Fertility goal-based counseling increases contraceptive implant and IUD use in HIV-discordant couples in Rwanda and Zambia

Khu, Naw Htee; Vwalika, Bellington; Karita, Etienne; Kilembe, William; Bayingana, Roger; Sitrin, Deborah; Roeber-Rice, Heidi; Learner, Emily R; Tichacek, Amanda; Haddad, Lisa; Wall, Kristin M.; Chomba, Elwyn; Allen, Susan

doi:10.1016/j.contraception.2012.10.004

Cited by 47 publications

(42 citation statements)

References 32 publications

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“…Comparable to other findings by our group indicating that HIV status was not predictive of LARC uptake in multivariate analyses [36], we did not see a role for HIV status in method downgrading or upgrading behaviors in this study. Similarly, a study among HIV positive and negative couples in Malawi found that, while HIV positive individuals were more likely to desire to cease childbearing relative to HIV negative individuals, HIV positivity did not translate into higher contraception uptake [37].…”

Section: Discussioncontrasting

confidence: 63%

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Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia

Haddad

Wall

Vwalika³

et al. 2013

Aids

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Objective To describe predictors of contraceptive method discontinuation and switching behaviors among HIV positive couples receiving couples' voluntary HIV counseling and testing services in Lusaka, Zambia. Design Couples were randomized in a factorial design to two family planning educational intervention videos, received comprehensive family planning services, and were assessed every 3-months for contraceptive initiation, discontinuation and switching. Methods We modeled factors associated with contraceptive method upgrading and downgrading via multivariate Andersen-Gill models. Results Most women continued the initial method selected after randomization. The highest rates of discontinuation/switching were observed for injectable contraceptive and intrauterine device users. Time to discontinuing the more effective contraceptive methods or downgrading to oral contraceptives or condoms was associated with the women's younger age, desire for more children within the next year, heavy menstrual bleeding, bleeding between periods, and cystitis/dysuria. Health concerns among women about contraceptive implants and male partners not wanting more children were associated with upgrading from oral contraceptives or condoms. HIV status of the woman or the couple was not predictive of switching or stopping. Conclusions We found complicated patterns of contraceptive use. The predictors of contraception switching indicate that interventions targeted to younger couples that address common contraception-related misconceptions could improve effective family planning utilization. We recommend these findings be used to increase the uptake and continuation of contraception, especially long acting reversible contraceptive (LARC) methods, and that fertility-goal based, LARC-focused family planning be offered as an integral part of HIV prevention services.

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Section: Discussioncontrasting

confidence: 63%

“…Prior evaluation by our group noted that among discordant couples condoms were systematically used more often among the LARC users as compared to those using only condoms [36]. …”

Section: Discussionmentioning

confidence: 99%

Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia

Haddad

Wall

Vwalika³

et al. 2013

Aids

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“…Interestingly, 4 respondents were initially concerned that LARC may decrease condom use in HIV discordant couples, though in fact condom use is more consistent among LARC-using discordant couples in Rwanda compared with non-LARC using discordant couples. 29 Several participants cited antenatal clinics as an optimal venue to discuss HIV testing and FP because husband and wife attend together for CVCT. Stakeholders gave insights around the need for preser-vice as well as in-service training for both FP and HIV counseling and testing services.…”

Section: Discussionmentioning

confidence: 99%

Rwandan stakeholder perspectives of integrated family planning and HIV services

Wall

Bayingana

Ingabire

et al. 2018

Health Planning & Management

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SummaryThe purpose of this qualitative study was to understand the knowledge, attitudes, and practices among key Rwandan policymakers and stakeholders related to family planning (FP) and integrated HIV/FP services. Motivational in-depth interview format and content was developed after an extensive policy review. A convenience sample of 10 high-level HIV and FP Rwandan policymakers and stakeholders completed the interview. Stakeholders demonstrated strong foundational knowledge of HIV and FP. Given the choice, stakeholders would allocate more monies to FP and less to HIV than currently distributed. Respondents felt that improved FP method knowledge, especially long-acting reversible contraception, among clients/couples and providers, was needed to address myths, misconceptions, and biases. The most often cited way to integrate HIV/FP services was development of integrated tools (eg, training materials, data collection tools, and advocacy and policy guidance). We recommend strategies for policy advancement supportive of HIV/FP service integration inclusive of couples and long-acting reversible contraception methods.

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“…Recall bias may have also affected responses of individual questionnaires. We did not assess clients' experiences of the quality of family planning services, which can impact LARC uptake 25 . Nonetheless, the lack of active LARC providers and heavy work burden described in the questionnaires were consistent with the focus group discussions.…”

Section: Discussionmentioning

confidence: 99%

Family Planning Providers’ Experiences and Perceptions of LongActing Reversible Contraception in Lilongwe, Malawi

Mwafulirwa¹,

O’Shea²,

Hamela³

et al. 2016

Afr J Reprod Health

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Less than 2% of Malawian women use long-acting reversible contraception (LARC). We describe experiences of Malawian family planning providers, focusing on LARC. We conducted a mixed-methods study using questionnaires and focus group discussions with providers in Lilongwe. Data were analyzed separately and triangulated. Most (58%) participants saw over 30 patients daily. Only 19% had ever inserted IUC. Qualitative data were complementary; participants noted that LARC provision was important, though hindered by lack of experienced providers, work burden, and low demand. Future efforts to improve LARC access in Lilongwe must address both supply and demand-side barriers. (Afr J Reprod Health 2016; 20[2]: 62-71).Keywords: Family planning, long-acting reversible contraception, Malawi. RésuméMoins de 2% des femmes malawiennes utilisent la contraception de longue durée d'action réversible (CLDR). Nous décrivons les expériences des prestataires de planification familiale malawienne, en nous concentrant sur CLDR. Nous avons effectué une étude des méthodes mixtes à l'aide des questionnaires et des discussions de groupes cibles avec les fournisseurs à Lilongwe. Les données ont été analysées séparément et ont été triangulées. La plupart (58%) des participants ont vu plus de 30 patientes par jour. Seulement 19% avaient déjà inséré DIU. Les données qualitatives etaient complémentaires; les participants ont noté que la provision de la CLDR était importante, quoique entravée par le manque de fournisseurs expérimentés, la charge de travail, et la faible demande. Les futurs efforts pour améliorer l'accès à la CLDR à Lilongwe doit s'occuper des deux barrières de coté de l'offre et de la demande. (Afr J Reprod Health 2016; 20[2]: 62-71).Mots-clés: planification familiale, contraception de longue durée d'action réversible, Malawi.

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Fertility goal-based counseling increases contraceptive implant and IUD use in HIV-discordant couples in Rwanda and Zambia

Cited by 47 publications

References 32 publications

Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia

Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia

Rwandan stakeholder perspectives of integrated family planning and HIV services

Family Planning Providers’ Experiences and Perceptions of LongActing Reversible Contraception in Lilongwe, Malawi

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