Characterizing longitudinal patterns of unmet need for family planning and estimating the effect of fertility intentions on retention in care among HIV-infected women on ART in South Africa
Awarded 2017
Trainee Grants
Katherine Rucinski, MPH
University of North Carolina, Chapel Hill

With expanded access to affordable antiretroviral therapy (ART) in sub-Saharan Africa and the recommendation of earlier thresholds for treatment initiation, HIV-infected women are living longer, healthier lives. For HIV-infected women taking ART, using modern methods of contraception to plan pregnancy when CD4 count is high and viral load is low benefits maternal health and prevents mother-to-child transmission (MTCT). In South Africa, high incidence of unplanned pregnancy among women taking antiretrovirals warrants a more nuanced understanding of the changes in fertility intentions and unmet need for family planning that occur in the period following ART initiation. Successful expansion of ART also depends on maximizing the proportion of HIV-infected women engaged in HIV care. Because health-seeking behaviors in HIV-infected women are partially motivated by concerns regarding MTCT, fertility intentions may also impact a woman’s relationship with care. The proposed study will leverage a unique, observational cohort of HIV-infected women taking ART in Johannesburg to 1) characterize longitudinal trajectories of unmet need for family planning and to 2) estimate the effect of fertility intentions on retention in care. Group-based trajectory models will be used to estimate changes in unmet need for family planning and associated predictors. Inverse probability weighting will be used to fit a series of generalized linear models, marginal structural Cox proportional hazards models and extended adjusted Kaplan-Meier curves to assess whether a woman’s relationship with care is affected by her fertility intentions. As a whole, this research will identify potential opportunities for integrated contraceptive and HIV counseling in this population.