Changes in Fertility at the Population Level in the Era of ART in Rural Malawi.
|Abstract||HIV reduces fertility through biological and social pathways, and antiretroviral treatment (ART) can ameliorate these effects. In northern Malawi, ART has been available since 2007 and lifelong ART is offered to all pregnant or breastfeeding HIV-positive women.|
Adolescent and young pregnant women at increased risk of mother-to-child transmission of HIV and poorer maternal and infant health outcomes: A cohort study at public facilities in the Nelson Mandela Bay Metropolitan district, Eastern Cape, South Africa.
|Journal Title||journal of acquired immune deficiency syndromes (1999)|
|Publication Year Start||2017-01-01|
PMID- 28653969 OWN - NLM STAT- MEDLINE DA - 20170627 DCOM- 20170707 LR - 20170707 IS - 1944-7884 (Electronic) IS - 1525-4135 (Linking) VI - 75 IP - 4 DP - 2017 Aug 01 TI - Changes in Fertility at the Population Level in the Era of ART in Rural Malawi. PG - 391-398 LID - 10.1097/QAI.0000000000001395 [doi] AB - INTRODUCTION: HIV reduces fertility through biological and social pathways, and antiretroviral treatment (ART) can ameliorate these effects. In northern Malawi, ART has been available since 2007 and lifelong ART is offered to all pregnant or breastfeeding HIV-positive women. METHODS: Using data from the Karonga Health and Demographic Surveillance Site in Malawi from 2005 to 2014, we used total and age-specific fertility rates and Cox regression to assess associations between HIV and ART use and fertility. We also assessed temporal trends in in utero and breastfeeding HIV and ART exposure among live births. RESULTS: From 2005 to 2014, there were 13,583 live births during approximately 78,000 person years of follow-up of women aged 15-49 years. The total fertility rate in HIV-negative women decreased from 6.1 [95% confidence interval (CI): 5.5 to 6.8] in 2005-2006 to 5.1 (4.8-5.5) in 2011-2014. In HIV-positive women, the total fertility rate was more stable, although lower, at 4.4 (3.2-6.1) in 2011-2014. In 2011-2014, compared with HIV-negative women, the adjusted (age, marital status, and education) hazard ratio was 0.7 (95% CI: 0.6 to 0.9) and 0.8 (95% CI: 0.6 to 1.0) for women on ART for at least 9 months and not (yet) on ART, respectively. The crude fertility rate increased with duration on ART up to 3 years before declining. The proportion of HIV-exposed infants decreased, but the proportion of ART-exposed infants increased from 2.4% in 2007-2010 to 3.5% in 2011-2014. CONCLUSIONS: Fertility rates in HIV-positive women are stable in the context of generally decreasing fertility. Despite a decrease in HIV-exposed infants, there has been an increase in ART-exposed infants. FAU - McLean, Estelle AU - McLean E AD - *Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; anddaggerMalawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi. FAU - Price, Alison AU - Price A FAU - Chihana, Menard AU - Chihana M FAU - Kayuni, Ndoliwe AU - Kayuni N FAU - Marston, Milly AU - Marston M FAU - Koole, Olivier AU - Koole O FAU - Zaba, Basia AU - Zaba B FAU - Crampin, Amelia AU - Crampin A CN - ALPHA Network LA - eng PT - Journal Article PL - United States TA - J Acquir Immune Defic Syndr JT - Journal of acquired immune deficiency syndromes (1999) JID - 100892005 RN - 0 (Anti-HIV Agents) SB - IM SB - X MH - Adolescent MH - Adult MH - Anti-HIV Agents/*therapeutic use MH - Breast Feeding/*statistics & numerical data MH - Female MH - Fertility/drug effects/*physiology MH - HIV Infections/*drug therapy/epidemiology/prevention & control MH - Humans MH - Infant MH - Infant, Newborn MH - Infectious Disease Transmission, Vertical/*prevention & control/statistics & numerical data MH - Longitudinal Studies MH - Malawi/epidemiology MH - Middle Aged MH - Pregnancy MH - Pregnancy Complications, Infectious/*drug therapy/epidemiology/prevention & control MH - Rural Population MH - Sentinel Surveillance MH - Young Adult EDAT- 2017/06/28 06:00 MHDA- 2017/07/08 06:00 CRDT- 2017/06/28 06:00 AID - 10.1097/QAI.0000000000001395 [doi] AID - 00126334-201708010-00003 [pii] PST - ppublish SO - J Acquir Immune Defic Syndr. 2017 Aug 1;75(4):391-398. doi: 10.1097/QAI.0000000000001395.