The authors declare that they have no competing interests.
RKW initiated the topic, coordinated the data collection and analysis and wrote the first draft of the paper. JKBM led the data analysis and participated in writing the paper. NMT participated in the analysis and review of the paper. GJW, MRK, MN, and NMT made input into the design and review of the paper. All authors contributed to the interpretation and review of the paper, and approved the final version of the manuscript.
Eliminating 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.
In 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.
Overall, 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.
More 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.
World Health Organization. Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: recommendations for a public health approach. – 2010 version. 2010. World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
World Health Organization. Consolidated guidelines on general HIV care and the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2013. World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
Ciaranello AL, Perez F, Keatinge J, Park JE, Engelsmann B, Maruva M, et al. What will it take to eliminate pediatric HIV? Reaching WHO target rates of mother-to-child HIV transmission in Zimbabwe: a model-based analysis. PLoS Med. 2012;9(1):e1001156. doi:10.1371/journal.pmed.1001156. Epub 2012 Jan 10. CrossRefPubMedPubMedCentral
Leach-Lemens C. Preventing unintended pregnancies in women living with HIV in resource-poor settings. HIV & AIDS Treatment in Practice. Issue 155, March 2010. http://www.aidsmap.com/Preventing-unintended-pregnancies-in-women-living-with-HIV-in-resource-poor-settings/page/1396517/.
Kancheva Landolt N, Ramautarsing RA, Phanuphak N, Teeratakulpisarn N, Pinyakorn S, Rodbamrung P, et al. Factors associated with the use of irreversible contraception and continuous use of reversible contraception in a cohort of HIV-positive women. Contraception. 2013;88(1):67–73. doi:10.1016/j.contraception.2012.10.017. Epub 2012 Nov 21. CrossRefPubMed
Lopez LM, Otterness C, Chen M, Steiner MJ, Gallo MF. Behavioral interventions for improving condom use for dual protection. Cochrane Database Syst Rev. 2013;10:CD010662. doi:10.1002/14651858.CD010662.pub2. Review.
Population Action International 2012. Promoting FP/RH-HIV/AIDS Integration: A Summary of Global Health Initiative Strategies in Ethiopia, Kenya, Tanzania, and Zambia. Available at: http://populationaction.org/wp-content/uploads/2012/07/GHI_Analysis_FINAL.pdf. July 2012 Population Action International 1300 19th Street NW Second Floor; Washington, DC 20036 USA.
Kosgei RJ, Lubano KM, Shen C, Wools-Kaloustian KK, Musick AM, Siika BS, et al. Impact of integrated family planning and HIV care services on contraceptive use and pregnancy outcomes: a retrospective cohort study. J Acquir Immune Defic Syndr. 2011;58(5):e121–6. doi:10.1097/QAI.0b013e318237ca80. CrossRefPubMedPubMedCentral
Stephenson R, Vwalika B, Greenberg L, Ahmed Y, Vwalika C, Chomba E, et al. A Randomized controlled trial to promote long-term contraceptive use among HIV Serodiscordant and concordant positive couples in Zambia. J Womens Health (Larchmt). 2011;20(4):567–74. doi:10.1089/jwh.2010.2113. Epub 2011 Mar 16. CrossRef
Millennium Development Goal Indicators website: http://millenniumindicators.un.org/.
Bland M. An introduction to medical statistics, 3rd Edition. 2000. Oxford University Press 2000, Oxford University Press Inc., New York, USA.
Wanyenze RK, Wagner GJ, Tumwesigye NM, Nannyonga M, Wabwire-Mangen F, Kamya MR. Fertility and contraceptive decision-making and support for HIV infected individuals: client and provider experiences and perceptions at two HIV clinics in Uganda. BMC Public Health. 2013;13(1):98. CrossRefPubMedPubMedCentral
World Health Organization. Sexual and reproductive health of women living with HIV/AIDS: Guidelines on care, treatment and support for women living with HIV/AIDS and their children in resource-constrained settings. 2006. World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
Matthews TL, Mukherjee JS. Strategies for harm reduction among HIV-Affected couples who want to conceive. AIDS Behav. 2009;12:S5–11. CrossRef
Wanyenze RK, Tumwesigye NM, Kindyomunda R, Beyeza-Kashesya J, Atuyambe L, Kansiime A, et al. Uptake of family planning methods and unplanned pregnancies among HIV infected individuals: a cross-sectional survey among clients at HIV clinics in Uganda. J Int AIDS Soc. 2011;14(1):35. CrossRefPubMedPubMedCentral
Uganda Bureau of Statistics Kampala, Uganda and MEASURE DHS ICF International Calverton, Maryland, USA (2012). Uganda Demographic Health Survey 2011. www.ubos.org/onlinefiles/uploads/ubos/UDHS/UDHS2011.pdf.
Harrington EK, Newmann SJ, Onono M, Schwartz KD, Bukusi EA, Cohen CR, et al. Fertility intentions and interest in integrated family planning services among women living with HIV in Nyanza Province, Kenya: a qualitative study. Infect Dis Obstet Gynecol. 2012;2012:809682. doi:10.1155/2012/809682. Epub 2012 Jul 12. CrossRefPubMedPubMedCentral
- Fertility desires and unmet need for family planning among HIV infected individuals in two HIV clinics with differing models of family planning service delivery
Rhoda K Wanyenze
Joseph KB Matovu
Moses R Kamya
Nazarius M Tumwesigye
Glenn J Wagner
- BioMed Central
Neu im Fachgebiet Gynäkologie und Geburtshilfe
Meistgelesene Bücher aus dem Fachgebiet
e.Med Kampagnen-Visual, Mail Icon II