Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania

Antelman, Gretchen; Medley, Amy; Mbatia, Redempta; Pals, Sherri; Arthur, Gilly; Haberlen, Sabina; Ackers, Marta; Elul, Batya; Parent, Julie; Rwebembera, Anath; Wanjiku, Lucy; Muraguri, Nicholas; Gweshe, Justice; Mudhune, Sandra; Bachanas, Pamela

doi:10.1136/jfprhc-2013-100784

Cited by 36 publications

(54 citation statements)

References 40 publications

(72 reference statements)

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“…For PLWH with a partner living without HIV or HIV unknown status partner, one study revealed that 44% of the participants desired for child in future. Lastly, among PLWH with a partner with unknown HIV status, a wider range of percentages was observed in the four studies, varying from 8% to 63% .…”

Section: Resultsmentioning

confidence: 87%

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Prevalence and factors associated with fertility desires/intentions among individuals in HIV‐serodiscordant relationships: a systematic review of empirical studies

et al. 2019

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Introduction Better knowledge about fertility desires/intentions among HIV ‐serodiscordant partners who face unique challenges when considering childbearing may be helpful in the development of targeted reproductive interventions. The aim of this systematic review was to synthesize the published literature regarding the prevalence of fertility desires/intentions and its associated factors among individuals in HIV ‐serodiscordant relationships while distinguishing low‐ and middle‐income countries ( LMIC ) from high‐income countries ( HIC ). Methods A systematic search of all papers published prior to February 2017 was conducted in four electronic databases (PubMed/ MEDLINE , Psyc INFO , Web of Science and Cochrane Library). Empirical studies published in peer‐reviewed journals with individuals in HIV ‐serodiscordant relationships assessing the prevalence of fertility desires/intentions and/or the associated factors were included in this systematic review. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses ( PRISMA ) guidelines. Results and discussion After screening 1852 references, 29 studies were included, of which 21 were conducted in LMIC and eight in HIC . A great variability in the prevalence of fertility desires/intentions was observed in LMIC (8% to 84% (one member of the dyad included)). In HIC , the results showed a smaller discrepancy between in the prevalence (32% to 58% (one member of the dyad included)); the prevalence was higher when the couple was the unit of analysis (64% to 73%), which may be related to the fact that all these studies were conducted in the context of assisted reproduction. Few studies examined the factors associated with fertility desires/intentions, and all except one were conducted in LMIC . Individuals (e.g. number of children), couple‐level (e.g. belief that the partner wanted children) and structural factors (e.g. discussions with health workers) were found to be associated. Conclusions The results of this systematic review suggest that many individuals in HIV ‐serodiscordant relationships have fertility desires/intentions, although the prevalence is particularly heterogeneous in LMIC in comparison to HIC . Well‐known factors such as younger age and a fewer number of living children were consistently associated with increased fertility desires/intentions. Different couple‐level factors emerged, reflecting the importance of considering both the individual and the couple. However, further stu...

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Section: Resultsmentioning

confidence: 87%

“…Concerning PLWH, studies conducted after the introduction of combination therapies in 1996 have suggested that a substantial proportion would like/expect to have children. However, this prevalence varied greatly by country and by study [24][25][26].…”

mentioning

confidence: 99%

Prevalence and factors associated with fertility desires/intentions among individuals in HIV‐serodiscordant relationships: a systematic review of empirical studies

et al. 2019

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“…Although these findings are not surprising [28,29], the decreasing trend in condom use both alone and in conjunction with other more effective contraceptive methods is concerning. The EMR routinely prompts health providers to offer condoms to all adults in ART clinics, yet despite these attempts, the use of condoms in combination with other contraceptives remains low.…”

Section: Discussionmentioning

confidence: 99%

Integrating family planning services into HIV care: use of a point-of-care electronic medical record system in Lilongwe, Malawi

