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Incident pregnancy in IEDEA East Africa

Incident pregnancy in IEDEA East Africa. Batya Elul, Yingfeng Wu, Harriet Nuwagaba-Biribonwoha, Kara Wools-Kaloustian, Beverly Musick, Constantin Yiannoutsos, Elaine Abrams, Pius Okong and Denis Nash for the East Africa IeDEA Consortium. Background. Women account for majority of PLWHA in Africa

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Incident pregnancy in IEDEA East Africa

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  1. Incident pregnancy in IEDEA East Africa Batya Elul, Yingfeng Wu, Harriet Nuwagaba-Biribonwoha, Kara Wools-Kaloustian, Beverly Musick, Constantin Yiannoutsos, Elaine Abrams, Pius Okong and Denis Nash for the East Africa IeDEA Consortium

  2. Background • Women account for majority of PLWHA in Africa • Increasing data on reproductive behaviors among women enrolled in HIV care • Sexual activity continues among patients in care • Increase in sexual activity and desire for children after ART initiation • However, little information on reproductive outcomes • Few single-site studies among ART patients • One multi-site study among pre-ART and ART patients

  3. Objectives • What is the incidence of pregnancy among IEDEA cohorts? • Does ART initiation influence risk of incident pregnancy? • Do pregnancy intentions influence risk of incident pregnancy? • Do site- and contextual-level factors influence risk of incident pregnancy, after controlling for patient-level factors?

  4. Methods: Data management • Identified incidentpregnancies via recording of a pregnancy, gestational age or delivery date at a given visit • Estimated conception date using delivery date, gestational age or last visit date with pregnancy report • When not reported, estimated delivery date using gestational age or last visit date with pregnancy report • Calculated pregnancy-free follow-up time with censoring during pregnancy, at program discontinuation or last visit • Same woman could contribute pregnancies and follow-up time to pre-ART and post-ART periods

  5. Methods: Analytic approach • Calculated crude pregnancy incidence rates and 95% CI, by: • ART status • Time since enrollment into care • Site • Patient socio-demographic characteristics • Baseline clinical factors • Site characteristics

  6. Sample • 48,679 women aged 15-49 (range across sites: 188-9,070) • 17,727 observed only in pre-ART period • 7,514 observed only in ART period • 23,438 observed in post pre-ART and post-ART periods • 78,943 women-years (WY) of follow-up • Pre-ART: 28,773 WY • Post-ART: 50,170 WY • 5,011 incident pregnancies from 4,670 women • 1 pregnancy, n=4338 • 2 pregnancies, n=323 • 3 pregnancies, n=9

  7. Crude pregnancy ratesand 95% CI

  8. Crude pregnancy rates in context

  9. Trends in pregnancy rates over follow-up time

  10. Crude pregnancy rates and 95% CI by site

  11. Socio-demographic characteristics: Crude PR (per 100 WY) and 95% CI

  12. Baseline clinical characteristics: Crude PR (per 100 WY) and 95% CI

  13. Site characteristics: Crude PR (per 100 WY) and 95% CI

  14. Conclusions • Overall 6.6 pregnancies per 100 WY • Lower than general population but still highlight significant programmatic needs (PMTCT, EID, FP) • More pregnancies occurring earlier on in follow-up • Variability in pregnancy rates by site • May be explained by patient- and site-level factors • Internal and external validity in pregnancy rates

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