Background At public health centres in Ethiopia, the proportion of known HIV-positive pregnant women at entry into ANC grew from 17% in 2009 to 36% in 2011. To assess the reasons for this apparent rise in pregnancy among known HIV-positive women, we reviewed pregnancy rates among HIV-positive women of reproductive age (WRA) enrolled in HIV services.

Methods

1. Retrospective study of 3 cohorts of WRA starting ART at 4 health centres in Addis Ababa between 2009 and 2011 to examine pregnancy rates over time;

2. Interviews with HIV+ pregnant women regarding reasons for their pregnancy.

Results Among 167 women who started ART in 2008/9, 4.2% had become pregnant. Of 165 who started ART in 2009/10, 9.1% had become pregnant. Of 161 enrolled on ART in 2010/11, 13.7% had become pregnant. In the first cohort, the pregnancy rate dropped from 4.2% to 4.1% after one year and 3.8% after two years on ART. In the second cohort, the rate dropped from 9.1% to 7.5% after one year on ART. The third cohort was too recent to assess pregnancy rates after one year.

Among 297 WRA enrolled in HIV care, 24% had become pregnant after knowing they were HIV+. Of these, 74% were on ART; 61% were planned pregnancies.

Conclusions Women recently enrolled on ART had higher pregnancy rates than women on ART after one year, possibly reflecting the monthly FP counselling once on ART. The data further show substantial unmet need for FP, as 39% reported an unintended pregnancy.