Effect of predictors on incidence rate of pregnancy among reproductive age women on antiretroviral therapy at public hospitals of Jigjiga and Harar Towns, Eastern Ethiopia: a retrospective cohort study

(2022) 22:548 Wariyo et al. BMC Women’s Health https://doi.org/10.1186/s12905-022-02135-9 Open Access RESEARCH Effect of predictors on incidence rate of pregnancy among reproductive age women on antiretroviral therapy at public hospitals of Jigjiga and Harar Towns, Eastern Ethiopia: a retrospective cohort study Abdi Wariyo1, Lemessa Oljira2, Wako Golicha3 and Gebisa Dirirsa4*    Abstract Background: Globally, Human Immunodeficiency Virus (HIV) is the leading cause of death in women of reproductive age and accountable for a quarter of deaths during pregnancy in sub-Saharan Africa including Ethiopia. Introduction of antiretroviral therapy to women living with HIV highly improves lifestyle and the desire to have children. A comprehensive understanding of baseline predictors of pregnancy among women receiving ART essential to reduces unintended pregnancies, appropriate care, and preventing transmission from mother to child. Objective: To determine the effect of baseline predictors on incidence rate of pregnancy among reproductive age women on antiretroviral therapy at public hospitals of Jigjiga and Harar town, Eastern Ethiopia from February 15 to march 15, 2020. Methods: Retrospective cohort study was conducted on randomly selected 420 HIV-infected women using data recorded from September 11, 2014, to September 10, 2019 in Jigjiga and Harar town in Eastern Ethiopia. Simple random sampling was used to select study subjects from each hospital. Data were entered to Epi data version 3.2 and exported to Stata version 14.2 for analysis. Kaplan–Meier failure, and Cox proportional hazards model were used to estimate the incidence, and to identify predictors of pregnancy respectively. Variables which were significant (P value < 0.05) in the multivariate analysis were considered independent predictors of pregnancy. Results: The overall incidence rate of pregnancy was 9.1 per 100 person-years (95% CI 7.19, 11.76). Being unadvanced HIV disease stage (AHR: 2.50; 95% CI 1.46, 4.19), having less than two children (AHR: 2.93; 95% CI 1.59, 5.40), and disclosed HIV status (AHR: 2.25; 95% CI 1.34, 3.79) were independent predictors of pregnancy. Conclusion: The incidence rate of pregnancy among reproductive age women on ART was found to be considerable. Being unadvanced HIV disease stage, having less than two children, and disclosed HIV status were independent predictors of pregnancy. Thus, tailoring counseling have to be designed to enhance better pregnancy planning and consecutive health outcomes. *Correspondence: 4 Department of Environmental Health, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Wariyo et al. BMC Women’s Health (2022) 22:548 Page 2 of 10 Keywords: Antiretroviral therapy, Disease stage, Incidence rate, Pregnancy, Retrospective Introduction The Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) remains a serious public health challenge, as well as a social dilemma especially among women of reproductive age [1]. In 2018, around 18.8 million women of reproductive age globally, living with HIV [2]. Of these, 61% were residing in subSaharan Africa [2]. In Ethiopia, the prevalence of HIV/ AIDS among women of reproductive age was 1.2% and the prevalence increases with increasing women’s age [3]. Introduction of antiretroviral therapy to women living with HIV highly improves lifestyle and the desire to have children [4]. Women who have HIV should seek treatment in accordance with WHO treatment guidelines because the virus can be passed on to their babies during pregnancy, childbirth, and breastfeeding [4]. Despite the fact that providing antiretroviral treatment to women living with HIV/AIDS has a tremendous effect on a mother’s health and can virtually eliminate the risk of passing on the virus to a newborn, a birth from an HIV positive mother may result not only in an HIV positive baby but also in maternal death [5]. If proper care for the mothers is not in place, maternal death due to complications related to HIV and pregnancy can be very high [6]. Reports have shown that even in the presence of ART maternal mortality rates have been reported to be five times higher in HIV infected women than in uninfected women [7], and it is responsible for at least 20% of all deaths, a figure that is higher than any direct obstetric cause [8]. In Ethiopia, pregnancy related complications among women on ART are among the many health problems. Even if the country is constructing and equipping health facilities with staff and equipment, still morbidity and mortality due to complications related to pregnancy among women on ART are very high [9]. Evidence indicates that HIV-positive women continue to desire more children in the future, though to differing degrees in different contexts. According to studies from Canada and Tanzania, 69% and 37% of HIV-positive mothers want to have more children, respectively [10, 11]. Various studies in Ethiopia have found varying levels of fertility desire among HIV-positive women. According to research conducted in North Wollo [12], Addis Ababa [13], and Tigray region [14], the majority of HIV positive women desired to have more children. Successful translation of HIV-prevention strategies requires a comprehensive understanding of the magnitude and baseline predictors of pregnancy among HIV positive women. This knowledge essential to reduce unintended pregnancies, appropriate care, and preventing transmission from mother to child. Therefore, this study aimed to determine effect of baseline predictors on incidence rate of pregnancy among reproductive age women receiving antiretroviral therapy at public hospitals of Jigjiga and Harar town, Eastern Ethiopia. Methods Study setting and period This study was conducted at public hospitals of Jigjiga a (...truncated)