Abstract:
Background: The objective of this study was to estimate the prevalence, incidence and risk factors for pregnancy
among HIV-positive adolescents in a large HIV treatment program in western Kenya.
Methods: The Academic Model Providing Access to Healthcare (AMPATH) program is a partnership between Moi
University, Moi Teaching and Referral Hospital and a consortium of 11 North American academic institutions. AMPATH
currently provides care to 85,000 HIV-positive individuals in western Kenya. Included in this analysis were adolescents
aged 10–19 enrolled in AMPATH between January 2005 and February 2017. Socio-demographic, behavioural, and
clinical data at baseline and time-updated antiretroviral treatment (ART) data were extracted from the electronic
medical records and summarized using descriptive statistics. Follow up time was defned as time of inclusion in the
cohort until the date of frst pregnancy or age 20, loss to follow up, death, or administrative censoring. Adolescent
pregnancy rates and associated risk factors were determined.
Results: There were 8565 adolescents eligible for analysis. Median age at enrolment in HIV care was 14.0 years. Only
17.7% had electricity at home and 14.4% had piped water, both indicators of a high level of poverty. 12.9% (1104)
were pregnant at study inclusion. Of those not pregnant at enrolment, 5.6% (448) became pregnant at least once dur ing follow-up. Another 1.0% (78) were pregnant at inclusion and became pregnant again during follow-up. The overall
pregnancy incidence rate was 21.9 per 1000 woman years or 55.8 pregnancies per 1000 women. Between 2005 and
2017, pregnancy rates have decreased. Adolescents who became pregnant in follow-up were more likely to be older,
to be married or living with a partner and to have at least one child already and less likely to be using family planning.
Conclusions: A considerable number of these HIV-positive adolescents presented at enrolment into HIV care as
pregnant and many became pregnant as adolescents during follow-up. Pregnancy rates remain high but have
decreased from 2005 to 2017. Adolescent-focused sexual and reproductive health and ante/postnatal care programs may have the potential to improve maternal and neonatal outcomes as well as further decrease pregnancy rates in this high-risk group.
