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Improving access to contraception through integration of family planning services into a multidrug-resistant tuberculosis treatment programme
  1. Emily F Cornish1,
  2. Jonathan Hudson2,
  3. Ross Sayers2,
  4. Marian Loveday3,4
  1. 1Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
  2. 2Multidrug-Resistant Tuberculosis (MDR-TB) Programme, Estcourt Hospital, Estcourt, KwaZulu-Natal, South Africa
  3. 3Health Systems Research Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
  4. 4Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
  1. Correspondence to Dr Emily F Cornish, UCL Elizabeth Garrett Anderson Institute for Women's Health, 86-98 Chenies Mews, London WC1E 6HX, UK; e.cornish{at}ucl.ac.uk

Abstract

Objectives Multidrug-resistant tuberculosis (MDR-TB) is a global public health priority. The advent of the World Health Organisation’s Short Course regimen for MDR-TB, which halves treatment duration, has transformed outcomes and treatment acceptability for affected patients. Bedaquiline, a cornerstone of the Short Course regimen, has unknown teratogenicity and the WHO therefore recommends reliable contraception for all female MDR-TB patients in order to secure eligibility for bedaquiline. We were concerned that low contraceptive uptake among female patients in our rural South African MDR-TB treatment programme could jeopardise their access to bedaquiline. We therefore conducted a service delivery improvement project that aimed to audit contraceptive use in female MDR-TB patients, integrate family planning services into MDR-TB care, and increase the proportion of female patients eligible for bedaquiline therapy.

Methods Contraceptive use and pregnancy rates were audited in all female patients aged 13–50 years initiated on our MDR-TB treatment programme in 2016. We then implemented an intervention consisting of procurement of depot-medroxyprogesterone acetate (DMPA) for the MDR-TB unit and training of specialist MDR-TB nurses in administration of DMPA. The audit cycle was repeated for all female patients aged 13–50 years initiated on the programme in January–October 2017 (post-intervention).

Results The proportion of women on injectable contraceptives by the time of MDR-TB treatment initiation increased significantly in the post-intervention cohort (77.4% vs 23.9%, p<0.0001).

Conclusion By integrating contraceptive services into our MDR-TB programme we significantly increased contraceptive uptake, protecting women from the obstetric risks associated with pregnancy during MDR-TB treatment and maximising their eligibility for bedaquiline therapy.

  • hormonal contraception
  • long-acting reversible contraception
  • family planning service delivery
  • multidrug-resistant tuberculosis
  • HIV
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Footnotes

  • EFC and JH are joint first authors.

  • Contributors EFC contributed to conception and design of the work, acquisition and analysis of data and drafting of the manuscript. JH contributed to conception and design of the work, acquisition and analysis of data, and critical revision of the manuscript. RS contributed to conception and design of the work, acquisition and analysis of data, and critical revision of the manuscript. ML contributed to design of the work, interpretation of data and critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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