Incidence and Predictors of Pregnancy among HIV Positive Women on ART in North West Ethiopia, a Retrospective Cohort Study

Review Article

Austin Med Sci. 2022; 7(2): 1067.

Incidence and Predictors of Pregnancy among HIV Positive Women on ART in North West Ethiopia, a Retrospective Cohort Study

Gebrie YF¹*, Dessie TM² and Yeshiwas D¹

¹Department of Statistics, Debre Markos University, Debre Markos, Ethiopia

²Department of Applied Human Nutrition, Marie Stopes International, Ethiopia

*Corresponding author: Yenesew Fentahun Gebrie, Department of Statistics, Debre Markos University, Debre Markos, Ethiopia

Received: July 25, 2022; Accepted: August 23, 2022; Published: August 30, 2022


Objective: The objective of this study was to identify the prevalence and significant factors of incidence of pregnancy among HIV positive women under ART follow up.

Methods: A retrospective cohort study was employed and a sample size of 429 was selected using simple random sampling technique. Both chi-square test of association and multiple binary logistic regression analysis were used.

Results: The study has shown that 21.2% of women were pregnant during the follow-up. Variables like, WHO clinical stage, spouse’s HIV status, marital status, contraception use, body weight, occupation, CD4 count, age and time of ART were significant predictors of incidence of pregnancy.

Conclusion: Women with advance WHO clinical stage were less likely to be pregnant. Women, who are married, employed, had never used contraceptive methods were more likely to had pregnancy. When CD4 cell count and body weight increase, incidence of pregnancy also increases and women who had longer time on ART were more likely to be pregnant.

Health institutions and clinicians should be cautious when the patients have faced advanced WHO clinical stage and low CD4 count. We would like to put remarks of increasing employment of HIV Positive women, providing effective services of ART health care, and studying further investigation for the general wellbeing of mothers and their respective potentially born children.

Keywords: Antiretroviral therapy; Binary logistic regression; Incidence of pregnancy


AIDS: Acquired Immunodeficiency Syndrome; ART: Antiretroviral Therapy; ARV: Antiretroviral Drugs; CD4: Cluster Designation 4 Positive Lymphocytes; HIV: Human Immunodeficiency Virus; MLE: Maximum Likelihood Estimation; OR: Odds Ratio; UNAIDS: United Nations AIDS Programme; USAID: United State Agency for International Development; WHO: World Health Organization


HIV is the most serious disease that human kind has ever faced, and it is a social dilemma as well. It becomes one of the world’s most serious health and development challenges for women under productive age [1]. In 2020, an estimated of 37.7 million people were living with HIV worldwide, and 27.5 million people were receiving HIV treatment in the year. In 2020, nearly threefourth of (73%) of all people living with HIV were receiving lifesaving antiretroviral therapy, and 85% of pregnant women living with HIV had access to antiretroviral treatments to prevent transmission of HIV to their child. In 2020, about 680,000 death were record due to AIDS-related illnesses, which is the great declination compared with death in 2010 (1.3 million) worldwide. Out of the global number of pregnant women, 83% were living with HIV and 68% of them were receiving life-saving antiretroviral therapy in 2020. The two-third (67%) of sub-Saharan Africa people was living with HIV in 2020 [2].

In Ethiopia, 690 000 people were living with HIV and 65% of them were on treatment in 2018.In this year, 92% of pregnant women with HIV received ART to prevent the disease’s mother to child transmission during pregnancy and to the mothers’ own health. In Ethiopia, seven regions and two administrative cities have HIV prevalence above one percent. In the regions, the prevalence of HIV was highest in Gambella (4.8%), followed by Addis Ababa (3.4%), Dire Dawa (2.5%), and Harari (2.4%) [3]. For HIV/AIDS infected woman, significantly ameliorated to having HIV negative child by increasing the accessibility of ART; because, it has the potential to decrease the risk of HIV transmission of mother-to-child and prevents AIDSrelated illness and death [4]. However, HIV positive women are not volunteer to have pregnancy and they are frightened to get HIV negative child. Hence, it is significant to identify the prevalence and significant predictors of incidence of pregnancy under ART followup.

So far, in different areas of the world, studies were conducted including Ethiopia. However, Most of the studies where done using descriptive statistics, and studies conducted in different parts of Ethiopia were not addressing the problem. Hence it is mandatory to conduct studies on the area under discussion. The aim of the study was to assess the prevalence and predictors of incidence of pregnancy among HIV positive women under ART follow-up in Finote Selam general hospital.


Description of the Study Area

The study was conducted at Finote Selamgeneral Hospital which is located in Finote Selam City administration, capital of west Gojjam zone, Amhara Region, Ethiopia. The town is located at about 387 km far from Addis Ababa and 173 km far from Bahir Dar Capital city of Amhara national regional state, Ethiopia. This hospital is the only general hospital in West Gojjam Zone which provides ART service for peoples living with HIV in the area of rural and urban surrounding the hospital.

Study Design and Data sources

A four year institution based retrospective cohort study was employed from October 2016to September 2019 based on secondary data from of medical charts of ART clinic of the hospital.

The sources of data were HIV positive women under ART follow up in the Hospital. The data included all HIV positive women under the follow up of ART those who are aged between 15 and 49 years at the ART clinic of the hospital.

Variables in the Study

The response variable of the study was incidence of pregnancy of HIV positive women under ART follow-up (pregnancy occurred = 1, pregnancy not occurred =0).

The independent variables that include in this study were age, educational level, occupation, marital status, religion, place of residence, child alive of women before ART follow up, contraceptive use, WHO clinical stage, co-infection, body weight, time on ART follow up, CD4 count and Spouse HIV status of women.

Sample Size Determination and Sampling Technique

In the research, sample size is the core element, and it can be determined based on the following constraints: objective of the research, design of the research, cost constraint and degree of precision required. Considering these things, the sample size was determined using the following formula: