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Amsalu M, worku K, Ayalew M, Alamneh AA. Contraceptive use and associated factors among women of reproductive age on antiretroviral therapy in Awabel Woreda health centers, Northwest Ethiopia. SAGE Open Med 2023; 11:20503121231190275. [PMID: 38020801 PMCID: PMC10640806 DOI: 10.1177/20503121231190275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background The family planning options for reproductive-age women who are in antiretroviral therapy should consider different types of contraceptive methods including condom use. There is a high unmet need and unplanned pregnancies in Ethiopia among HIV-positive women. Attention was not given towards contraceptive use for HIV women in Ethiopia including the study area. The study aimed to assess contraceptive use and associated factors among women of reproductive age (15-49 years) on Antiretroviral therapy in Awabel Woreda, Northwest Ethiopia. Methods A facility-based cross-sectional study was conducted among 572 women of reproductive age who were receiving HIV care and treatment. Data were collected using interviewer-administered questionnaire, entered by Epidata3.1 and exported to IBM SPSS for statistics version 20 for analysis.Multivariable logistic regression was used to identify factors associated with contraceptive use and the presence of significant association was declared at p-value <0.05 and 95% confidence level. Result A total of 526 out of 572 women have responded, with a response rate of 91.9%. Two-thirds (66.5% (95% CI: 63.5, 69.5)) of the study participants were using contraceptive methods at the time of the survey. Women living in areas (Adjusted Odds Ratio = 1.95; 95% CI: 1.16, 3.72), and those who disclosed their HIV status to their partner (Adjusted Odds Ratio = 2.61; 95% CI: 1.37, 4.95) were more likely to use contraceptives. While Women (Adjusted Odds Ratio = 0.41; 95% CI: 0.24, 0.69) and their partners (Adjusted Odds Ratio = 0.57; 95% CI: 0.34, 0.97) who had desire to have a child were less likely to use contraceptives. Conclusions The prevalence of contraceptive use among reproductive-age women who were on antiretroviral therapy (ART) was lower than a systematic review done in Ethiopia and higher than the national target. Intervention targeting on implementation of contraceptive methods, and counseling about contraceptives to address their question of fertility desire and knowledge were recommended.
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Affiliation(s)
- Menichil Amsalu
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Kalkidan worku
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mulugeta Ayalew
- Federal Police Hospital Department of Disease Prevention, Addis Ababa, Ethiopia
| | - Alehegn Aderaw Alamneh
- Department of Human Nutrition, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Ashore A, Erkalo D, Prakash R. Dual contraceptives and associated predictors in HIV positive women: a case-control study. Reprod Health 2022; 19:168. [PMID: 35906704 PMCID: PMC9336104 DOI: 10.1186/s12978-022-01475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 07/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background People living with the human immune deficiency virus (PLHIV) are an important group to address HIV prevention. Mostly, 90% of the HIV cases in children are usually through mother-to-child transmission. Dual contraception (barrier condoms i.e., male, and female condoms) are one of the most effective ways to avoid HIV transmission. Thus, the present study was carried out to establish the predictors associated with the use of dual contraceptives in sexually active HIV positive women in Hossana, Southern Ethiopia. Methods An institution based unmatched case–control study among randomly selected 312 sexually active HIV positive women was conducted from February 2021 to May 2021. The data were collected through structured questionnaire and anti-retroviral treatment (ART) cards considering the case-to-control ratio of 1:3. The information was coded, entered into Epi-Info7.0 and exported to SPSS 20.0 for further analysis. A P-value < 0.25 in bi-variate analysis was further processed for multi-variate analysis and P-value < 0.05 was considered statistically significant. Results A response rate of 97.2% was recorded. A significant difference was observed towards the use of dual contraceptives in sexually active HIV positive women living in urban vs rural areas (AOR = 0.28; 95% CI = 0.09–0.84), having sexual intercourse with a regular partner (AOR = 3.77; 95% CI = 1.48–9.55) and taking first initiation to use (AOR = 0.05; 95% CI = 0.02–0.11). Conclusion The determinants associated with lower use of dual contraceptives were residing in rural areas, sexual intercourse with a regular partner and low initiation rate at first time for use of dual contraceptives. Therefore, we strongly recommend that open discussion about sexually transmitted infections like HIV and their prevention, providing adequate facilities in rural areas can help to prevent HIV transmission and reduce the disease burden. The health professionals are encouraged to organize awareness campaigns in rural areas for use of dual contraceptives among PLHIV. HIV/AIDS has become a serious global threat to human beings. People living with HIV are an important group that needs attention. About 90% of the children get HIV infection through their mothers that involved mother-to-child transmission of HIV. Therefore, World Health Organization has focused on the use of condoms to prevent the transmission of sexually transmitted diseases (STDs) and to avoid unwanted pregnancies. Out of these contraceptives, the use of dual contraceptives has been considered the best to prevent the transmission of STDs/HIV. Therefore, the present study tried to identify the use of dual contraceptives (barrier condoms i.e., male, and female condoms) and factors associated with its use in sexually active HIV women in Hossana, SNNPR, Ethiopia. We conducted a case–control study and recruited 312 sexually active HIV positive women that were on antiretroviral therapy and visiting the ART clinics for their follow-ups. The present investigation revealed that women living in rural areas were not aware about the use of dual contraceptives when compared to urban areas. Also, it was observed that women, those involved in sexual activities with multiple partners and had an open discussion with their partners about using dual contraceptives at first were more when compared to others. Although, the use of dual contraceptives among HIV positive women living in Hossana was low. Hence, this needs more focused awareness programs in rural areas and people having sexual intercourse with regular partners.
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Affiliation(s)
- Alemu Ashore
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia.,Hossana Health Center, Hossana, Ethiopia
| | - Desta Erkalo
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Ravi Prakash
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia. .,Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA.
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Aynalem GL, Badi MB, Solomon AA. Consistent Condom Utilization and its Associated Factors among Sexually Active Female Anti-Retro Viral Treatment Users in Finoteselam District Hospital, Northwest Ethiopia, 2018. J Int Assoc Provid AIDS Care 2022; 21:23259582221088430. [PMID: 35317701 PMCID: PMC8949742 DOI: 10.1177/23259582221088430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Consistent condom utilization is the key strategy to prevent new HIV strain transmissions among ART users. There are limited evidences on consistent condom utilization among women who are on ART in Ethiopia. Methods: A cross-sectional study design was conducted among sexually active female ART users from June to August, 2018. Data were collected using a systematic random sampling data collection method. The multivariable logistic regression model was used to identify the predictors for the outcome Results: study indicated that 137(34.2%) women reported that they were using condom for the last three months, of whom 81 (59.1% (n = 137)) used condoms consistently. Respondents` age group from 21-30 (AOR = 4.381, 95%CI = 1.05, 18.331), Counseling about condom utilization (ARO = 9.442, 95% CI = 4.387, 20.32) and husbands` educational status “diploma and above” (AOR = 3.65, 95% CI = 1.007, 13.227) were significantly associated with condom utilization.
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Affiliation(s)
- Getie Lake Aynalem
- Department of Clinical Midwifery, 362057University of Gondar, Gondar city, Ethiopia
| | - Marta Berta Badi
- Department of Clinical Midwifery, 362057University of Gondar, Gondar city, Ethiopia
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Contraception values and preferences of people living with HIV: a systematic review. Contraception 2021; 111:48-60. [PMID: 34748747 DOI: 10.1016/j.contraception.2021.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Attention to the contraception values and preferences of those living with HIV is essential to meeting their reproductive rights and health needs. We systematically reviewed the literature on contraception values and preferences among women and men living with HIV. STUDY DESIGN We searched ten electronic databases for articles from 1 January 2005 through 27 July 2020 for qualitative and quantitative studies of the values and preferences for contraceptive methods among individuals living with HIV. RESULTS Twenty-one studies, primarily from sub-Saharan Africa, met the inclusion criteria. Contraception values and preferences were shaped by several factors: availability, accessibility, and convenience; perceived effectiveness; safety and tolerability; dual protection; fertility desires; partnership dynamics; and provider recommendations. Male condoms were a frequently preferred contraceptive method, offering an affordable and accessible form of dual protection against HIV and unwanted pregnancy. Fears of infertility and side effects decreased interest in hormonal contraceptive methods. Financial burdens incurred by HIV management and a desire to reduce dual reproductive health and HIV care burdens influenced preferences. Healthcare providers contributed to contraceptive preferences of women living with HIV, informing perceptions of safety, tolerability, and effectiveness. CONCLUSION Contraception values and preferences among women living with HIV are complex and influenced by factors related and unrelated to their HIV status. Considering contraception values and preferences of people living with HIV will ensure that their autonomy and right to make decisions about the contraceptive methods best for them are upheld.
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Ayele AD, Kassa BG, Beyene FY, Sewyew DA, Mihretie GN. Dual contraceptive utilization and determinant factors among HIV positive women in Ethiopia: a systematic review and meta-analysis, 2020. Contracept Reprod Med 2021; 6:19. [PMID: 34193304 PMCID: PMC8247245 DOI: 10.1186/s40834-021-00161-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background Dual contraceptive is the use of a barrier like condom along with any modern contraceptive methods which has double significance for the prevention STI including HIV and unintended pregnancy. The prevalence and determinants of dual contraceptive utilization described by different studies were highly inconsistent in Ethiopia. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and determinants of dual contraceptive utilization among HIV positive women in Ethiopia. Methods International database mainly Pub Med, Google scholar, HINARI, EMBASE, Cochrane Library, AJOL was applied to identify original studies. STATA software version 14 was applied to analyze the pooled prevalence of dual contraceptive. I2 test statistics was computed to check the presence of heterogeneity across the studies and eggers test was used to identify publication bias. The pooled prevalence of dual contraceptive utilization was estimated by using a random effects model. The associations between determinants and dual contraceptive utilization were evaluated by using both random and fixed effect models. Result A total 9 studies with 9168 HIV positive women were enrolled in this study. The pooled prevalence of dual contraceptive utilization among HIV positive women in Ethiopia was 26.14% (95% CI 21.20–31.08). Disclosure of HIV status (OR = 4.18,95%CI:2.26–7.72), partner involvement in post-test counselling (OR = 2.31,95%CI:1.63–3.25), open discussion about dual contraceptive with partner (OR = 4.27 95% CI:1.69–10.77), provision of counselling on dual contraceptives by health care provider (OR = 4.47,95% CI:3.81–5.24) and CD4 count > 350 cells/ mm3 (OR = 3.87,95%CI:3.53–4.23) were among the significant factors associated with dual contraceptive utilization. Conclusion The overall prevalence of dual contraceptive utilization among HIV positive women was significantly low. Disclosure of HIV status, partner involvement in post-test counselling, open discussion about dual contraceptive with partner, counselling on dual contraceptive by health care provider and CD4 count > 350 cells/ mm3 were positively affect dual contraceptive utilization. This study implies the need to develop plans and policies to improve partner involvement posttest counseling, integrate the counseling and provision of dual contraceptive at ART clinic at each level of health system. Supplementary Information The online version contains supplementary material available at 10.1186/s40834-021-00161-w.
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Affiliation(s)
- Alemu Degu Ayele
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Bekalu Getnet Kassa
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentahun Yenealem Beyene
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Dagne Addisu Sewyew
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret Mihretie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Tilahun Y, Bala ET, Bulto GA, Roga EY. Dual Contraceptive Utilization and Associated Factors Among Reproductive-Age Women on Anti-Retroviral Therapy at Hospitals in Central Ethiopia. Risk Manag Healthc Policy 2021; 14:619-627. [PMID: 33623452 PMCID: PMC7894880 DOI: 10.2147/rmhp.s290362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Ethiopia is one of the Sub-Saharan African countries with an increasingly risky sexual practice and mostly affected by the Human Immunodeficiency Virus (HIV) epidemic. Dual protection is an important preventive approach which can prevent both unwanted pregnancy and sexually transmitted infections including HIV/AIDS. Therefore, this study aimed to assess the dual contraceptive utilization and associated factors among reproductive-age women on Anti-Retroviral Therapy (ART) in central Ethiopia. Methods An-institution based cross-sectional study was conducted among 311 women on ART at public hospitals of West Shewa Zone from June to September 2019. A systematic random sampling technique was used to select the study participants. A pretested structured interviewer-administered questionnaire was used for data collection. The data were entered into Epi data version 3.1 and exported to IBM SPSS statistical software version 25 for analysis. Bivariate and multivariable logistic regression analysis were computed. Odds ratio along with 95% confidence interval was computed to ascertain the association. Results The prevalence of dual contraceptive utilization among women on ART was 21.4% (95% CI: 16.8-25.9). Age of respondents between 15 and 24 years [AOR=8.35, (95% CI: 3.12-17.78)], living in urban [AOR=2.59, 95% CI: 1.15-4.22], separated women [AOR=2.28, 95% CI (1.26-5.04)], had post-diagnosis counselling on family planning [AOR=5.33, 95% CI: 1.52-18.68], disclosed HIV status [AOR=5.98, 95% CI: 1.63-21.93], freely discuss with their husband [AOR=4.22, 95% CI, 1.84-12.36], have no fertility desire [AOR=2.46, (95% CI: 1.34-6.44)] were significantly associated with dual contraceptive utilization. Conclusion and Recommendation The overall magnitude of dual contraceptive utilization among women on ART was found to be low. Factors like age, residence, marital status, post-diagnosis counselling, disclosure of HIV status, and free discussion with husband were significantly associated with dual contraceptive method utilization. Therefore, it is necessary to expand the range of strategies and tools available to married and single women's for protecting themselves from being infected with other strains and pregnancy. The concerned stakeholders also should emphatically consider those identified factors for intervention.
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Affiliation(s)
- Yohannes Tilahun
- Disease Prevention and Control Division, Addis Ababa Health Bureau, Addis Ababa, Ethiopia
| | - Elias Teferi Bala
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Gizachew Abdissa Bulto
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Ephrem Yohannes Roga
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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Aradom HS, Sendo EG, Teshome GS, Dinagde NG, Demie TG. Factors associated with modern family planning use among women living with HIV who attended care and treatment clinics in Jigjiga town, Eastern Ethiopia. Ther Adv Reprod Health 2021; 14:2633494120976961. [PMID: 33403360 PMCID: PMC7739204 DOI: 10.1177/2633494120976961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background Family planning helps to reduce the number of high-risk births and prevent unplanned pregnancies and mother-to-child transmission of HIV. The main purpose of this study was to determine the usage of family planning and its associated factors among women living with HIV who attended care and treatment clinics. Methods This was a health facility-based cross-sectional study conducted among 332 sexually active reproductive-age women living with HIV who visited care and treatment clinics from 15 April and 15 June 2017. We used a systematic sampling technique for sample selection. The data were collected using pretested and structured questionnaires through face-to-face interviews. Seriously ill women living with HIV who were unable to respond to the questionnaire and refused to participate were excluded from this study. Logistic regression was fitted, and an odds ratio with a 95% confidence interval with a p value less than 0.05 was used to identify factors associated with modern family planning use. Result The study revealed that the overall use of the modern family planning method was 56.3%, and the most common method used was injectable (37.4%) followed by implants (28.9%). About 19% of the users reported dual contraceptive use. About 58% got family planning from antiretroviral therapy clinics. Almost all the women (97.6%) had heard of seven modern family planning methods. Desire to have another child was the most common (79.7%) reason for not using family planning. Women who attended primary/secondary education (adjusted odds ratio: 2.61; 95% confidence interval: 1.29-5.28], who had no future fertility desire (adjusted odds ratio: 2.94; 95% confidence interval: 1.51-5.73), who had discussed family planning with their husband (adjusted odds ratio: 2.06; 95% confidence interval: 1.04-4.10), and who were counseled by the antiretroviral therapy provider about family planning (adjusted odds ratio: 4.53; 95% confidence interval: 1.70-12.06) were more likely to use family planning methods than their counterparts. Conclusion The results of this study revealed that the use of modern family planning was low. There is a high frequency of implant usage, fear of mother-to-child transmission as a motivator for family planning usage, and low dual method usage. Hence, improving women's education, involving husbands, and consistent family planning counseling by antiretroviral therapy providers are promising strategies to improve the uptake of modern family planning by women living with HIV.
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Affiliation(s)
- Habtom Semereab Aradom
- Department of Midwifery, College of Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Endalew Gemechu Sendo
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girum Sebsibe Teshome
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negalign Getahun Dinagde
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Takele Gezahegn Demie
- Department of Public Health, St. Paul's Hospital Millennium Medical College, P.O. Box 1271, Addis Ababa, Ethiopia
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Adeniyi OV, Ajayi AI, Somefun OD, Lambert JS. Provision of immediate postpartum contraception to women living with HIV in the Eastern Cape, South Africa; a cross-sectional analysis. Reprod Health 2020; 17:194. [PMID: 33298097 PMCID: PMC7724693 DOI: 10.1186/s12978-020-01049-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Universal access to contraception is an important strategy adopted by the South African government to reduce the high rate of unintended pregnancies, especially in women living with HIV. In this article, we describe the choices of contraception and also, examine the influencing factors of the choices of contraception in the immediate postpartum period in parturient women with HIV in the Eastern Cape, South Africa. METHODS In this prospective cross-sectional study, 1617 parturient women with HIV completed a survey on the choice of contraception received in the immediate postpartum period (within 72 h) across three large maternity services in the Eastern Cape between September 2015 to May 2016. Additional information was extracted from their medical records. Choices of contraception were categorised as; short-acting (injectables), long-acting reversible (intrauterine device and implants) and permanent contraception (tubal ligation). Adjusted and unadjusted logistic regression models were employed to determine the influencing factors of the choices of contraception received by the cohort. RESULTS Participants were predominantly single (69.1%), unemployed (75.1%), had a grade 7-12 level of education (88.4%) and were HIV positive before their index pregnancy (81.3%). The prevalence of immediate postpartum contraception was high (n = 1507; 93.2%) with Injectables being the preferred choice in the majority of the participants (n = 1218; 75.3%). After controlling for all relevant covariates, single marital status was associated with a higher likelihood of immediate postpartum contraceptive initiation (AOR; 1.82 95% CI 1.10-3.03). Overall, women were more likely to initiate a long-acting reversible and irreversible methods when older than 35 years and having had more than two children. CONCLUSIONS We found a high prevalence of immediate postpartum contraception with a preference for Injectables in the study setting. Long-term monitoring of this cohort will elucidate on contraceptive discontinuation and risk of unintended pregnancies in the region. Ensuring universal access to contraceptives is an important strategy to reduce the rate of unintended pregnancies at the population level. This strategy was adopted by the South African government with a vision of stemming the tide of unintended pregnancies among women living with HIV. In this study, the choices of contraception adopted by women living with HIV following the delivery of their babies were explored. In addition, the study highlights the factors that predict these choices. Participants were asked the choice of contraception they had received prior to being discharged from the maternity centres where they had delivered their babies. The various types of contraception were then categorised by their duration of action. Three distinct groups emerged; short-acting injectables, long acting reversible contraceptives and permanent methods. Of the 1617 women included in the study, 1117 were single and 1314 knew their HIV status prior to the onset of the index pregnancy. Almost all the women (1507 out of 1617) received one form of contraception before leaving the hospital. Many women (1218 out of 1617) chose injectable contraception (short-acting contraception) over the other types of contraception. Women who were older than 34 years and who had three or more children were more likely to choose a long-acting reversible contraceptive and permanent method over the short-acting contraception or nothing. In conclusion, given the short duration of action of the predominant method adopted by these women, a long-term follow up of the study participants will provide more information on the continued use of contraception and risk for unintended pregnancies.
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Affiliation(s)
- Oladele Vincent Adeniyi
- Department of Family Medicine & Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha/East London Hospital Complex, Cecilia Makiwane Hospital, East London, South Africa.
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi, Kenya
| | - Oluwaseyi Dolapo Somefun
- Demography and Population Studies (DPS), University of the Witwatersrand, Johannesburg, South Africa
| | - John Shearer Lambert
- Department of Infectious Diseases, Medicine and Sexual Health. Mater, Rotunda and University College, Dublin, Ireland
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Tewabe T, Ayalew T, Abdanur A, Jenbere D, Ayehu M, Talema G, Asmare E. Contraceptive use and associated factors among sexually active reproductive age HIV positive women attending ART clinic at Felege Hiwot Referral Hospital, Northwest Ethiopia: A cross-sectional study. Heliyon 2020; 6:e05653. [PMID: 33344789 PMCID: PMC7736717 DOI: 10.1016/j.heliyon.2020.e05653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/26/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Contraception helps prevent unplanned pregnancies and mother to child Human Immune Virus (HIV) transmission among human immune virus positive women. Ethiopia has made remarkable progress in increasing contraceptive use rate but there is still a disparity of contraceptive use within the country. Although there were some studies about contraceptive use in Ethiopia, evidences about contraceptive use among sexually active HIV positive women was limited. Understanding the extent of and barriers in Ethiopia is important for learning how to best improve level of contraceptive use. Therefore, this study aimed to assess contraceptives use and associated factors among HIV positive sexually active women at anti-retroviral therapy clinic at Felege Hiwot Referral Hospital ART clinic in Bahir Dar, Ethiopia. METHOD A facility-based cross-sectional study was conducted from June 01-30, 2018 among (n = 308) randomly selected HIV positive women at Felege Hiwot Referral Hospital. Data were collected using a pretested interviewer-administered questionnaire and analyzed using SPSS version 20. Survey logistic regression analysis was employed to identify determinants of contraceptive use. Statistical significance was declared at p-value <0.05. RESULTS Out of three hundred eight participants, 118 (38.3%) reported contraceptive use at the time of the study. Injectable is the most preferred (43.5%) contraceptive method. Participants with age 15-34 years (AOR = 3.09, 95%CI: 1.59-5.99), disclosed their status to sex partner, (AOR = 2.7, 95%CI: 1.14-6.66), had history of contraception use; (AOR = 3.36, 95%CI: 1.68-6.74), were sexually active (AOR = 5.45, 95%CI: 2.72-10.91) had higher odds of contraceptive use. However, participants who had drinking habit (AOR = 4.35, 95%CI: 1.82-10.38) had lower odds of contraceptive use. CONCLUSION A significant proportion of HIV positive women had low level of contraceptive use that was lower than the national recommended level. Participants with younger age (15-34years), who disclosed HIV status to sex partner, had history of contraceptive use, and who were sexually active six months prior to the study were more likely to use contraception. However, participants who had drinking habit were less likely to use contraception. These results suggest that multi-sectorial and multi-disciplinary approaches are needed to increase contraceptive use in the HIV positive women.
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Affiliation(s)
- Tilahun Tewabe
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilksew Ayalew
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Maternal and Reproductive Health Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abdulhakim Abdanur
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - Demoze Jenbere
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - Mastewal Ayehu
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - Girma Talema
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - Eden Asmare
- Department of Midwifery, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Gedefaw G, Wondmieneh A, Demis A. Contraceptive Use and Method Preferences among HIV Positive Women in Ethiopia: A Systematic Review and Meta-analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6465242. [PMID: 33015174 PMCID: PMC7520013 DOI: 10.1155/2020/6465242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Preventing unintended pregnancies among HIV positive women has a vital role to prevent mother to child transmission. Besides, increasing access to contraceptives has a number of economical importance and reducing the costs for mitigating the unintended pregnancy consequences. Therefore, this study is aimed at assessing the contraceptive use and method of preference among HIV positive women in Ethiopia. METHODS A systematic review and meta-analysis reporting guideline was applied. Articles searched from the Scopus, Pubmed/MEDLINE, EMBASE, AJOL, Hinari, and Google scholar were included in this review. The Stata 11 software was used to compute the analysis. Heterogeneity of the studies was detected using the Cochran Q test and I 2 test statistics. Egger's test was used to check the evidence of publication bias within the studies. Subgroup analysis and sensitivity analysis was computed with the evidence of heterogeneity. RESULTS Ten thousand one hundred twenty one (10121) women living with HIV/AIDS were recruited in this study. The national estimated prevalence of contraceptive use among HIV positive women in Ethiopia was 57.78% (95% CI: 48.53-67.03). Injectables and male condom were the most preferred contraceptives accounted for 36.00% (95% CI: 6.64-45.35) and 32.74% (95% CI: 21.08-44.40), respectively. Discussion with husband/partner (AOR: 4.70, 95% CI: 2.18-10.12), disclosure of HIV status to spouse/partner (AOR: 2.18, 95% CI: 1.55-3.06), ever counseled for modern contraceptives (AOR: 2.79, 95% CI: 2.01-3.88), attending secondary and above education (AOR: 3.12, 95% CI: 2.15-4.51), and having more than one live child (AOR: 2.61, 95% CI: 1.86-3.66) were increasing the likelihood of contraceptive use whereas not currently married women (AOR: 0.23, 95% CI: 0.16-0.34) was decreases the odds of contraceptive use. CONCLUSION In Ethiopia, more than half of the women living with HIV/AIDS were using contraceptives. Discussion with husband/partner, disclosure of HIV status to spouse/partner, ever counseled for modern contraceptives, attending secondary and above education, and having more than one live child were increasing the uptake of contraceptives among HIV positive women. Partner discussion, having adequate information towards contraceptive use, and having desired number of child could increase the utilization; as a result, obstetric complication with HIV positive women due to unintended pregnancy is significantly decreasing.
