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J Acquir Immune Defic Syndr. 2019 Aug 15;81(5):497-507. doi: 10.1097/QAI.0000000000002053.

High Incidence of Intended Partner Pregnancy Among Men Living With HIV in Rural Uganda: Implications for Safer Conception Services.

Author information

1
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
2
Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda.
3
Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda.
4
Bennett Statistical Consulting, Ballston Lake, NY.
5
Department of General Medicine, Massachusetts General Hospital (MGH) Global Health, Boston, MA.
6
Epicentre, Médicins Sans Frontières (MSF), Yaoundé, Cameroon.
7
Department of Medicine, University of California at San Francisco (UCSF), San Francisco, CA.
8
School of Public Health, Oregon Health Sciences University, Portland, OR.
9
Division of Infectious Diseases, MGH Global Health, Boston, MA.

Abstract

BACKGROUND:

Many men with HIV express fertility intentions and nearly half have HIV-uninfected sexual partners. We measured partner pregnancy among a cohort of men accessing antiretroviral therapy in Uganda.

METHODS:

Self-reported partner pregnancy incidence and bloodwork (CD4, HIV-RNA) were collected quarterly. Interviewer-administered questionnaires assessed men's sexual and reproductive health annually and repeated at time of reported pregnancy (2011-2015). We measured partner pregnancy incidence overall, by pregnancy intention and by reported partner HIV serostatus. We assessed viral suppression (≤400 copies/mL) during the periconception period. Cox proportional hazard regression with repeated events identified predictors of partner pregnancy.

RESULTS:

Among 189 men, the baseline median age was 39.9 years (interquartile range: 34.7-47.0), years on antiretroviral therapy was 3.9 (interquartile range: 0.0-5.1), and 51% were virally suppressed. Over 530.2 person-years of follow-up, 63 men reported 85 partner pregnancies (incidence = 16.0/100 person-years); 45% with HIV-serodifferent partners. By 3 years of follow-up, 30% of men reported a partner pregnancy, with no difference by partner HIV serostatus (P = 0.75). Sixty-nine percent of pregnancies were intended, 18% wanted but mistimed, and 8% unwanted. Seventy-eight percent of men were virally suppressed before pregnancy report. Men who were younger [adjusted hazard ratio (aHR): 0.94/yr; 95% confidence interval (CI): 0.89 to 0.99], had incomplete primary education (aHR: 2.95; 95% CI: 1.36 to 6.40), and reported fertility desires (aHR: 2.25; 95% CI: 1.04 to 4.85) had higher probability of partner pregnancy.

CONCLUSIONS:

A high incidence of intended partner pregnancy highlights the need to address men's reproductive goals within HIV care. Nearly half of pregnancy partners were at-risk for HIV, and one-quarter of men were not virally suppressed during periconception. Safer conception care provides opportunity to support men's health and reproductive goals, while preventing HIV transmission to women and infants.

PMID:
30973545
PMCID:
PMC6625849
[Available on 2020-08-15]
DOI:
10.1097/QAI.0000000000002053

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