Impact of Availability and Use of ART/PMTCT Services on Fertility Desires of Previously Pregnant Women in Rakai, Uganda: A Retrospective Cohort Study

Lindsay E. Litwin, Frederick E. Makumbi, Ronald H Gray, Maria J Wawer, Godfrey Kigozi, Joseph Kagaayi, Gertrude Nakigozi, Tom Lutalo, David Serwada, Heena Brahmbhatt

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Objective: To assess fertility desires by availability and use of antiretroviral therapy and prevention of mother-to-child transmission (ART/PMTCT) services in Rakai, Uganda. Design: Retrospective analyses of longitudinal data from the Rakai Community Cohort Study. Methods: Study participants were retrospectively identified and categorized by HIV status. Availability of ART/PMTCT services in Rakai was defined in three periods: (1) pre-ART/PMTCT (2006); and use of ART/PMTCT was coded as yes if the woman received services. Trends in fertility desires were assessed by x2. "Modified" Poisson regression was performed using generalized linear models with a log link and Poisson family to estimate prevalence rate ratios (PRRs) and 95% confidence intervals (CIs) of desire for another child among previously and currently pregnant women; PRRs were adjusted for demographic and behavioral factors. Results: A total of 4227 sexually active women in Rakai, including 436 HIV+ women, contributed 13,970 observations over 5 survey rounds. Fertility desires increased in the population in the ART/PMTCT rollout [adjusted (adj.) PRR: 1.08, 95% CI: 1.04 to 1.13] and the universal availability periods (adj. PRR: 1.11, 95% CI: 1.08 to 1.14) compared with pre-ART/PMTCT period. A total of 862 woman observations used ART/PMTCT services. Fertility desires were similar among ART/PMTCT service users and nonusers in cross-sectional analysis (adj. PRR: 0.84, 95% CI: 0.62 to 1.14) and 1 year after ART/PMTCT use (adj. PRR: 1.27, 95% CI: 0.83 to 1.94). Conclusions: Availability of ART/PMTCT may increase fertility desires of previously pregnant women in Rakai, Uganda. Use of ART/PMTCT services was not correlated with fertility desires of previously or current pregnant women.

Original languageEnglish (US)
Pages (from-to)377-384
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number3
Publication statusPublished - Jul 1 2015



  • fertility
  • HIV
  • pregnancy intentions
  • prevention of mother-to-child transmission
  • Uganda

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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