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Background <p>Sexual and reproductive health issues in adolescents living with HIV (ALHIV) have been left behind in HIV care programs. ALHIV are at risk of unintended pregnancy which jeopardizes their socio-economic future, health outcomes and exposes their newborn to HIV transmission. A better understanding of these events is needed. We studied the 18-month pregnancy incidence, and explored experiences of pregnancy among female ALHIV enrolled in the OPTIMISE-AO cohort, nested in the prospective paediatric IeDEA cohort in Côte d’Ivoire and Burkina Faso.</p> Methods <p>We conducted a mixed-method study nested in the OPTIMISE-AO-ANRS-12390 project, a stepped-wedge interventional trial launched in 2021 to support HIV-disclosure and antiretroviral treatment (ART) adherence in assenting ALHIV aged 10–17&#xa0;years in Abidjan, Cote d’Ivoire and Ouagadougou, Burkina Faso. We estimated the 18-month incidence rate of pregnancy per 100 woman-years (WY) among those older than 14&#xa0;years at inclusion. In Abidjan, semi-structured interviews were also conducted with eight adolescents who became pregnant since their inclusion to report their pregnancy experience.</p> Results <p>After 18&#xa0;months of follow-up, 12 pregnancies occurred among the 111 ALHIV followed up over 153 WY, yielding an overall pregnancy incidence of 7.8/100 WY (95% confidence interval [95%CI]: 4.4–13.7). Stratified by age at enrolment, it was 2.2 (95%CI: 0.3–15.5), 7.6 (95%CI: 2.8–20.3), 13.1 (95%CI:5.4–31.4), 11.5 (95%CI: 2.8–45.8) per 100 WY in those aged 14, 15, 16, and 17&#xa0;years, respectively. After birth, all the newborns (12/12) had received prevention of HIV mother-to-child transmission ART, and were HIV-negative at the 6-week early infant HIV diagnosis. The eight ALHIV interviewed shared that the discovery of their pregnancy, all unintended, was a shock, and led to negative consequences, such as rejection from their family, and stigmatisation. Most attempted to terminate their pregnancy unsuccessfully. They reported major financial challenges associated with their pregnancy that forced them to find a job rather than going back to school after delivery.</p> Conclusions <p>In West Africa, the incidence of unintended pregnancy was high among female ALHIV and resulted in negative socioeconomic outcomes. HIV care programs should include interventions that improve awareness and access to sexual and reproductive healthcare, including contraception, to meet the needs of ALHIV in West Africa.</p> Trial registration <p>Registered with the Pan African Clinical Trials Registry on 13 February 2024 (reference no. PACTR202402863175053).</p>

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Incidence of unintended pregnancies and pregnancy experience among adolescents living with perinatally-acquired HIV in West Africa: a mixed-method study

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  • 发表日期：

    2025年1月30日

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  • Désiré Lucien Dahourou,
  • Clément Tisseron,
  • Caroline Yonaba,
  • Joël Djaha,
  • Marie-Sylvie N’Gbeche,
  • Corinne Moh,
  • Kouakou Kouadio,
  • Patricia Nindjin,
  • François Eboua,
  • Belinda Bouah,
  • Karen Malateste,
  • Jean-Claude Azani,
  • Eulalie Kangah,
  • Elisabeth Thio,
  • Philippe Msellati,
  • Julie Jesson,
  • Valériane Leroy,
  • Marcel Djimon Zannou,
  • Armel Poda,
  • Fred Stephen Sarfo,
  • Eugene Messou,
  • Henri Chenal,
  • Kla Albert Minga,
  • Emmanuel Bissagnene,
  • Aristophane Tanon,
  • Moussa Seydi,
  • Akessiwe Akouda Patassi,
  • Sikiratou Adouni Koumakpai-Adeothy,
  • Lorna Awo Renner,
  • Sylvie Marie N’Gbeche,
  • Clarisse Amani Bosse,
  • Kouadio Kouakou,
  • Madeleine Amorissani Folquet,
  • Fatoumata Dicko Traore,
  • Elom Takassi,
  • François Dabis,
  • Renaud Becquet,
  • Charlotte Bernard,
  • Shino Chassagne Arikawa,
  • Antoine Jaquet,
  • Elodie Rabourdin,
  • Thierry Tiendrebeogo,
  • Sophie Desmonde,
  • Didier Koumavi Ekouevi,
  • Patrick Coffie,
  • Abdoulaye Cissé,
  • Guy Gnepa,
  • Apollinaire Horo,
  • Christian Kouadio,
  • Boris Tchounga

摘要

Background

Sexual and reproductive health issues in adolescents living with HIV (ALHIV) have been left behind in HIV care programs. ALHIV are at risk of unintended pregnancy which jeopardizes their socio-economic future, health outcomes and exposes their newborn to HIV transmission. A better understanding of these events is needed. We studied the 18-month pregnancy incidence, and explored experiences of pregnancy among female ALHIV enrolled in the OPTIMISE-AO cohort, nested in the prospective paediatric IeDEA cohort in Côte d’Ivoire and Burkina Faso.

Methods

We conducted a mixed-method study nested in the OPTIMISE-AO-ANRS-12390 project, a stepped-wedge interventional trial launched in 2021 to support HIV-disclosure and antiretroviral treatment (ART) adherence in assenting ALHIV aged 10–17 years in Abidjan, Cote d’Ivoire and Ouagadougou, Burkina Faso. We estimated the 18-month incidence rate of pregnancy per 100 woman-years (WY) among those older than 14 years at inclusion. In Abidjan, semi-structured interviews were also conducted with eight adolescents who became pregnant since their inclusion to report their pregnancy experience.

Results

After 18 months of follow-up, 12 pregnancies occurred among the 111 ALHIV followed up over 153 WY, yielding an overall pregnancy incidence of 7.8/100 WY (95% confidence interval [95%CI]: 4.4–13.7). Stratified by age at enrolment, it was 2.2 (95%CI: 0.3–15.5), 7.6 (95%CI: 2.8–20.3), 13.1 (95%CI:5.4–31.4), 11.5 (95%CI: 2.8–45.8) per 100 WY in those aged 14, 15, 16, and 17 years, respectively. After birth, all the newborns (12/12) had received prevention of HIV mother-to-child transmission ART, and were HIV-negative at the 6-week early infant HIV diagnosis. The eight ALHIV interviewed shared that the discovery of their pregnancy, all unintended, was a shock, and led to negative consequences, such as rejection from their family, and stigmatisation. Most attempted to terminate their pregnancy unsuccessfully. They reported major financial challenges associated with their pregnancy that forced them to find a job rather than going back to school after delivery.

Conclusions

In West Africa, the incidence of unintended pregnancy was high among female ALHIV and resulted in negative socioeconomic outcomes. HIV care programs should include interventions that improve awareness and access to sexual and reproductive healthcare, including contraception, to meet the needs of ALHIV in West Africa.

Trial registration

Registered with the Pan African Clinical Trials Registry on 13 February 2024 (reference no. PACTR202402863175053).