Fertility desires and unmet need for family planning among HIV infected individuals in two HIV clinics with differing models of family planning service delivery

Abstract

BackgroundEliminating family planning (FP) unmet need among HIV-infected individuals (PLHIV) is critical to elimination of mother-to-child HIV transmission. We assessed FP unmet need among PLHIV attending two clinics with differing models of FP services. Nsambya Home Care provided only FP information while Mulago HIV clinic provided information and contraceptives onsite.MethodsIn a cross-sectional study conducted between February-June 2011, we documented pregnancies, fertility desires, and contraceptive use among 797 HIV-infected men and women (408 in Mulago and 389 in Nsambya). FP unmet need was calculated among women who were married, unmarried but had sex within the past month, did not desire the last or future pregnancy at all or wished to postpone for ≥ two years and were not using contraceptives. Multivariable analyses for correlates of FP unmet need were computed for each clinic.ResultsOverall, 40% (315) had been pregnant since HIV diagnosis; 58% desired the pregnancies. Of those who were not pregnant, 49% (366) did not desire more children at all; 15.7% wanted children then and 35.3% later. The unmet need for FP in Nsambya (45.1%) was significantly higher than that in Mulago at 30.9% (p = 0.008). Age 40+ compared to 18–29 years (OR = 6.05; 95% CI: 1.69, 21.62 in Mulago and OR = 0.21; 95% CI: 0.05, 0.90 in Nsambya), other Christian denominations (Pentecostal and Seventh Day Adventists) compared to Catholics (OR = 7.18; 95% CI: 2.14, 24.13 in Mulago and OR = 0.23; 95% CI: 0.06, 0.80 in Nsambya), and monthly expenditure > USD 200 compared to < USD40 in Nsambya (OR = 0.17; 95% CI: 0.03, 0.90) were associated with FP unmet need.ConclusionsMore than half of the pregnancies in this population were desired. Unmet need for FP was very high at both clinics and especially at the clinic which did not have contraceptives onsite. Lower income and younger women were most affected by the lack of contraceptives onsite. Comprehensive and aggressive FP programs are required for fertility support and elimination of FP unmet need among PLHIV, even with integration of FP information and supplies into HIV clinics.

Integration of Family Planning Services into HIV Care and Treatment Services: A Systematic Review

“…; Wanyenze et al. ). One HIV care and treatment clinic served populations where many female clients had engaged in sex work (Thyda et al.…”

“…; Wanyenze et al. ; Phiri et al. ), two in Europe (Coyne, Hawkins, and Desmond ; Wielding and Flynn ) and one in Asia (Thyda et al.…”

“…All but one program in Uganda (Wanyenze et al. ) also offered at least one LARC on‐site, IUDs or implants, and clients were referred for voluntary female or male sterilization services. Only the Malawi program reported providing female condoms (Phiri et al.…”

“…A case comparison study in Uganda reported less unmet need in a clinic that provided FP services and commodities on‐site as compared with a regular care site (30.9 percent versus 45.1 percent, p < 0.01), although the statistical comparison did not account for confounders (Wanyenze et al. ). Another case comparison study, in Swaziland, reported the unanticipated finding of higher unmet need among women attending the most fully integrated HIV care delivery site compared with those attending the standalone HIV clinic in the same area (45 percent versus 25 percent), although the difference was not statistically significant after adjustment for confounders (aOR=2.76, 95% CI: 0.88–8.72) (Church et al.…”

“…; Wanyenze et al. ). However, the level of unmet need was extremely high, even at the integrated sites, and points to the need for other interventions to reduce the gap between pregnancy intentions and contraceptive use.…”