Incidence of unintended pregnancies and pregnancy experience among adolescents living with perinatally‑acquired HIV in West Africa: a mixed‑method study

---

Résumé

Background Sexual and reproductive health issues in adolescents living with HIV (ALHIV) have been left
behind in HIV care programs. ALHIV are at risk of unintended pregnancy which jeopardizes their socio-economic
future, health outcomes and exposes their newborn to HIV transmission. A better understanding of these events
is needed. We studied the 18-month pregnancy incidence, and explored experiences of pregnancy among female
ALHIV enrolled in the OPTIMISE-AO cohort, nested in the prospective paediatric IeDEA cohort in Côte d’Ivoire and Burkina
Faso.
Methods We conducted a mixed-method study nested in the OPTIMISE-AO-ANRS-12390 project, a stepped-wedge
interventional trial launched in 2021 to support HIV-disclosure and antiretroviral treatment (ART) adherence in assenting
ALHIV aged 10–17 years in Abidjan, Cote d’Ivoire and Ouagadougou, Burkina Faso. We estimated the 18-month
incidence rate of pregnancy per 100 woman-years (WY) among those older than 14 years at inclusion. In Abidjan,
semi-structured interviews were also conducted with eight adolescents who became pregnant since their inclusion
to report their pregnancy experience.
Results After 18 months of follow-up, 12 pregnancies occurred among the 111 ALHIV followed up over 153 WY,
yielding an overall pregnancy incidence of 7.8/100 WY (95% confidence interval [95%CI]: 4.4–13.7). Stratified by age
at enrolment, it was 2.2 (95%CI: 0.3–15.5), 7.6 (95%CI: 2.8–20.3), 13.1 (95%CI:5.4–31.4), 11.5 (95%CI: 2.8–45.8) per 100
WY in those aged 14, 15, 16, and 17 years, respectively. After birth, all the newborns (12/12) had received prevention
of HIV mother-to-child transmission ART, and were HIV-negative at the 6-week early infant HIV diagnosis. The eight
ALHIV interviewed shared that the discovery of their pregnancy, all unintended, was a shock, and led to negative
consequences, such as rejection from their family, and stigmatisation. Most attempted to terminate their pregnancy
unsuccessfully. They reported major financial challenges associated with their pregnancy that forced them to find
a job rather than going back to school after delivery.

Mots-clés

Sexual and reproductive health, Adolescent, HIV, Côte d’Ivoire, Burkina Faso, Pregnancy, Incidence, Qualitative research