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Affiliation(s)
- Getnet Gedefaw
- Department of Midwifery, College of Health Sciences, Woldia University, P.O. Box: 400, Woldia, Ethiopia
| | - Adam Wondmieneh
- Department of Nursing, College of Health Sciences, Woldia University, P.O. Box: 400, Woldia, Ethiopia
| | - Asmamaw Demis
- Department of Nursing, College of Health Sciences, Woldia University, P.O. Box: 400, Woldia, Ethiopia
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Contraceptive use among sexually active women living with HIV in western Ethiopia. PLoS One 2020; 15:e0237212. [PMID: 32760140 PMCID: PMC7410321 DOI: 10.1371/journal.pone.0237212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 07/22/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Contraception can help to meet family planning goals for women living with HIV (WLHIV) as well as to support the prevention of mother to child transmission of HIV (PMTCT). However, there is little research into the contraceptive practice among sexually active WLHIV in Ethiopia. Therefore, we aimed to examine contraceptive practice among sexually active WLHIV in western Ethiopia and identify the factors that influenced such practice using the Health Belief Model (HBM). Methods A facility-based cross-sectional survey of 360 sexually active WLHIV was conducted from 19th March to 22nd June 2018 in western Ethiopia. The eligible participants were WLHIV aged between 18 and 49 years who reported being fecund and sexually active within the previous six months but were not pregnant and not wanting to have another child within two years. Modified Poisson regression analyses were conducted to identify factors that influenced contraceptive practice among sexually active WLHIV in western Ethiopia. Results Among sexually active WLHIV (n = 360), 75% used contraception with 25% having unmet needs. Of the contraceptive users, 44.8% used injectables, 37.4% used condoms and 28.5% used implants. Among 152 recorded births in the last five years, 17.8% were reported as mistimed and 25.7% as unwanted. Compared to WLHIV having no child after HIV diagnosis, having two or more children after HIV diagnosis (Adjusted Prevalence Ratio [APR] = 1.31; 95%CI 1.09–1.58) was associated with increased risk of contraceptive practice. However, sexually active unmarried WLHIV (APR = 0.69; 95%CI 0.50–0.95) were less likely to use any contraception compared to their sexually active married counterparts. Importantly, high perceived susceptibility (APR = 1.49; 95%CI 1.20–1.86) and medium perceived susceptibility (APR = 1.55; 95%CI 1.28–1.87) towards unintended pregnancy were associated with higher risk of contraceptive use than WLHIV with low perceived susceptibility. Conclusions Although contraceptive use amongst sexually active WLHIV was found to be high, our findings highlight the need for strengthening family planning services given the high rate of unintended pregnancies, the high rate of unmet needs for contraception, as well as the lower efficacy with some of the methods. Our findings also suggest that the HBM would be a valuable framework for healthcare providers, programme planners and policymakers to develop guidelines and policies for contraceptive counselling and choices.
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Abay F, Yeshita HY, Mekonnen FA, Sisay M. Dual contraception method utilization and associated factors among sexually active women on antiretroviral therapy in Gondar City, northwest, Ethiopia: a cross sectional study. BMC Womens Health 2020; 20:26. [PMID: 32050961 PMCID: PMC7017555 DOI: 10.1186/s12905-020-0890-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mother to child transmission is responsible for 90% of child infection with human immune deficiency virus (HIV). Dual contraceptive use is one of the best actions to prevent mother's human immune deficiency virus transmission to her child and partner. This study aimed at assessing the prevalence and factors associated with dual contraceptive use among sexually active women on antiretroviral therapy in Gondar City, northwest, Ethiopia. METHODS An institution based cross sectional study was conducted in Gondar City public health facilities from December 1 to 31, 2018. Systematic random sampling technique was utilized to include 563 study participants. Data were collected by interview using a structured questionnaire. Descriptive analysis was made to compute mean, median and proportion. Finally, multivariable logistic regression model was fitted to identify the factors associated with dual contraceptive method utilization. Analysis was performed by using Statistical Package for Social Sciences (SPSS) software version 20. RESULTS The overall prevalence of dual contraceptive method utilization among sexually active women on antiretroviral therapy was 28.8% (95% CI: 24.9, 32.7). Women aged 35-49 years (Adjusted odds ratio (AOR): 6.99; 95% CI: 3.11, 15.71)), who lived in urban areas (AOR: 4.81; 95% CI: 2.04, 11.31), attended secondary and above education (AOR: 4.43; 95% CI: 1.92, 10.22), and disclosed HIV status to sexual partners (AOR: 9.84; 95% CI: 3.48, 27.81) were more likely to use dual contraceptive method. CONCLUSION In this study, the proportion of women who utilized dual contraceptive method was low. Age, place of residence, educational status and disclosure of HIV status were factors associated with dual contraceptive use. Therefore, providing education about the advantages of disclosing HIV status to sexual partners and strengthening of counseling about the advantages of dual contraceptive use will be helpful in enhancing the use of dual contraceptive method among sexually active women on antiretroviral therapy.
