Kelly Blanchard1, Tsungai Chipato2, Gita Ramjee3, Tzadzaa Nhemachena2, Cynthia C Harper4. 1. Ibis Reproductive Health, Cambridge, MA 02138 USA. Electronic address: kblanchard@ibisreproductivehealth.org. 2. University of Zimbabwe College of Health Sciences, Harare, Zimbabwe. 3. HIV Research Unit, Medical Research Council, Westville, 3630, South Africa. 4. University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco, CA, USA 94143-0744.
Abstract
OBJECTIVES: To assess clinician provision of hormonal contraception for HIV-positive and at-risk women in Southern Africa. STUDY DESIGN: We conducted a nationally representative survey of clinicians (n=1444) in HIV-prevalent settings in South Africa and Zimbabwe to evaluate evidence-based contraceptive care and clinician views of hormonal contraceptives for HIV-positive and at-risk women. Multivariable logistic regression was used to analyze differences in contraceptive provision by professional training and practice setting. RESULTS: Most providers offered oral contraceptives (85%), but only a small minority considered them appropriate for women at risk of HIV (27%) or HIV-positive women (25%). A higher proportion of clinicians considered injections appropriate for women at risk of HIV (42%) or HIV-positive women (46%). Very few considered emergency contraceptives appropriate (13%). Multivariable results showed that family planning training and clinic as compared to hospital practices were associated with evidence-based attitudes about contraception for HIV-positive or at-risk women and greater provision. There were no differences, however, between physicians and nurses or by HIV training. CONCLUSIONS: These findings emphasize the need to improve clinicians' awareness of evidence-based guidelines for hormonal contraception for women at high risk of HIV and HIV-positive women. Evidence-based information that oral contraception and injections are appropriate is essential. Contraceptive education should be integrated into HIV training to reach at-risk populations.
OBJECTIVES: To assess clinician provision of hormonal contraception for HIV-positive and at-risk women in Southern Africa. STUDY DESIGN: We conducted a nationally representative survey of clinicians (n=1444) in HIV-prevalent settings in South Africa and Zimbabwe to evaluate evidence-based contraceptive care and clinician views of hormonal contraceptives for HIV-positive and at-risk women. Multivariable logistic regression was used to analyze differences in contraceptive provision by professional training and practice setting. RESULTS: Most providers offered oral contraceptives (85%), but only a small minority considered them appropriate for women at risk of HIV (27%) or HIV-positive women (25%). A higher proportion of clinicians considered injections appropriate for women at risk of HIV (42%) or HIV-positive women (46%). Very few considered emergency contraceptives appropriate (13%). Multivariable results showed that family planning training and clinic as compared to hospital practices were associated with evidence-based attitudes about contraception for HIV-positive or at-risk women and greater provision. There were no differences, however, between physicians and nurses or by HIV training. CONCLUSIONS: These findings emphasize the need to improve clinicians' awareness of evidence-based guidelines for hormonal contraception for women at high risk of HIV and HIV-positive women. Evidence-based information that oral contraception and injections are appropriate is essential. Contraceptive education should be integrated into HIV training to reach at-risk populations.
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