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Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania
  1. Gretchen Antelman1,
  2. Amy Medley2,
  3. Redempta Mbatia3,
  4. Sherri Pals4,
  5. Gilly Arthur5,
  6. Sabina Haberlen6,
  7. Marta Ackers7,
  8. Batya Elul8,
  9. Julie Parent9,
  10. Anath Rwebembera10,
  11. Lucy Wanjiku11,
  12. Nicholas Muraguri12,
  13. Justice Gweshe13,
  14. Sandra Mudhune14,
  15. Pamela Bachanas15
  16. for the Prevention in Care and Treatment Settings Study Group
  1. 1Research and Evaluation Director (Tanzania), ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
  2. 2Behavioral Scientist, US Centers for Disease Control and Prevention, Atlanta, GA, USA
  3. 3Executive Director, Tanzania Health Promotion Support, Dar es Salaam, United Republic of Tanzania
  4. 4Mathematical Statistician, US Centers for Disease Control and Prevention, Atlanta, GA, USA
  5. 5Associate Director of Science, CTS Global Inc., assigned to US Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
  6. 6Science Office Team Lead, CTS Global Inc., assigned to US Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
  7. 7HIV Care and Treatment Branch Chief, US Centers for Disease Control and Prevention, Nairobi, Kenya
  8. 8Director of Strategic Information (ICAP) and Assistant Professor of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
  9. 9Study Coordinator, Ministry of Health and Social Services, Windhoek, Namibia
  10. 10Pediatrician, Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania
  11. 11Senior Care and Treatment Medical Officer, US Centers for Disease Control and Prevention, Nairobi, Kenya
  12. 12Director of Medical Services, Ministry of Health, Nairobi, Kenya
  13. 13Chief Medical Officer and National Programme Manager, Ministry of Health and Social Services, Windhoek, Namibia
  14. 14Senior 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
  15. 15Behavioral Scientist, US Centers for Disease Control and Prevention, Atlanta, GA, USA
  1. Correspondence to Dr Gretchen Antelman, ICAP, Mailman School of Public Health, Columbia University, 722 West 16th Street, New York, NY 10032, USA; ga_zzz{at}yahoo.com

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.

  • family planning service provision
  • hormonal contraception
  • human immunodeficiency virus
  • service delivery
  • counselling
  • condom
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