Reproductive Intentions & Family Planning Practices of Pregnant HIV-Infected Malawian Women on Antiretroviral Therapy

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.

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By:  O'Shea MS1, Rosenberg NE1,2,3, Tang JH1,4,5, Mukuzunga C1, Kaliti S6, Mwale M6, Hosseinipour MC1,2,3.

• 1a UNC Project-Malawi , Lilongwe , Malawi.
• 2b UNC Institute of Global Health & Infectious Diseases , Chapel Hill , NC , USA.
• 3c Department of Medicine , University of North Carolina , Chapel Hill , NC , USA.
• 4d Department of Obstetrics & Gynecology , University of North Carolina , Chapel Hill , NC , USA.
• 5e Department of Obstetrics & Gynaecology , Malawi College of Medicine , Blantyre , Malawi.
• 6f Bwaila Hospital, Lilongwe District Health Office , Lilongwe , Malawi. 

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Why Did I Stop? Barriers and Facilitators to Uptake and Adherence to ART in Option B+ HIV Care in Lilongwe, Malawi

Causes for loss-to-follow-up, including early refusals of and stopping antiretroviral therapy (ART), in Malawi's Option B+ program are poorly understood. 

This study examines the main barriers and facilitators to uptake and adherence to ART under Option B+. In depth interviews were conducted with HIV-infected women who were pregnant or postpartum in Lilongwe, Malawi (N = 65). Study participants included women who refused ART initiation (N = 10), initiated ART and then stopped (N = 26), and those who initiated ART and remained on treatment (N = 29). 

The barriers to ART initiation were varied and included concerns about partner support, feeling healthy, and needing time to think. The main reasons for stopping ART included side effects and lack of partner support. A substantial number of women started ART after initially refusing or stopping ART. 

There were several facilitators for re-starting ART, including encouragement from community health workers, side effects subsiding, decline in health, change in partner, and fear of future sickness. Amongst those who remained on ART, desire to prevent transmission and improve health were the most influential facilitators. Reasons for refusing and stopping ART were varied. ART-related side effects and feeling healthy were common barriers to ART initiation and adherence. 

Providing consistent pre-ART counseling, early support for patients experiencing side effects, and targeted efforts to bring women who stop treatment back into care may improve long term health outcomes.

Below:  Socio-ecological framework to understand barriers and facilitators of uptake and progression through the B+ PMTCT program cascade

Full article at:   http://goo.gl/03peF5

By:  Kim MH1,2, Zhou A3, Mazenga A2, Ahmed S1,2, Markham C4, Zomba G5, Simon K2, Kazembe PN2, Abrams EJ6.

• 1Baylor College of Medicine Department of Pediatrics, Section of Global Health and Retrovirology, Texas Children's Hospital, Houston, Texas, United States of America.
• 2Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
• 3Department of Sociology, University of California Los Angeles, Los Angeles, California, United States of America.
• 4Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, Houston, Texas, United States of America.
• 5HIV Unit, Malawi Ministry of Health, Lilongwe, Malawi.
• 6ICAP, Mailman School of Public Health and College of Physicians & Surgeons, Columbia University, New York, New York, United States of America. 

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