Changes in fertility at the population level in the era of ART in rural Malawi

McLean, E., Price, A., Chihana, M., Kayuni, N., Marston, M., Koole, O., Zaba, B. and Crampin, A. (2017) Changes in fertility at the population level in the era of ART in rural Malawi. JAIDS: Journal of Acquired Immune Deficiency Syndromes, 75(4), pp. 391-398. (doi: 10.1097/QAI.0000000000001395) (PMID:28653969) (PMCID:PMC5483985)

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Abstract

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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Crampin, Professor Mia
Authors: McLean, E., Price, A., Chihana, M., Kayuni, N., Marston, M., Koole, O., Zaba, B., and Crampin, A.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:JAIDS: Journal of Acquired Immune Deficiency Syndromes
Publisher:Lippincott, Williams and Wilkins
ISSN:1525-4135
ISSN (Online):1944-7884
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in JAIDS: Journal of Acquired Immune Deficiency Syndromes 75(4):391-398
Publisher Policy:Reproduced under a Creative Commons License

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