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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, PhD§,1; Kabakyenga, Jerome, MBChB2; Bwana, Mwebesa, MBChB2,3; Bajunirwe, Francis, MD, PhD2; Muyindike, Winnie, MBChB, MMED2,3; Bennett., Kara, MSc4; Kembabazi, Annet, MSc2; Haberer, Jessica E., MD5; Boum, Yap, PhD2,6; Martin, Jeffrey N., MD, MPH7; Hunt, Peter W., MD7; Bangsberg, David R., MD, MPH2,8; Matthews., Lynn T., MD, MPH9

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 15, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002053
Original Article: PDF Only
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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 (ART) 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 peri-conception period. Cox proportional hazard regression with repeated events identified predictors of partner pregnancy.

Results: Among 189 men, baseline median age was 39.9 years [IQR:34.7,47.0], years on ART was 3.9 [IQR: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 three years of follow-up, 30% of men reported a partner pregnancy, with no difference by partner HIV-serostatus (p=0.75). 69% of pregnancies were intended, 18% wanted but mis-timed, and 8% unwanted. 78% of men were virally suppressed prior to pregnancy report. Men who were younger (aHR:0.94/year;95%CI:0.89-0.99), had incomplete primary education (aHR:2.95;95%CI:1.36-6.40), and reported fertility desires (aHR:2.25;95%CI:1.04-4.85) had higher probability of partner pregnancy.

Conclusion: 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 peri-conception. Safer conception care provides opportunity to support men’s health and reproductive goals, while preventing HIV transmission to women and infants.

1Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada

2Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda

3Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda

4Bennett Statistical Consulting, Ballston Lake, New York, USA;

5Massachusetts General Hospital (MGH) Global Health and Department of General Medicine, Boston, USA

6Epicentre, Médicins sans Frontières (MSF), Yaoundé, Cameroon

7Department of Medicine, University of California at San Francisco (UCSF), San Francisco, USA

8School of Public Health, Oregon Health Sciences University, Portland, USA

9MGH Global Health and Division of Infectious Diseases, Boston, USA

Corresponding author: Angela Kaida Faculty of Health Sciences, Simon Fraser University Blusson Hall Rm 10522, 8888 University Drive Burnaby, B.C. V5A 1S6 CANADA Phone: +1 778-782-9068 Email: kangela@sfu.ca

E-mail addresses of authors: AK: kangela@sfu.ca, JK: jkabakyenga@gmail.com, MB: mwebesa_bwana@yahoo.com, FB: fbaj@yahoo.com, WM: wmuyindike@gmail.com, KB: karabstat@gmail.com, AK: akembabazi2005@yahoo.com, JEH: JHABERER@partners.org, YB: yap.boum2@gmail.com, JNM: Martin@psg.ucsf.edu, PWH: peter.hunt@ucsf.edu, DRB: bangsber@ohsu.edu, LTM: LTMATTHEWS@mgh.harvard.edu

Meetings where some of these data have been previously presented: Some of these data have been previously presented at the International AIDS Conference (AIDS2016) in Durban, South Africa. July 18-22, 2016 [Oral Poster Abstract THPDC0106].

Sources of support: We gratefully acknowledge our funders: NICHD (R21-HD069194), NIMH (R01-MH54907, K23-MH095655, K24-MH87227), NIH P30-AI027763, and the Canada-Sub Saharan Africa (CANSSA) HIV/AIDS Network.

Competing interests:All authors declare no competing interests.

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