Dahourou Désiré Lucien, Tisseron Clément, Yonaba Caroline, Djaha Joël, N'Gbeche Marie-Sylvie, Moh Corinne, Kouadio Kouakou, Nindjin Patricia, Eboua François, Bouah Belinda, Malateste Karen, Azani Jean-Claude, Kangah Eulalie, Thio Elisabeth, Msellati Philippe, Jesson Julie, Leroy Valériane
Département Biomédical Et de Santé Publique, Institut de Recherche en Sciences de La Santé (IRSS/CNRST), 03 B.P. 7192, Ouagadougou 03, Burkina Faso.
Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de Toulouse III, Toulouse, France.
BMC Public Health. 2025 Jan 30;25(1):385. doi: 10.1186/s12889-025-21595-w.
Sexual and reproductive health issues in adolescents living with HIV (ALHIV) have been left behind in HIV care programs. ALHIV are at risk of unintended pregnancy which jeopardizes their socio-economic future, health outcomes and exposes their newborn to HIV transmission. A better understanding of these events is needed. We studied the 18-month pregnancy incidence, and explored experiences of pregnancy among female ALHIV enrolled in the OPTIMISE-AO cohort, nested in the prospective paediatric IeDEA cohort in Côte d'Ivoire and Burkina Faso.
We conducted a mixed-method study nested in the OPTIMISE-AO-ANRS-12390 project, a stepped-wedge interventional trial launched in 2021 to support HIV-disclosure and antiretroviral treatment (ART) adherence in assenting ALHIV aged 10-17 years in Abidjan, Cote d'Ivoire and Ouagadougou, Burkina Faso. We estimated the 18-month incidence rate of pregnancy per 100 woman-years (WY) among those older than 14 years at inclusion. In Abidjan, semi-structured interviews were also conducted with eight adolescents who became pregnant since their inclusion to report their pregnancy experience.
After 18 months of follow-up, 12 pregnancies occurred among the 111 ALHIV followed up over 153 WY, yielding an overall pregnancy incidence of 7.8/100 WY (95% confidence interval [95%CI]: 4.4-13.7). Stratified by age at enrolment, it was 2.2 (95%CI: 0.3-15.5), 7.6 (95%CI: 2.8-20.3), 13.1 (95%CI:5.4-31.4), 11.5 (95%CI: 2.8-45.8) per 100 WY in those aged 14, 15, 16, and 17 years, respectively. After birth, all the newborns (12/12) had received prevention of HIV mother-to-child transmission ART, and were HIV-negative at the 6-week early infant HIV diagnosis. The eight ALHIV interviewed shared that the discovery of their pregnancy, all unintended, was a shock, and led to negative consequences, such as rejection from their family, and stigmatisation. Most attempted to terminate their pregnancy unsuccessfully. They reported major financial challenges associated with their pregnancy that forced them to find a job rather than going back to school after delivery.
In West Africa, the incidence of unintended pregnancy was high among female ALHIV and resulted in negative socioeconomic outcomes. HIV care programs should include interventions that improve awareness and access to sexual and reproductive healthcare, including contraception, to meet the needs of ALHIV in West Africa.
Registered with the Pan African Clinical Trials Registry on 13 February 2024 (reference no. PACTR202402863175053).
感染艾滋病毒的青少年（ALHIV）的性与生殖健康问题在艾滋病毒护理项目中被忽视。ALHIV面临意外怀孕的风险，这会危及他们的社会经济未来、健康状况，并使他们的新生儿面临艾滋病毒传播风险。需要更好地了解这些情况。我们研究了18个月内的怀孕发生率，并探讨了参与OPTIMISE-AO队列研究的感染艾滋病毒女性青少年的怀孕经历，该队列嵌套于科特迪瓦和布基纳法索的前瞻性儿科IeDEA队列研究中。
我们开展了一项嵌套于OPTIMISE-AO-ANRS-12390项目的混合方法研究，该项目是一项于2021年启动的阶梯楔形干预试验，旨在支持在科特迪瓦阿比让和布基纳法索瓦加杜古同意参与的10至17岁感染艾滋病毒青少年进行艾滋病毒披露及抗逆转录病毒治疗（ART）依从性干预。我们估计了纳入时年龄超过14岁的青少年每100妇女年（WY）的18个月怀孕发生率。在阿比让，还对8名自纳入研究后怀孕的青少年进行了半结构化访谈，以了解她们的怀孕经历。
经过18个月的随访，在111名接受随访的ALHIV中，共发生了12次怀孕，随访时间总计153妇女年，总体怀孕发生率为7.8/100妇女年（95%置信区间[95%CI]：4.4 - 13.7）。按入组时年龄分层，14岁、15岁、16岁和17岁青少年每100妇女年的怀孕发生率分别为2.2（95%CI：0.3 - 15.5）、7.6（95%CI：2.8 - 20.3）、13.1（95%CI：5.4 - 31.4）、11.5（95%CI：2.8 - 45.8）。分娩后，所有新生儿（12/12）均接受了预防母婴传播的ART治疗，且在6周龄早期婴儿艾滋病毒诊断时为艾滋病毒阴性。接受访谈的8名ALHIV表示，她们意外怀孕的发现令人震惊，并导致了负面后果，如被家人拒绝和受到污名化。大多数人试图终止妊娠但未成功。她们报告称怀孕带来了重大经济挑战，这迫使她们在分娩后去找工作而不是返校上学。
在西非，感染艾滋病毒的女性青少年意外怀孕发生率较高，并导致了负面的社会经济后果。艾滋病毒护理项目应纳入改善性与生殖健康保健意识及可及性的干预措施，包括避孕措施，以满足西非感染艾滋病毒青少年的需求。
于2024年2月13日在泛非临床试验注册中心注册（注册号：PACTR202402863175053）
