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Unintended Pregnancy in Women Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-analysis

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Abstract

In 2014, about 1.5 million pregnancies occurred among HIV-positive women in low and middle-income countries. To pool magnitude and factors associated with unintended pregnancy in women living with HIV in sub-Saharan Africa, a systematic search of electronic databases was undertaken in November 2016. Pooling the magnitude of unintended pregnancy reported by 14 studies yielded a crude summary prevalence of 55.9%. The magnitude of unwanted pregnancy and mistimed pregnancy in six studies ranged from 14 to 59 and 9 to 47.2%, respectively. Contraceptive failure was an important factor for many unintended pregnancies. The magnitude of unintended pregnancy was significantly higher in HIV-positive women than for HIV-negative women in three out of six studies. The available evidence suggests that there is a high magnitude of unintended pregnancy in this population. Improving effective contraceptive utilization is thus a priority to address unintended pregnancies and to prevent mother to child transmission of HIV. PROSPERO Number: CRD42016051310.

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Abbreviations

ANC:

Antenatal care

ART:

Antiretroviral therapy

AOR:

Adjusted odds ratio

APR:

Adjusted prevalence ratio

CI:

Confidence interval

JBI:

Johanna Briggs Institute

MeSH:

Medical subject headings

OR:

Odds ratio

PLHIV:

People living with HIV

PMTCT:

Prevention of mother to child transmission

WLHIV:

Women living with HIV

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Acknowledgements

TRF and ASM are supported by The University of Newcastle International Postgraduate Research Scholarship (UNIPRS) and The University of Newcastle Research Scholarship Central 50:50 (UNRSC 50:50). We are grateful to Hunter Medical Research Institute/Greaves Family Postgraduate Top Up Scholarship (G1701582). We would also like to thank Ryan O’Neill for language edition. Finally, we thank Debbie Booth for supporting in searching.

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Authors and Affiliations

  1. College of Health Science, Wollega University, O7 Burka Jato, 395, Nekemte, Ethiopia

    Tesfaye Regassa Feyissa & Alemu Sufa Melka

  2. Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia

    Tesfaye Regassa Feyissa, Melissa L. Harris, Alemu Sufa Melka & Deborah Loxton

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  1. Tesfaye Regassa Feyissa
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  2. Melissa L. Harris
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Contributions

Contributed to conception and design of the systematic review: TRF, MLH, and DL. Involved in the development of the search strategy, the selection criteria, the strategy for assessment of risk of bias, and data abstraction form: TRF, MLH, and DL. Involved in the screening, assessment of eligibility, selection of studies and critical appraisal as well as data extraction: TRF, MLH, ASM, and DL. Contributed to analysis and interpretation of the data: TRF, MLH, ASM, and DL. Involved in drafting the manuscript and revising it critically: TRF, MLH, ASM, and DL. All authors have given final approval for the manuscript to be published.

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Correspondence to Tesfaye Regassa Feyissa.

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Feyissa, T.R., Harris, M.L., Melka, A.S. et al. Unintended Pregnancy in Women Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-analysis. AIDS Behav 23, 1431–1451 (2019). https://doi.org/10.1007/s10461-018-2346-4

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