title: 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.
authors.affiliation: Wits Reproductive Health & HIV Institute, Hillbrow Health Precinct, University of the Witwatersrand, Johannesburg, South Africa, sschwartz@rhru.co.za
authors.forename: Sheree R
authors.initials: SR
authors.lastname: Schwartz
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Taha E
authors.initials: TE
authors.lastname: Taha
authors.forename: Helen V
authors.initials: HV
authors.lastname: Rees
authors.forename: Francois
authors.initials: F
authors.lastname: Venter
authors.forename: Vivian
authors.initials: V
authors.lastname: Black
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D044383:Black People; D018791:CD4 Lymphocyte Count; D003142:Communication; D003376:Counseling; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D033182:Intention; D010817:Physician-Patient Relations; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013019:South Africa; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents