title: Impact of Availability and Use of ART/PMTCT Services on Fertility Desires of Previously Pregnant Women in Rakai, Uganda: A Retrospective Cohort Study.
abstract: 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.
  
  
  METHODS
  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 χ. "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.
authors.affiliation: *Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Jhpiego Corporation, Baltimore, MD; ‡Makerere University School of Public Health, Kampala, Uganda; and §Rakai Health Sciences Program, Entebbe, Uganda.
authors.forename: Lindsay E
authors.initials: LE
authors.lastname: Litwin
authors.forename: Frederick E
authors.initials: FE
authors.lastname: Makumbi
authors.forename: Ronald
authors.initials: R
authors.lastname: Gray
authors.forename: Maria
authors.initials: M
authors.lastname: Wawer
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Joseph
authors.initials: J
authors.lastname: Kagaayi
authors.forename: Gertrude
authors.initials: G
authors.lastname: Nakigozi
authors.forename: Tom
authors.initials: T
authors.lastname: Lutalo
authors.forename: David
authors.initials: D
authors.lastname: Serwada
authors.forename: Heena
authors.initials: H
authors.lastname: Brahmbhatt
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D015331:Cohort Studies; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008137:Longitudinal Studies; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
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