Rucinski Katherine B, Powers Kimberly A, Pettifor Audrey E, Black Vivian, Pence Brian W, Chi Benjamin H, Rees Helen, Schwartz Sheree R
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
AIDS Care. 2021 Feb;33(2):180-186. doi: 10.1080/09540121.2020.1719969. Epub 2020 Feb 2.
Fertility intentions are thought to be dynamic among women of reproductive age, yet few studies have assessed fertility intentions over time among women with HIV. We examine temporal patterns of fertility intentions in women with HIV to assess the extent to which fertility intentions - and the corresponding need for safer conception and judicious antiretroviral therapy (ART) regimen selection - vary over time. 850 non-pregnant HIV-positive women aged 18-35 on or being initiated onto ART in Johannesburg, South Africa were enrolled into a prospective cohort study (2009-2010). Fertility intentions were assessed at enrollment and at 30-day intervals via an interviewer-administered questionnaire. We used group-based trajectory modelling to identify longitudinal patterns of fertility intentions over 12 months. We identified four patterns of fertility intentions, which we labelled "consistently low" (representing ∼60% of the population), "low and increasing" (∼23%), "high and increasing" (∼12%), and "high and decreasing" (∼5%). Our findings suggest that a single family-planning assessment at one time point is insufficient to fully identify and meet the reproductive needs of women with HIV. As HIV testing and treatment evolve in South Africa, routine screening for fertility intentions can offer important opportunities to optimize HIV treatment, prevention, and maternal and child health.
生育意愿被认为在育龄女性中是动态变化的，但很少有研究评估感染艾滋病毒女性的生育意愿随时间的变化情况。我们研究了感染艾滋病毒女性生育意愿的时间模式，以评估生育意愿以及相应的更安全受孕需求和明智的抗逆转录病毒治疗（ART）方案选择随时间变化的程度。在南非约翰内斯堡，850名年龄在18至35岁、正在接受或即将开始接受抗逆转录病毒治疗的未怀孕艾滋病毒阳性女性被纳入一项前瞻性队列研究（2009 - 2010年）。通过访员管理的问卷在入组时和每隔30天评估生育意愿。我们使用基于群体的轨迹模型来确定12个月内生育意愿的纵向模式。我们确定了四种生育意愿模式，分别标记为“持续低意愿”（约占总体的60%）、“低意愿且上升”（约23%）、“高意愿且上升”（约12%）和“高意愿且下降”（约5%）。我们的研究结果表明，在一个时间点进行单次计划生育评估不足以充分识别和满足感染艾滋病毒女性的生殖需求。随着南非艾滋病毒检测和治疗的发展，对生育意愿进行常规筛查可为优化艾滋病毒治疗、预防以及母婴健康提供重要机会。
