High Incidence of Unplanned Pregnancy after Antiretroviral Therapy Initiation Findings from a Prospective Cohort Study in South Africa 英文参考文献.docVIP

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High Incidence of Unplanned Pregnancy after Antiretroviral Therapy Initiation Findings from a Prospective Cohort Study in South Africa 英文参考文献.doc

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High Incidence of Unplanned Pregnancy after Antiretroviral Therapy Initiation Findings from a Prospective Cohort Study in South Africa 英文参考文献

HighIncidenceofUnplannedPregnancyafter AntiretroviralTherapyInitiation:Findingsfroma ProspectiveCohortStudyinSouthAfrica ShereeR.Schwartz1,2*,HelenRees1,ShrutiMehta2,WillemDanielFrancoisVenter1,TahaE.Taha2, VivianBlack1 1WitsReproductiveHealthandHIVInstitute,UniversityoftheWitwatersrand,Johannesburg,SouthAfrica, 2DepartmentofEpidemiology,JohnsHopkinsBloomberg SchoolofPublicHealth,Baltimore,Maryland,UnitedStatesofAmerica Abstract Background:IncreasedfertilityratesinHIV-infectedwomenreceivingantiretroviraltherapy(ART)havebeenattributedto improved immunological function; it is unknown to what extent the rise in pregnancy rates is due to unintended pregnancies. Methods: Non-pregnant women ages 18–35 from four public-sector ART clinics in Johannesburg, South Africa, were enrolled into a prospective cohort and followed from August 2009–March 2011. Fertility intentions, contraception and pregnancystatusweremeasuredlongitudinallyatparticipants’routineARTclinicvisits. Findings:Ofthe850womenenrolled,822(97%)hadatleastonefollow-upvisitandcontributed745.2person-years(PY)at- riskforincidentpregnancy.Overall,170pregnanciesweredetectedin161women(incidencerate[IR]:21.6/100PY[95% confidenceinterval(CI):18.5–25.2]).Ofthe170pregnancies,105(62%)wereunplanned.Unmetneedforcontraceptionwas 50%higherinwomeninitiatingARTinthepastyearascomparedtowomenonART.1year(prevalenceratio1.5[95%CI: 1.1–2.0]);bytwoyearspost-ARTinitiation,nearlyonequarterofwomenhadatleastoneunplannedpregnancy.Cumulative incidence of pregnancy was equally high among recentART initiatorsand ART experienced participants: 23.9% [95% CI: 16.4–34.1],15.9%[12.0–20.8],and21.0%[16.8–26.1]forwomenonART0–1yr,.1yr–2yrs,and.2yrsrespectively(log- rank, p=0.54). Eight hormonal contraceptive failures were detected [IR: 4.4 [95% CI: 2.2–8.9], 7/8 among women using injectablemethods.Overall47%(80/170)ofpregnancieswerenotcarriedtoterm. Conclusions:RatesofunintendedpregnanciesamongwomenonARTarehigh,includingwomenrecentlyinitiatingA