The relationship between HIV and fertility in the era of antiretroviral therapy in sub Saharan Africa – Evidence from 49 Demographic & Health Surveys
| Autor: | Marston, M, Zaba, B, Eaton, JW |
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| Přispěvatelé: | Medical Research Council (MRC), National Institutes of Health |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Rural Population Adolescent Urban Population Anti-HIV Agents antiretroviral therapy demographic and Health surveys HIV Infections Health Services Accessibility fertilité Young Adult thérapie antirétrovirale Pregnancy infections VIH/thérapie Tropical Medicine Humans highly active Africa South of the Sahara Demography enquêtes démographiques et de santé fertility infections VIH/prévention et lutte Health Services Needs and Demand Age Factors virus diseases HIV VIH Middle Aged Infectious Disease Transmission Vertical très efficace 1117 Public Health And Health Services HIV infections/therapy Infertility Female HIV Infections/prevention and control |
| Popis: | Objectives To describe regional differences in the relative fertility of HIV-positive vs. HIV-negative women and changes as antiretroviral treatment (ART) is scaled up, to improve estimates of predicted need for and coverage of prevention of mother-to-child transmission services at national and subnational levels. Methods We analysed 49 nationally representative household surveys in sub-Saharan Africa between 2003 and 2016 to estimate fertility rate ratios of HIV-positive and HIV-negative women by age using exponential regression and test for regional and urban/rural differences. We estimated the association between national ART coverage and the relationship between HIV and fertility. Results Significant regional differences exist in HIV and fertility relationships, with less HIV-associated subfertility in Southern Africa. Age patterns of relative fertility are similar. HIV impact on fertility is weaker in urban than rural areas. For women below age 30, regional and urban/rural differences are largely explained by differences in age at sexual debut. Higher levels of national ART coverage were associated with slight attenuation of the relationship between HIV and fertility. Conclusions Regional differences in HIV-associated subfertility and urban–rural differences in age patterns of relative fertility should be accounted for when predicting need for and coverage of PMTCT services at national and subnational level. Although HIV impacts on fertility are somewhat reduced at higher levels of national ART coverage, differences in fertility between HIV positive and negative remain, and fertility of women on ART should not be assumed to be the same as HIV-negative women. There were few data in recent years, when ART has reached high levels, and this relationship should continue to be assessed as further evidence becomes available. |
| Databáze: | OpenAIRE |
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