title: Determinants and Experiences of Repeat Pregnancy among HIV-Positive Kenyan Women--A Mixed-Methods Analysis.
abstract: OBJECTIVE
  To identify factors associated with repeat pregnancy subsequent to an index pregnancy among women living with HIV (WLWH) in western Kenya who were enrolled in a 24-month phase-II clinical trial of triple-ART prophylaxis for prevention of mother-to-child transmission, and to contextualize social and cultural influences on WLWH's reproductive decision making.
  
  
  METHODS
  A mixed-methods approach was used to examine repeat pregnancy within a 24 month period after birth. Counselor-administered questionnaires were collected from 500 WLWH. Forty women (22 with a repeat pregnancy; 18 with no repeat pregnancy) were purposively selected for a qualitative interview (QI). Simple and multiple logistic regression analyses were performed for quantitative data. Thematic coding and saliency analysis were undertaken for qualitative data.
  
  
  RESULTS
  Eighty-eight (17.6%) women had a repeat pregnancy. Median maternal age was 23 years (range 15-43 years) and median gestational age at enrollment was 34 weeks. In multiple logistic regression analyses, living in the same compound with a husband (adjusted odds ratio (AOR): 2.33; 95% confidence interval (CI): 1.14, 4.75) was associated with increased odds of repeat pregnancy (p ≤ 0.05). Being in the 30-43 age group (AOR: 0.25; 95% CI: 0.07, 0.87), having talked to a partner about family planning (FP) use (AOR: 0.53; 95% CI: 0.29, 0.98), and prior usage of FP (AOR: 0.45; 95% CI: 0.25, 0.82) were associated with a decrease in odds of repeat pregnancy. QI findings centered on concerns about modern contraception methods (side effects and views that they 'ruined the womb') and a desire to have the right number of children. Religious leaders, family, and the broader community were viewed as reinforcing cultural expectations for married women to have children. Repeat pregnancy was commonly attributed to contraception failure or to lack of knowledge about post-delivery fertility.
  
  
  CONCLUSIONS
  In addition to cultural context, reproductive health programs for WLWH may need to address issues related to living circumstances and the possibility that reproductive-decision making may extend beyond the woman and her partner.
authors.affiliation: Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Victor
authors.initials: V
authors.lastname: Akelo
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Eleanor
authors.initials: E
authors.lastname: McLellan-Lemal
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, United States of America; ICF International, Atlanta, GA, United States of America.
authors.forename: Lauren
authors.initials: L
authors.lastname: Toledo
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, United States of America; ICF International, Atlanta, GA, United States of America.
authors.forename: Sonali
authors.initials: S
authors.lastname: Girde
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Craig B
authors.initials: CB
authors.lastname: Borkowf
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
authors.forename: Laura
authors.initials: L
authors.lastname: Ward
authors.affiliation: Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ondenge
authors.affiliation: Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Richard
authors.initials: R
authors.lastname: Ndivo
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Shirley L
authors.initials: SL
authors.lastname: Lecher
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mills
authors.affiliation: Centers for Disease Control and Prevention, Kisumu, Kenya.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D015999:Multivariate Analysis; D011247:Pregnancy; D055815:Young Adult