Differences in fertility by HIV serostatus and adjusted HIV prevalence data from an antenatal clinic in northern Uganda
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Date
2006
Journal Title
Journal ISSN
Volume Title
Publisher
Tropical Medicine & International Health
Abstract
To estimate differences in fertility by HIV serostatus and to validate an adjustment
method for estimating the HIV prevalence in the general female population using data from an antenatal
clinic.
methods We used Cox regression models to retrospectively estimate the age-specific relative fertility
(RF) of HIV-positive compared to HIV-negative women among 3314 antenatal clinic attenders in
northern Uganda. RF and the age distribution of women in the general female population were used to
extrapolate the antenatal clinic-based HIV prevalence. This procedure was indirectly validated by
comparing the adjusted estimate with those based on standard adjustment factors derived from general
female populations in Uganda and Tanzania.
results HIV-positive women reported a lower fertility than HIV-negative women [age-adjusted RF ¼
0.83, 95% confidence interval (CI): 0.75–0.93]. Except for girls aged 15–19 (RF ¼ 0.96, 95% CI: 0.74–
1.24) HIV-positive women in all age groups were less fertile (20–24 year: RF ¼ 0.83, 95% CI: 0.67–
1.01; 25–29 years: RF ¼ 0.79, 95% CI: 0.62–1.00; 30–49 year: RF ¼ 0.79, 95% CI: 0.65–0.96].
Adjusting the antenatal clinic-based HIV prevalence (11.6%) for these differences yields a higher estimate
(13.8%) that is lower than those based on standard adjustment factors derived from general female
populations (from 14.6% to 17.7%).
conclusions The age-specific pattern of differential fertility by HIV serostatus derived from antenatal
clinic data is consistent with findings from population-based studies conducted in Africa. However,
differences in fertility between HIV positive and HIV-negative clients underestimate those in the general
female population yielding inaccurate estimates when used to extrapolate the HIV prevalence.
Description
Keywords
HIV, Fertility, Surveillance, Africa
Citation
Fabiani, M., Nattabi, B., Ayella, E. O., Ogwang, M., & Declich, S. (2006). Differences in fertility by HIV serostatus and adjusted HIV prevalence data from an antenatal clinic in northern Uganda. Tropical Medicine & International Health, 11(2), 182-187. doi:10.1111/j.1365-3156.2005.01554.x