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. 2017 Aug 1;75(4):391-398.
doi: 10.1097/QAI.0000000000001395.

Changes in Fertility at the Population Level in the Era of ART in Rural Malawi

Estelle McLean  1 , Alison Price, Menard Chihana, Ndoliwe Kayuni, Milly Marston, Olivier Koole, Basia Zaba, Amelia Crampin; ALPHA Network
Affiliations

Changes in Fertility at the Population Level in the Era of ART in Rural Malawi

Estelle McLean et al. J Acquir Immune Defic Syndr. .

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.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Age-specific fertility rates by HIV/ART status and era of ART availability. NB. Vertical lines show confidence limits around each estimate (capped at 500).
See this image and copyright information in PMC

References

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