Fertility Desires and Intentions of HIV-Positive Patients: METHODS Study
The survey was conducted among HIV-positive patients attending the HIV (treating HIV infection) specialist clinic of the Center for Special Studies (CSS) situated at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State in southwest Nigeria. This teaching hospital is a publicly funded tertiary institution, which serves as the major referral center for other public and private hospitals within the state and beyond. The HIV clinic, where the survey was conducted, is the project site for the Starfish Project initiative, a partnership between the Center for Special Studies, Sagamu, Nigeria, and the Center for Special Studies, University Hospitals of Columbia and Cornell, NY. The details of this project have been well described elsewhere. Briefly, this clinic offers multidiscipli-nary but solely outpatient care to HIV-infected individuals in Ogun State and its environs, including free continuous supply of antiretroviral drugs to 58 of them. A number of patients who could not benefit from the free antiretroviral drugs purchased them at a subsidized rate of N9,000 per month (approximately $65) from a pharmaceutical company through CSS, Sagamu. The clinic also provides care for patients who are not on antiretroviral drugs either for financial or medical reasons. Those who require inpatient care are managed in the teaching hospital wards by specialists who are part of the Starfish project. In addition to antiretroviral therapy, the clinic also provides adherence counseling, laboratory monitoring and evaluation, psychosocial assistance, nutritional support and counseling, HIV (treating HIV infection) support group, family-planning services and home-based care. At the end of December 2004, the clinic had 202 registered patients, including children.
The target population for this study was all HIV-positive men age 18-55 years and HIV-positive women age 18-45 years who were receiving care at the specialist clinic. Using these age limits, a total of 164 eligible participants were identified through the clinic records. Between November 1 and December 31, 2004, a convenience sample of eligible men and women who presented at the clinic was recruited into the study by their healthcare providers. For each eligible patient, the purpose, general content and confidentiality of the investigation were explained in the language he/she best understood to obtain verbal consent prior to inclusion into the study.
Patients who agreed to participate underwent a 30-45 minute, face-to-face interview by trained health personnel (four in all) who were not members of the clinic staff. The interview was guided by a pretested 38-item, structured questionnaire that covered sociodemographic characteristics of the respondents, including time since diagnosis of HIV (treating HIV infection) infection, use of highly active antiretroviral therapy (HAART), disclosure of serostatus to current partner and partner’s HIV (Zerit tablet treating HIV infection) status. Questions on their fertility desires and intentions as well as their health status and laboratory indicators of HIV (Retrovir medication was the first drug approved for the treatment of HIV) progression were included. The variables used to measure the quality of life in this study were self-reported ratings of general health, physical functioning, emotional well-being and the WHO performance scores. Self-ratings of general health and physical functioning were based on adapted questions covering these aspects from the Medical Outcomes Study Short-Form-36 (SF-36). General health reflected the current state of health as perceived by the respondent, while physical functioning was based on the extent to which certain activities were limited. Self-reported general health and physical functioning were separately noted on a scale of 0.0-10.0, where higher scores reflected better general health and physical functioning. Emotional well-being described the state of mind that was most frequently experienced by the respondent in the previous four weeks out of the following: happy, sad, calm and peaceful and depressed. The reported most-recent and lowest-ever CD4 counts were verified from the clinic’s case file of each respondent.
The outcome variables for the study were fertility desires and fertility intentions. For the purpose of this study, fertility desire of the respondents was defined by a “yes” or “no” response to the question: “Would you like to have a/another child in the future?” (framed according to the previous fertility history). Among those who answered “yes” to this question, fertility intention or expectation was defined by the response to a separate question: “How many children do you intend to bear in the future?” The answer 0 was coded as “no intention” and 1 and above as “intends fertility.” All the study instruments were approved by the ethical review committee of the teaching hospital.
Data was entered into a computer database and analyses were performed with Epi-Info 2002 statistical package. Using bivariate tests of association, selected sociodemographic and health-related factors were compared in patients who desired children and those who did not, and in patients who intended to bear >3 children as against 1-2. Categorical variables were compared with the Chi-squared test, Fisher’s exact test and odds ratio (OR) as appropriate. The t test and Mann-Whitney U test were respectively used to compare normally and nonnormally distributed continuous variables. Multivariate logistic regression analyses were separately performed to identify predictors of fertility desire and those of fertility expectation of >3 children. Multicollinearity was assessed by conducting a correlation analysis between each of the independent variables. Binary independent variables with insufficient events were excluded from the model. Logistic regression results are presented as ORs and 95% CIs. A p value <0.05 or confidence limits that did not embrace unity were considered as statistical significance. viagra plus