Targeted Counseling Needed for Women in HIV Prevention Trials

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Data showed that approximately 60% of all pregnancies would be avoided if women were using injectable contraception.
Data showed that approximately 60% of all pregnancies would be avoided if women were using injectable contraception.

Overlapping risk factors for HIV incidence and unintended pregnancy (such as being unmarried/not cohabitating and young age) among women in South Africa suggest a strong need for targeted, practical, individual-centered counseling and interventions, according to a study published in The Journal of Infectious Diseases.

Approximately 270,000 individuals were newly infected with HIV in South Africa in 2016, with the KwaZulu-Natal province exhibiting the highest burden, with approximately 44.4% of antenatal attendees testing positive for HIV in 2015. To better understand the risk factors for incident pregnancy and HIV incidence in this population, study investigators analyzed combined data from several cohorts of women in HIV prevention trials, with a total of 9165 consenting participants. Eligibility requirements were age 18 or older, being sexually active, a negative pregnancy test and no intention of becoming pregnant during the study, and a negative HIV test at screening and at enrollment. Women were offered free examinations and free contraception, and were compensated for time, travel, and refreshments.

Of the 9165 study participants, 1034 became pregnant (11.3%), with an overall incidence rate of 9.6 pregnancies per 100-person years (95%, CI, 9.1-10.3). Seventy-five of the women had incident HIV, with an overall incident rate of 5.93 per 100-person years (95% CI, 4.73-7.44). After analysis, overlapping risk factors were found for both HIV incidence and pregnancy. Being 20 years old or younger made participants more than 3 times more likely to become pregnant or acquire HIV. Unmarried women who were not cohabitating were more than 2 times more likely to acquire HIV and had a 30% greater risk for incident pregnancy.

Study investigators conclude, “HIV prevention trials are costly and require high rates of accrual and retention together with high quality data to measure the desired efficacy outcomes. The high rates of incident pregnancy and incidence of HIV/STIs in the trial population, warrants a change in our counselling approach to address reproductive health and HIV prevention needs of women during the course of their trial participation with a more focussed and targeted approach when the risk is the highest.”

Reference

Ramjee G, Dassaye R, Reddy T, Wand H. Targeted pregnancy and HIV prevention risk-reduction counselling for young women: lessons learned from biomedical prevention trials [published online June 26, 2018]. J Infect Dis. doi: 10.1093/infdis/jiy388

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