Kilimanjaro Christian Medical University College (KCMCUCo), Moshi, Tanzania.
Jhpiego Tanzania, Dar es Salaam, Tanzania.
PLoS One. 2019 Sep 6;14(9):e0222173. doi: 10.1371/journal.pone.0222173. eCollection 2019.
The modelling of HIV trends in Tanzania uses surveillance data from antenatal clinics after adjusting for the reduction in fertility of women living with HIV (WLWH). The rollout of HIV care and treatment services has enabled many WLWH to start on antiretroviral treatment (ART) earlier and are counselled on the options to prevent HIV transmission to their children. The assumption that being HIV positive leads to lower fertility needs to be revisited. This study aims to quantify the effect of ART program expansion on the fertility rate of WLWH in Tanzania. We used Cox regression model to estimate fertility rate and associated factors among WLWH of reproductive age (15-49 years) who enrolled in HIV care and treatment at 57 centers in Tabora from 2008 to 2014. A decomposition of Poisson regression was used to explore the reasons for fertility rate differences observed among WLWH. A total of 6,397 WLWH aged 15-49 years were followed for a median time of 2.0 years. The total fertility rate of 48.8/1,000 person years (95%CI: 44.6 to 52.9/1,000) was inversely proportional to age and WHO clinical staging. WLWH on ART had higher fertility compared to those not started on ART (aHR = 1.5, 95%CI: 1.2-1.9). Being married or cohabiting, having higher CD4 cell count and not using contraceptives were associated with higher fertility rate. The fertility rate after post-ART initiation was 54.95/1,000 and among pre-ART users was 40.52/1,000, a difference of 14.43/1,000 in fertility rate between the groups. In the decomposition analysis, proximate determinants of fertility rate among WLWH on ART accounted for a 93.8% smaller increase than expected. In an era of ART expansion in Tabora region, fertility rates of WLWH increased. Higher fertility rates in women on ART may alter the estimation of HIV prevalence and incidence.
坦桑尼亚的 HIV 趋势建模使用了来自产前诊所的监测数据，并对 HIV 阳性女性（WLWH）生育率降低进行了调整。HIV 护理和治疗服务的推出使许多 WLWH 能够更早地开始接受抗逆转录病毒治疗（ART），并就预防 HIV 传播给子女的选择进行了咨询。需要重新审视 HIV 阳性导致生育率降低的假设。本研究旨在量化坦桑尼亚扩大 ART 项目对 WLWH 生育率的影响。我们使用 Cox 回归模型来估计 2008 年至 2014 年在塔波拉的 57 个中心参加 HIV 护理和治疗的育龄（15-49 岁）WLWH 的生育率和相关因素。泊松回归分解用于探索 WLWH 之间观察到的生育率差异的原因。共有 6397 名 15-49 岁的 WLWH 接受了中位数为 2.0 年的随访。总生育率为 48.8/1000 人年（95%CI：44.6 至 52.9/1000），与年龄和世界卫生组织临床分期呈反比。正在接受 ART 的 WLWH 的生育率高于未开始接受 ART 的 WLWH（aHR = 1.5，95%CI：1.2-1.9）。已婚或同居、较高的 CD4 细胞计数和不使用避孕药具与较高的生育率相关。ART 后启动后的生育率为 54.95/1000，ART 前使用者的生育率为 40.52/1000，两组之间的生育率差异为 14.43/1000。在分解分析中，ART 使用者生育率的近因决定因素导致生育率的增加比预期小 93.8%。在塔波拉地区扩大 ART 的时代，WLWH 的生育率增加。ART 使用者的生育率较高可能会改变 HIV 流行率和发病率的估计。
