[Contraceptive use and incidence of pregnancy among women after HIV testing in Abidjan, Ivory Coast].
BACKGROUND
Within the framework of programs for the prevention of mother-to-child HIV transmission, women who discover their HIV-infection during their pregnancy receive perinatal interventions in order to reduce the risk of HIV transmission to the child. They also receive family planning counselling and free contraceptives in order to avoid a new pregnancy. In this study, we compared contraceptive use and pregnancy incidence between HIV-positive and HIV-negative women who were offered HIV counselling and testing during a program of prevention of mother-to-child HIV transmission.


METHODS
In the Ditrame Plus program in Abidjan, 546 HIV-positive and 393 HIV-negative women were HIV-tested prenatally and followed up 2 years after delivery. At each post-partum visit, proportions of contraceptive use were noted, by method. The pregnancy incidence was calculated as the number of pregnancies for 100 women-years at risk. Factors related to the arrival of a new pregnancy were analyzed by Cox model.


RESULTS
Between 6 and 24 months post-partum, proportions of women using modern contraception varied from 52 to 65% among HIV-positive women, and from 65 to 75% among HIV-negative women. Pregnancy incidence for 100 women-years at risk was 5.70 (95%CI: 4.17-7.23) and 4.37 (95%CI : 2.83-5.91) (p=0.237) and unwanted pregnancy incidence was 1.07 (95%CI: 0.41-1.73) and 2.39 (95%CI: 1.25-3.53) (p=0.023), respectively among HIV-positive and HIV-negative women. The end of post-partum abstinence, the death of the index child and the end of breastfeeding were positively linked to the arrival of a new pregnancy in the post-partum period.


CONCLUSIONS
Among these women prenatally HIV-tested, family planning counselling and regular follow-up was accompanied by a high rate of contraceptive use after delivery, and consecutively to a low pregnancy incidence irrespective of serostatus. In particular, HIV-positive women had fewer unwanted pregnancies than HIV-negative women. Integration of adequate family planning services in the post-partum follow-up in prevention programs plays an important role in reducing the risk of mother-to-child transmission, by reducing pregnancies among HIV-positive women.
Brou
H
H
UMR CEPED, institut de recherche pour le développement (IRD), France. hermann_brou@yahoo.fr
Viho
I
I
Djohan
G
G
Ekouévi
D K
DK
Zanou
B
B
Leroy
V
V
Desgrées-du-Loû
A
A
D000328:Adult; D003267:Contraception / Q000706:statistics & numerical data*; D007560:Cote d'Ivoire / Q000453:epidemiology; D003627:Data Interpretation, Statistical; D005193:Family Planning Services; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control*; D011275:Pregnancy, Unwanted; D016016:Proportional Hazards Models; D013997:Time Factors