Incident pregnancy rates in HIV infected and HIV uninfected at-risk adolescents

Purpose: To compare pregnancy incidence between HIV infected and HIV uninfe cted adolescents over a 3-year period and to characterize factors that diff erentiate pregnant from nonpregnant HIV infected females. Methods: Female adolescents enrolled in Reaching for Excellence in Adolesce nt Care and Health (REACH), a national cohort study, and nonpregnant at bas eline comprised the sample (it = 345). Subject information on pregnancy, ri sk behavior, and psychosocial characteristics was obtained through intervie w, chart review, physical examination and laboratory data collected every 3 months. Incident pregnancy rate was analyzed using Cox proportional hazard s modeling; the predictors of incident pregnancy were evaluated using repea ted measures analysis. Results: Ninety-four pregnancies were identified over 3 years. No significa nt difference in pregnancy incidence was detected between HIV infected and uninfected females (20.6 and 28.4 per 100 person-years, respectively, p =.1 6). However, for adolescents with living children at entry, HIV infected fe males were significantly less likely to become pregnant than HIV uninfected (HR =.45; p =.03). Among HIV infected adolescents, significant predictors of incident pregnancy were older age (p =.01) and not using hormonal contra ception (p =.00), whereas increased spiritual hope and passive problem-solv ing capacity were protective against pregnancy (p =.02, and .05, respective ly). Multivariate analysis revealed pregnancy prior to study entry to be pr edictive for (OR = 3.0; 95% CI: 1.2-7.7), and increased spiritual hope to b e protective (OR = .4; 95% CI:.2-.9) against incident pregnancy in HIV infe cted females without the hormonal contraceptive variable in the model. Conclusions: The pregnancy rate is high in this study population. Further r esearch is needed into its determinants and attenuating factors, particular ly the role of spiritual elements, to design better contraceptive services and reproduction-related education targeting high-risk youth. Society for A dolescent Medicine, 2001.