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Affiliation(s)
- Fewuze Abay
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hedija Yenus Yeshita
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantahun Ayenew Mekonnen
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekonnen Sisay
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Derek A, Seme A, Anye CS, Nkfusai CN, Cumber SN. Modern family planning use among people living with HIV/AIDS: a facility based study in Ethiopia. Pan Afr Med J 2019; 33:224. [PMID: 31692753 PMCID: PMC6814915 DOI: 10.11604/pamj.2019.33.224.19025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/29/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Despite increasing efforts to address the reproductive health needs of persons living with Human Immuno-Deficiency Virus (HIV), a high unmet need for contraception exists among HIV+ women in sub-Saharan Africa. Currently, Ethiopia promotes integration of family planning (FP) services in to HIV chronic care. Yet the contraceptive prevalence rate among clients remains low. The objective of the study was to assess the role of socio-cultural factors on modern family planning use among HIV+ clients attending Anti-Retroviral Therapy clinics in Addis Ababa sub-cities. METHODS The study involved a facility based cross sectional survey. The ten sub cities were initially categorized/stratified into 5 based on direction (East, West, South, North and Central) and from each category one sub city was randomly selected. The total sample size was proportionally allocated to the selected health facilities according to previous monthly average client load per health center. Participants were selected using simple random sampling technique during their routine visit at the health centers. Data were collected through a semi-structured interviewer administered questionnaire. Both descriptive and inferential statistics were generated and results considered significant at 95% confidence level using STATA version 14.0. RESULTS Six hundred and thirty-six clients participated in the study. Majority of them were age between 30-39 years. Though majority, 607 (95.4%) participants approved the use of modern FP method, current use rate stood at 39%. Condom was the most (14.5%) commonly used single method. The odds of FP use by participants who disclosed their HIV status were almost twice that of their counterparts (AOR= 1.84; 95% CI: 1.14, 2.95). Participants who held discussion with their spouse/partners concerning FP, irrespective of the frequency had an odd of more than four when using FP than their counterparts (AO= 4.35; 95% CI: 2.69, 7.04). CONCLUSION This study revealed that 6 out of every 10 HIV+ clients are not currently using FP methods. Disclosure of HIV status as well as open discussion with spouse/partner were positively associated with family planning use. These study findings call for comprehensive and client focus FP education and counseling in line with disclosure of HIV status and dialogue with spouse/partner in order to increase uptake and utilization of FP among clients. Partners have a great influence on the use and choice of FP methods, so their views are paramount.
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Affiliation(s)
- Akateh Derek
- Department of Public Medicine and Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Department of Reproductive Health and Health System Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Cameroon Baptist Convention Health Services (CBCHS), Yaoundé, Cameroon
| | - Assefa Seme
- Department of Reproductive Health and Health System Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Cho Sabastine Anye
- Cameroon Baptist Convention Health Services (CBCHS), Yaoundé, Cameroon
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Claude Ngwayu Nkfusai
- Cameroon Baptist Convention Health Services (CBCHS), Yaoundé, Cameroon
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Samuel Nambile Cumber
- Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Institute of Medicine, Department of Public Health and Community Medicine (EPSO), University of Gothenburg, Box 414, SE-405 30 Gothenburg, Sweden
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria Private Bag X323, Gezina, Pretoria, 0001, Pretoria, South Africa
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Mersha AG, Erku DA, Belachew SA, Ayele AA, Gebresillassie BM, Abegaz TM. Contraceptive use among HIV-positive and negative women: implication to end unintended pregnancy. Contracept Reprod Med 2019; 4:3. [PMID: 30783537 PMCID: PMC6376717 DOI: 10.1186/s40834-019-0084-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 01/28/2019] [Indexed: 11/20/2022] Open
Abstract
Background With the advancement of antiretroviral therapy and improved life expectancy, women living with HIV/AIDS are enjoying a better sexual life. Yet, the consistent utilization of contraceptive in such patients is highly recommended. There is paucity of data regarding contraceptive use among HIV-positive and negative women in Ethiopia. The present study aimed at examining the use of contraceptives among HIV-positive and HIV-negative women in Ethiopia. Methods A comparative cross-sectional study was conducted among HIV-positive and HIV-negative women attending family planning Clinic of Gondar university referral hospital between January 2016 and August 2017. Descriptive statistics were used to present categorical data and Pearson’s chi-square test was done to examine differences in the utilization of contraceptives between HIV-positive and HIV-negative women. Kaplan Meier test was also carried out to determine the incidence of unintended pregnancy. A p-value of 0.05 was deemed significant with corresponding 95% confidence intervals. Results A total of 894 participants consisting of 314 HIV-positive and 580 HIV-negative women were included in the study. The rate of previous unintended pregnancy was 280 (31.3%) in HIV-negative women and 115 (12.9%) in HIV-infected women. Women who routinely utilized contraceptives were more likely to avoid unintended pregnancy [log rank: 2.89, p < 0.05]. Unlike HIV-negative women (2.9%), HIV-positive (28.4%) women reported a higher rate of intrauterine device use. Male condom was used more commonly in HIV-infected women (26.7%) as compared to HIV negative (3.9%) women (p-value < 0.05). Conclusions Intrauterine contraceptive device was reported to be the most commonly used contraceptive method in HIV patients. Further, unintended pregnancy was relatively common in women with low contraceptive practice. The use of dual contraceptives should be advocated for HIV-positive women so as to protect unintended pregnancy and curtail the transmission of HIV.
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Affiliation(s)
- Amanual Getnet Mersha
- 1Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Asfaw Erku
- 2Department of Medicinal Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sewunet Admasu Belachew
- 3Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asnakew Achaw Ayele
- 3Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Begashaw Melaku Gebresillassie
- 3Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Melaku Abegaz
- 3Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Reta MM, Tessema GA, Shiferaw G. Prevalence of dual contraceptive use and associated factors among HIV positive women at University of Gondar Hospital, Northwest Ethiopia. BMC Res Notes 2019; 12:36. [PMID: 30658683 PMCID: PMC6339424 DOI: 10.1186/s13104-019-4053-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/08/2019] [Indexed: 11/15/2022] Open
Abstract
Objective Dual contraceptive is the use of male condom besides any modern contraceptive. It reduces parent to child transmission of HIV and other sexually transmitted infections between partners. The aim of this study was to investigate the prevalence and associated factors of dual contraceptive use among HIV positive women at University of Gondar Hospital, North West Ethiopia. Result The prevalence of dual contraceptive use was found to be 13.2% (95% CI 10.5, 16.0). Partner involvement in post-test counseling [AOR = 3.11 (95% CI = 1.74, 5.57)], open partner discussion on using dual contraceptive [AOR = 7.84, 95% CI (4.26, 14.42)], provision of counseling about dual contraception [AOR = 6.56, 95% CI (3.54, 12.18)], age 18–24 years [AOR = 4.79, 95% CI (1.72, 13.32)], age 25–34 years [AOR = 1.97, 95% CI (1.01, 3.85)] and being a housewife [AOR = 4.38, 95% CI (1.89, 10.16)] were significant factors associated with dual contraceptive use. The prevalence of dual contraceptive use was low. This shows, there is a need to in promote partner involvement in HIV testing and counseling by offering counseling session in a couple-basis. It is also necessary for programmers to routinely focus on provision of dual contraception for HIV-infected women and Integration of family planning into HIV care follow-up clinic need to be strengthened.
