title: Reproductive intentions and family planning practices of pregnant HIV-infected Malawian women on antiretroviral therapy.
abstract: The objective of this study was to describe the pregnancy intentions of pregnant HIV-infected Malawian women on antiretroviral therapy (ART) for at least 6 months prior to the current pregnancy, and to assess whether time on ART was associated with pregnancy intention. We conducted a cross-sectional analysis of HIV-infected Malawian women receiving antenatal care at a government hospital with a survey assessing ART history, reproductive history, and family planning use at conception. We used Pearson's chi-square tests and Fisher's exact tests to compare these parameters between women on ART greater than 24 months with those on ART less than 24 months. Modified Poisson regression was performed to assess the association between time on ART and pregnancy intention. Most women (75%) reported that their current pregnancy was unintended, defined as either Mistimed (21%) or Unwanted (79%). Women on ART for longer than 2 years were more likely to report an unintended pregnancy (79% versus 65%, p = .03), though there was no significant association between time on ART and pregnancy intention in multivariate analysis. Most women (79%) were using contraception at the time of conception, with condoms being most popular (91%), followed by injectables (9%) and the implant (9%). HIV-infected women on ART continue to experience high rates of unintended pregnancy in the Option B+ era. As Option B+ continues to be implemented in Malawi and increasing numbers of HIV-infected women initiate lifelong ART, ensuring that the most effective forms of contraception are accessible is necessary to decrease unintended pregnancy.
authors.affiliation: a UNC Project-Malawi , Lilongwe , Malawi.
authors.forename: Michele S
authors.initials: MS
authors.lastname: O'Shea
authors.affiliation: a UNC Project-Malawi , Lilongwe , Malawi.|b UNC Institute of Global Health & Infectious Diseases , Chapel Hill , NC , USA.|c Department of Medicine , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Nora E
authors.initials: NE
authors.lastname: Rosenberg
authors.affiliation: a UNC Project-Malawi , Lilongwe , Malawi.|d Department of Obstetrics & Gynecology , University of North Carolina , Chapel Hill , NC , USA.|e Department of Obstetrics & Gynaecology , Malawi College of Medicine , Blantyre , Malawi.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Tang
authors.affiliation: a UNC Project-Malawi , Lilongwe , Malawi.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Mukuzunga
authors.affiliation: f Bwaila Hospital, Lilongwe District Health Office , Lilongwe , Malawi.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kaliti
authors.affiliation: f Bwaila Hospital, Lilongwe District Health Office , Lilongwe , Malawi.
authors.forename: Mwawi
authors.initials: M
authors.lastname: Mwale
authors.affiliation: a UNC Project-Malawi , Lilongwe , Malawi.|b UNC Institute of Global Health & Infectious Diseases , Chapel Hill , NC , USA.|c Department of Medicine , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
mesh_terms: D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D044383:Black People / Q000523:psychology; D017280:Condoms / Q000706:statistics & numerical data*; D003267:Contraception; D003268:Contraception Behavior; D003430:Cross-Sectional Studies; D005193:Family Planning Services; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control* / Q000523:psychology; D006679:HIV Seropositivity / Q000523:psychology / Q000635:transmission*; D006801:Humans; D033182:Intention; D008295:Malawi / Q000453:epidemiology; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012098:Reproduction; D055815:Young Adult
keywords: HIV; Malawi; antiretroviral therapy; family planning