Tweya

Feldacker

Haddad

et al. 2017

Global Health Action

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Background: Integrating family planning (FP) services into human immunodeficiency virus (HIV) clinical care helps improve access to contraceptives for women living with HIV. However, high patient volumes may limit providers’ ability to counsel women about pregnancy risks and contraceptive options. Objectives: To assess trends in the use of contraceptive methods after implementing an electronic medical record (EMR) system with FP questions and determine the reasons for non-use of contraceptives among women of reproductive age (15–49 years) receiving antiretroviral therapy (ART) at the Martin Preuss Center clinic in Malawi. Methods: In February 2012, two FP questions were incorporated into the ART EMR system (initial FP EMR module) to prompt providers to offer contraceptives to women. In July 2013, additional questions were added to the FP EMR module (enhanced FP EMR) to prompt providers to assess risks of unintended pregnancies, solicit reasons for non-use of contraceptives and offer contraceptives to non-pregnant women . We conducted a retrospective, longitudinal cohort study using the EMR routinely collected data. The primary outcome was the use of any modern contraceptive method. Descriptive statistics were used to describe the study population and report trends in contraceptive use during the initial and enhanced study periods. Results: Between February 2012 and December 2016, in HIV clinics, 20,253 women of reproductive age received ART, resulting in 163,325 clinic visits observations. The proportion of women using contraceptives increased significantly from 18% to 39% between February 2012 and June 2013, and from 39% to 67% between July 2013 and December 2016 (chi-square for trend p < 0.001). Common reasons reported for the non-use of contraceptives among those at risk of unintended pregnancy were: pregnancy ambivalence (n = 234, 51%) and never thought about it (n = 133, 29%). Conclusion: Incorporating the FP EMR module into HIV clinical care prompted healthcare workers to encourage the use of contraceptives.

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“…27 However, dual method use in most sub-Saharan settings is low. 21,28 A recent study in Namibia, Kenya and Tanzania observed low dual method use and low use of highly effective contraception among people living with HIV for whom contraceptive protection was predominantly through condom-only use. 28 Dual contraceptive use in Kenya is very low as some couples believe it is unnecessary.…”

Section: Discussionmentioning

confidence: 99%

“…21,28 A recent study in Namibia, Kenya and Tanzania observed low dual method use and low use of highly effective contraception among people living with HIV for whom contraceptive protection was predominantly through condom-only use. 28 Dual contraceptive use in Kenya is very low as some couples believe it is unnecessary. 29 Ralph et al 9 highlighted the need for future priorities to include expanding contraceptive choice and identifying effective ways of promoting use of dual methods.…”

Section: Discussionmentioning

confidence: 99%

HIV/AIDS and Contraceptive Method Choice: Demographic and Socio-Economic Correlates of Contraceptive Method Choice among HIV-Positive Women Practising Family Planning In Kenya

Magadi

2016

HIV/AIDS Res Treat Open J

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CitationAs the generalized HIV epidemic in specific settings of sub-Saharan Africa continues to evolve, there is need for evidence-based response to address emerging challenges, which include enabling the large number of women living with HIV make informed choices to achieve their reproductive goals. Objectives: This paper seeks to (i) examine the effect of HIV/AIDS on contraceptive method choice among women using contraceptives in Kenya; and (ii) identify correlates of contraceptive method choice among HIV-positive women practising family planning. Material and Methods: We apply multinomial Logistic regression models to a sample of 3190 sexually-active women of reproductive age using contraceptives from the 2003 and 2008 Kenya Demographic and Health Surveys to examine the effect of HIV/AIDS on contraceptive method choice. The analysis of correlates of method choice among HIV-positive women is based on a sample of 255 HIV-positive women using contraceptives and involves bivariate cross-tabulations with Chi-Square tests. Result: Overall association between HIV status and contraceptive method choice is consistent with expected patterns, with women who are HIV-positive being more than twice as likely to use condoms rather than hormonal contraceptives, compared to their counterparts of similar characteristics who are HIV-negative (p<0.05). Among women infected with HIV, those who were previously tested for HIV were more likely to use condoms and less likely to use hormonal methods (p<0.05) than those who had never been tested. The higher use of condoms by HIV-positive women is only evident among those who had previously been tested for HIV. Significant correlates of contraceptive method choice among HIV-positive women include parity, marital status, age group, education and ethnicity. Overall trends suggest a notable shift from use of hormonal methods to condoms by HIV-positive women, but predominant use of hormonal methods (60%) and low use of condoms (23%) by HIV-positive young women aged 15-24 practising family planning is of potential concern. Conclusion: The findings have important implications for family planning policies/programs targeting young women living with HIV and underscore the need to intensify efforts towards improved HIV testing coverage to enable HIV-positive women make informed reproductive choices.

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Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania

Cited by 36 publications

References 40 publications

Prevalence and factors associated with fertility desires/intentions among individuals in HIV‐serodiscordant relationships: a systematic review of empirical studies

Prevalence and factors associated with fertility desires/intentions among individuals in HIV‐serodiscordant relationships: a systematic review of empirical studies

Integrating family planning services into HIV care: use of a point-of-care electronic medical record system in Lilongwe, Malawi

HIV/AIDS and Contraceptive Method Choice: Demographic and Socio-Economic Correlates of Contraceptive Method Choice among HIV-Positive Women Practising Family Planning In Kenya

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