PubTransformer

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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.