Pregnancy, hormonal contraceptive use, and HIV-related death in Rwanda.
BACKGROUND
Few studies have examined the influence of pregnancy and hormonal contraception on HIV-related deaths in African women. Rwanda is a country with high fertility, high HIV prevalence, and frequent use of hormonal contraception in urban areas.


METHODS
Data from a prospective cohort study of 460 HIV-infected urban childbearing (18-35 years) women followed at 6-monthly intervals for 6 years in Kigali, Rwanda, were analyzed. The relationship of time-dependent measures of pregnancy and hormonal contraceptive use to death from HIV disease was assessed with multivariate models.


RESULTS
Incident pregnancy was not associated with elevated risk of death among HIV-infected women. Oral and injectable hormonal contraceptive use had borderline protective effects associated with reduced mortality (HR 0.40, 95% CI 0.15-1.07 and HR 0.48, 95% CI 0.21-1.08 for mortality, respectively) in a multivariate model including time-dependent measures.


CONCLUSIONS
The results point to the benefits of integrating family planning and HIV services. In a highly pronatalist society, such as Rwanda, which is experiencing high HIV prevalence, service integration affords an opportunity to provide HIV testing to women at risk of pregnancy and to promote family planning among HIV-positive women.
Allen
Susan
S
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Stephenson
Rob
R
Weiss
Heidi
H
Karita
Etienne
E
Priddy
Frances
F
Fuller
Laurie
L
Declercq
Andre
A
D000328:Adult; D015331:Cohort Studies; D003271:Contraceptive Agents, Female; D005260:Female; D015658:HIV Infections / Q000401:mortality* / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000401:mortality* / Q000517:prevention & control; D011322:Primary Prevention / Q000706:statistics & numerical data*; D012432:Rwanda / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*; D016387:Women's Health; D014932:Women's Health Services / Q000458:organization & administration
D003271:Contraceptive Agents, Female