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Affiliation(s)
- Mebratu Mitiku Reta
- Department of Internal Medicine, School of Medicine, University of Gondar, Gondar, Ethiopia.
| | - Gizachew Assefa Tessema
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Getachew Shiferaw
- Department of Gynecology and Obstetrics, School of Medicine, University of Gondar, Gondar, Ethiopia
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Araya BM, Solomon AA, Gebreslasie KZ, Gudayu TW, Anteneh KT. The role of counseling on modern contraceptive utilization among HIV positive women: the case of Northwest Ethiopia. BMC WOMENS HEALTH 2018; 18:121. [PMID: 29973171 PMCID: PMC6033227 DOI: 10.1186/s12905-018-0603-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
Abstract
Background Over 90% of the children with Human Immunodeficiency Virus are infected through the mother to child transmission process according to literatures. Preventing unintended pregnancy by using contraceptive methods is crucial for reducing maternal and child mortality and morbidity. Here we set out to assess the prevalence and associated factors of modern contraceptive utilization among sexually active reproductive age women attending Anti-Retroviral Therapy clinics in Amhara Region referral hospitals in 2016. Methods An institution based cross sectional study was carried out from April to July 2016 surveying women of reproductive age attending the Anti-Retroviral Therapy clinics in the five Amhara Region referral hospitals. A pretested and semi-structured questionnaire was used to collect data. EpiInfo7 and SPSS version 20 soft wares were used for data entry and analysis, respectively. Significant associations were identified on the basis of the adjusted odds ratio, with 95% Confidence Interval, and p value ≤0.05, was taken as statistically significant. Result The proportion of women utilizing modern contraceptives was 47.7% with (95% CI: 43, 52.5%), the male condom being the most (64.2%) utilized method. The use of the contraceptive methods was most prevalent among women 15–24 years of age (AOR = 6.5, 95% CI: 2–10) and age of 25–34 (AOR = 3, 95% CI: 1.6–5.5), having an urban residence (AOR = 0.095, 95% CI: 0.03–0.28), having discussed contraceptives with partner (AOR = 7, 95% CI: 5.3–11.9), receiving counseling from health care providers (AOR = 4.8, 95% CI: 1.8–7), previous history of contraceptive utilization (AOR = 5.6, 95% CI: 2.6–8.3), and with CD4 count >500mm3/dl (AOR = 2.4, 95% CI: 1.3–4.3). Conclusion The proportion of women utilizing contraceptive has been low in Amhara Region referral hospitals. Encouraging patients to discuss about contraception with partners and repeated counseling by health care providers may strengthen contraceptive utilization.
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Affiliation(s)
- Bilen Mekonnen Araya
- School of midwifery, college of medicine and health sciences, university of Gondar, Gondar, Ethiopia.
| | - Abayneh Akililu Solomon
- School of midwifery, college of medicine and health sciences, university of Gondar, Gondar, Ethiopia
| | | | - Temesgen Worku Gudayu
- School of midwifery, college of medicine and health sciences, university of Gondar, Gondar, Ethiopia
| | - Kiber Temesgen Anteneh
- School of midwifery, college of medicine and health sciences, university of Gondar, Gondar, Ethiopia
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Yaya I, Patassi AA, Landoh DE, Bignandi EM, Kolani K, Namoro ADD, Patchali PM, Djalogue L, Ekouevi DK, Saka B. Modern contraceptive use among HIV-infected women attending HIV care centres in Togo: a cross-sectional study. BMJ Open 2018; 8:e019006. [PMID: 29691241 PMCID: PMC5922471 DOI: 10.1136/bmjopen-2017-019006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Contraceptive use among HIV-infected women in Togo is poorly documented. We aim at assessing the prevalence of modern contraceptive use and associated factors among HIV-infected women in Togo. DESIGN Cross-sectional study. SETTING The study was conducted in five HIV care centres in the Centrale and Kara regions in Togo. PARTICIPANTS We included 461 HIV-positive women aged between 15 and 49 years and who were sexually active. MAIN OUTCOME MEASURE The outcome variable was HIV-infected women who were using modern contraceptive methods. RESULTS A total of 461 HIV-infected women were interviewed, with an average age of 34.3 (±7.1). Among them, 332 (73.1%) women reported using contraceptive methods, mostly condom alone (74.7%) or in combination with hormonal contraceptive (16.9%). In multivariate analysis, education level (primary: adjusted OR (aOR)=1.99, 95% CI (1.05 to 3.76); secondary level and higher: aOR=3.95, 95% CI (2.03 to 7.67)), WHO clinical stage (stage II: aOR=0.7, 95% CI (0.37 to 1.33)), follow-up in private care facilities (aOR=2.54, 95% CI (1.22 to 5.29)) and having a child (aOR=2.51, 95% CI (1.41 to 4.5)) were associated with higher contraceptive use, while marital status (living in union: aOR=0.45, 95% CI (0.28 to 0.74)) and WHO stages III and IV (aOR=0.47, 95% CI (0.24 to 0.94)) were associated with lower contraceptive use. CONCLUSION About three-quarters of sexually active HIV-infected women in Togo were using contraceptive methods, and private health facilities favoured this contraceptive use. It is important to strengthen the implementation of interventions to increase the incentives for HIV-infected women to use contraception in Togo.
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Affiliation(s)
- Issifou Yaya
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | | | | | | | | | | | | | | | - Didier Koumavi Ekouevi
- Département de Sante Publique, Université de Lomé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, Togo
| | - Bayaki Saka
- Service de dermatologie, CHU Sylvanus Olympio, Lomé, Togo
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Stifani BM, MacCarthy S, Nunn A, Benfield N, Dourado I. From Pill to Condom, or Nothing at all: HIV Diagnosis and Discontinuation of Highly Effective Contraceptives Among Women in Northeast Brazil. AIDS Behav 2018; 22:663-670. [PMID: 28688030 PMCID: PMC9982654 DOI: 10.1007/s10461-017-1846-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This is a cross-sectional study examining highly effective contraceptive (HEC) use among HIV-positive women in Salvador, Brazil. We used multivariate logistic regression to look for predictors of alternative contraceptive choices among women who discontinued HEC after HIV diagnosis. Of 914 participants surveyed, 38.5% of participants used HEC before but not after diagnosis. Of these, 65.9% used condoms alone; 19.3% used no protection; and 14.8% reported abstinence. Use of condoms alone was associated with a history of other sexually transmitted infections (AOR 2.18, 95% CI 1.09-4.66, p = 0.029). Abstinence was associated with recent diagnosis (AOR 8.48, 95% CI 2.20-32.64, p = 0.002). Using no method was associated with age below 25 (AOR 5.13, 95% CI 1.46-18.00, p = 0.011); income below minimum wage (AOR 2.54, 95% CI 1.31-4.92, p = 0.006); HIV-positive partner status (AOR 2.69, 95% CI 1.03-7.02, p = 0.043); and unknown partner status (AOR 2.90, 95% CI 1.04-8.05, p = 0.042). Improved contraceptive counseling is needed after HIV diagnosis. Continuation of HEC should be encouraged for women wishing to prevent pregnancy, and may increase contraceptive coverage among HIV-positive women.
