effective therapy can have a life expectancy that approaches that of HIV-uninfected people [4,5]. Not surprisingly, an increasing number of people in HIV-1-discordant partnerships desire conception [6][7][8]. The current study by Vernazza et al raises several important issues, two that are especially critical.…”