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High Incidence of Intended Partner Pregnancy Among Men Living With HIV in Rural Uganda

Implications for Safer Conception Services

Kaida, Angela PhDa; Kabakyenga, Jerome MBChBb; Bwana, Mwebesa MBChBb,c; Bajunirwe, Francis MD, PhDb; Muyindike, Winnie MBChB, MMEDb,c; Bennett, Kara MScd; Kembabazi, Annet MScb; Haberer, Jessica E. MDe; Boum, Yap PhDb,f; Martin, Jeffrey N. MD, MPHg; Hunt, Peter W. MDg; Bangsberg, David R. MD, MPHb,h; Matthews, Lynn T. MD, MPHi

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15, 2019 - Volume 81 - Issue 5 - p 497–507
doi: 10.1097/QAI.0000000000002053
Epidemiology
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Background: Many men with HIV express fertility intentions and nearly half have HIV-uninfected sexual partners. We measured partner pregnancy among a cohort of men accessing antiretroviral therapy in Uganda.

Methods: Self-reported partner pregnancy incidence and bloodwork (CD4, HIV-RNA) were collected quarterly. Interviewer-administered questionnaires assessed men's sexual and reproductive health annually and repeated at time of reported pregnancy (2011–2015). We measured partner pregnancy incidence overall, by pregnancy intention and by reported partner HIV serostatus. We assessed viral suppression (≤400 copies/mL) during the periconception period. Cox proportional hazard regression with repeated events identified predictors of partner pregnancy.

Results: Among 189 men, the baseline median age was 39.9 years (interquartile range: 34.7–47.0), years on antiretroviral therapy was 3.9 (interquartile range: 0.0–5.1), and 51% were virally suppressed. Over 530.2 person-years of follow-up, 63 men reported 85 partner pregnancies (incidence = 16.0/100 person-years); 45% with HIV-serodifferent partners. By 3 years of follow-up, 30% of men reported a partner pregnancy, with no difference by partner HIV serostatus (P = 0.75). Sixty-nine percent of pregnancies were intended, 18% wanted but mistimed, and 8% unwanted. Seventy-eight percent of men were virally suppressed before pregnancy report. Men who were younger [adjusted hazard ratio (aHR): 0.94/yr; 95% confidence interval (CI): 0.89 to 0.99], had incomplete primary education (aHR: 2.95; 95% CI: 1.36 to 6.40), and reported fertility desires (aHR: 2.25; 95% CI: 1.04 to 4.85) had higher probability of partner pregnancy.

Conclusions: A high incidence of intended partner pregnancy highlights the need to address men's reproductive goals within HIV care. Nearly half of pregnancy partners were at-risk for HIV, and one-quarter of men were not virally suppressed during periconception. Safer conception care provides opportunity to support men's health and reproductive goals, while preventing HIV transmission to women and infants.

aFaculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada;

bFaculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda;

cDepartment of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda;

dBennett Statistical Consulting, Ballston Lake, NY;

eDepartment of General Medicine, Massachusetts General Hospital (MGH) Global Health, Boston, MA;

fEpicentre, Médicins Sans Frontières (MSF), Yaoundé, Cameroon;

gDepartment of Medicine, University of California at San Francisco (UCSF), San Francisco, CA;

hSchool of Public Health, Oregon Health Sciences University, Portland, OR; and

iDivision of Infectious Diseases, MGH Global Health, Boston, MA.

Correspondence to: Angela Kaida, PhD, Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC V5A 1S6, Canada (e-mail: kangela@sfu.ca).

Presented in part at the International AIDS Conference (AIDS 2016); July 18–22, 2016; Durban, South Africa (Oral Poster Abstract THPDC0106).

Supported by NICHD (R21‐HD069194), NIMH (R01‐MH54907, K23‐MH095655, K24‐MH87227), NIH P30‐AI027763, and the Canada‐Sub Saharan Africa (CANSSA) HIV/AIDS Network.

The authors have no conflicts of interest to disclose.

Received December 08, 2018

Accepted March 11, 2019

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