Gretchen Antelman1, Amy Medley2, Redempta Mbatia3, Sherri Pals4, Gilly Arthur5, Sabina Haberlen6, Marta Ackers7, Batya Elul8, Julie Parent9, Anath Rwebembera10, Lucy Wanjiku11, Nicholas Muraguri12, Justice Gweshe13, Sandra Mudhune14, Pamela Bachanas2. 1. Research and Evaluation Director (Tanzania), ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA. 2. Behavioral Scientist, US Centers for Disease Control and Prevention, Atlanta, GA, USA. 3. Executive Director, Tanzania Health Promotion Support, Dar es Salaam, United Republic of Tanzania. 4. Mathematical Statistician, US Centers for Disease Control and Prevention, Atlanta, GA, USA. 5. Associate Director of Science, CTS Global Inc., assigned to US Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania. 6. Science Office Team Lead, CTS Global Inc., assigned to US Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania. 7. HIV Care and Treatment Branch Chief, US Centers for Disease Control and Prevention, Nairobi, Kenya. 8. Director of Strategic Information (ICAP) and Assistant Professor of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. 9. Study Coordinator, Ministry of Health and Social Services, Windhoek, Namibia. 10. Pediatrician, Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania. 11. Senior Care and Treatment Medical Officer, US Centers for Disease Control and Prevention, Nairobi, Kenya. 12. Director of Medical Services, Ministry of Health, Nairobi, Kenya. 13. Chief Medical Officer and National Programme Manager, Ministry of Health and Social Services, Windhoek, Namibia. 14. Senior M&E Officer, Research and Evaluation, The International Center for AIDS Care and Treatment Programs (ICAP), Mailman School of Public Health, Columbia University, New York, NY, USA.
Abstract
AIM: To describe factors associated with pregnancy desire and dual method use among people living with HIV in clinical care in sub-Saharan Africa. DESIGN: Sexually active HIV-positive adults were enrolled in 18 HIV clinics in Kenya, Namibia and Tanzania. Demographic, clinical and reproductive health data were captured by interview and medical record abstraction. Correlates of desiring a pregnancy within the next 6 months, and dual method use [defined as consistent condom use together with a highly effective method of contraception (hormonal, intrauterine device (IUD), permanent)], among those not desiring pregnancy, were identified using logistic regression. RESULTS: Among 3375 participants (median age 37 years, 42% male, 64% on antiretroviral treatment), 565 (17%) desired a pregnancy within the next 6 months. Of those with no short-term fertility desire (n=2542), 686 (27%) reported dual method use, 250 (10%) highly effective contraceptive use only, 1332 (52%) condom use only, and 274 (11%) no protection. Respondents were more likely to desire a pregnancy if they were from Namibia and Tanzania, male, had a primary education, were married/cohabitating, and had fewer children. Factors associated with increased likelihood of dual method use included being female, being comfortable asking a partner to use a condom, and communication with a health care provider about family planning. Participants who perceived that their partner wanted a pregnancy were less likely to report dual method use. CONCLUSIONS: There was low dual method use and low use of highly effective contraception. Contraceptive protection was predominantly through condom-only use. These findings demonstrate the importance of integrating reproductive health services into routine HIV care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
AIM: To describe factors associated with pregnancy desire and dual method use among people living with HIV in clinical care in sub-Saharan Africa. DESIGN: Sexually active HIV-positive adults were enrolled in 18 HIV clinics in Kenya, Namibia and Tanzania. Demographic, clinical and reproductive health data were captured by interview and medical record abstraction. Correlates of desiring a pregnancy within the next 6 months, and dual method use [defined as consistent condom use together with a highly effective method of contraception (hormonal, intrauterine device (IUD), permanent)], among those not desiring pregnancy, were identified using logistic regression. RESULTS: Among 3375 participants (median age 37 years, 42% male, 64% on antiretroviral treatment), 565 (17%) desired a pregnancy within the next 6 months. Of those with no short-term fertility desire (n=2542), 686 (27%) reported dual method use, 250 (10%) highly effective contraceptive use only, 1332 (52%) condom use only, and 274 (11%) no protection. Respondents were more likely to desire a pregnancy if they were from Namibia and Tanzania, male, had a primary education, were married/cohabitating, and had fewer children. Factors associated with increased likelihood of dual method use included being female, being comfortable asking a partner to use a condom, and communication with a health care provider about family planning. Participants who perceived that their partner wanted a pregnancy were less likely to report dual method use. CONCLUSIONS: There was low dual method use and low use of highly effective contraception. Contraceptive protection was predominantly through condom-only use. These findings demonstrate the importance of integrating reproductive health services into routine HIV care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
condom; counselling; family planning service provision; hormonal contraception; human immunodeficiency virus; service delivery
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