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Affiliation(s)
- Bianca M Stifani
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Sarah MacCarthy
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Amy Nunn
- School of Public Health of Brown University, 121 South Main Street, Suite 810, Providence, RI, 02912, USA
| | - Nerys Benfield
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (UFBA), Rua Basílio da Gama, s/n - Campus Universitário Canela, Salvador, Bahia, 40110-040, Brazil
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Mulongo AM, Lihana RW, Githuku J, Gura Z, Karanja S. Factors associated with uptake of dual contraception among HIV-infected women in Bungoma County, Kenya: a cross-sectional study. Pan Afr Med J 2017; 28:2. [PMID: 30167030 PMCID: PMC6113694 DOI: 10.11604/pamj.supp.2017.28.1.9289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 09/26/2016] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION dual contraception, the use of non-barrier contraceptive method in combination with condoms, is an effective strategy in the elimination of mother-to-child transmission (eMTCT) of human immunodeficiency virus (HIV) and the achievement of zero new HIV infections. Despite its effectiveness, dual contraception use among HIV-infected women in Kenya remains low. We identified factors associated with dual contraceptive uptake in Bungoma County, Kenya. METHODS this was a facility-based cross-sectional study in eight hospitals in Bungoma County. We interviewed women using structured questionnaires. We calculated descriptive statistics about the womens' baseline characteristics, examined the association between dual contraceptive use and other factors by calculating Odds Ratios (OR) and 95% Confidence Intervals (CI) and performed logistic regression. RESULTS we recruited 283 HIV-infected women.Among all enrolled women, 190 (67.1%) were aware of dual method and only 109 (38.5%) used dual contraception. The preferred dual pattern was male condom plus injectable contraceptive used by 53.2% of women (58/109). Among the 174 women who did not use dual contraception, 86 (49.4%) preferred using male condoms alone for contraception. Women were more likely to use dual contraception method if they were aware of dual contraception (AOR 12.2, 95% CI 4.7 - 31.7), used non-barrier contraceptives (AOR 9.8 95%; CI 4.5 - 21.3) and had disclosed their HIV status (AOR 7.1 95% CI 2.8 - 18.2) compared to those who did not. CONCLUSION dual contraceptive prevalence was low. Advocacy on dual contraception as an approach to preventing vertical transmission of HIV should be escalated in order to improve its uptake.
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Affiliation(s)
- Agnes Mideva Mulongo
- Jomo Kenyatta University of Agriculture and Technology, Kenya
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya
| | | | - Jane Githuku
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya
| | - Simon Karanja
- Jomo Kenyatta University of Agriculture and Technology, Kenya
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Gebrehiwot SW, Azeze GA, Robles CC, Adinew YM. Utilization of dual contraception method among reproductive age women on antiretroviral therapy in selected public hospitals of Northern Ethiopia. Reprod Health 2017; 14:125. [PMID: 28982364 PMCID: PMC5629799 DOI: 10.1186/s12978-017-0390-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/26/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sexually transmitted infections are highly prevalent among pregnant women in Africa. Among the incidence of HIV infection in children, 90% of the infection is attributable to their mothers. Ethiopia is one of the countries with an increasing risky sexual behavior and the most affected by the HIV epidemic. If prevention of mother to child transmission focuses on increasing contraception, it will prevent more than 29% of HIV infection at birth. Therefore, the aim of this study was to assess utilization of dual contraceptive method and associated factors among reproductive age women on antiretroviral therapy in selected public hospitals of Mekelle town, Northern Ethiopia. METHODS Institution based cross-sectional survey was conducted in selected public hospitals of Mekelle among women under antiretroviral therapy from March 1-April 31, 2016. We used a systematic sampling technique to select 331 women. A pretested interviewer administered questionnaire was used for data collection. The data were entered in to Epi data version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariable logistic regression analysis was computed. Odds ratio along with 95% CI was computed to ascertain the association. Statistical tests at p-value of < 0.05 were considered as cut off point to determine statistical significance. RESULTS Only 51(15.7%) of participants have utilized dual contraception method. Being single[AOR 5.43, 95% CI (1.61, 18.32)] and cohabitated [AOR 6.06; 95% CI: (2.16, 16.95)] in marital status, having HIV negative partner [AOR 4.44; 95% CI: (1.23, 16.04)], exposure to post diagnosis counseling [AOR 3.03; 95% CI: 1.34, 6.80], disclosed HIV status [AOR 6.06; 95% CI: (1.78, 20.87)] and discussing safer sex with partner [AOR 6.96; 95% CI: (2.75, 16.62)] were positively associated with utilization of dual contraceptive method. CONCLUSION The overall magnitude of dual contraceptive use is still low in this study. This will be a great concern on the transmission of the virus from mother to babies and partners and risk of complications following unintended pregnancy. This will continue to present as major public health problems in the region unless future interventions focuses on the barriers through tailored counseling and husband involvement in all aspects of the HIV/AIDS care.
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Affiliation(s)
| | - Gedion Asnake Azeze
- College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Carmen C. Robles
- Department of Midwifery, College of Health Science, Mekelle University, P.O. Box 1871, Mekelle, Ethiopia
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21
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Adilo TM, Wordofa HM. Prevalence of fertility desire and its associated factors among 15- to 49-year-old people living with HIV/AIDS in Addis Ababa, Ethiopia: a cross-sectional study design. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2017; 9:167-176. [PMID: 28919821 PMCID: PMC5587090 DOI: 10.2147/hiv.s133766] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background The magnitude of unprotected sex to satisfy the desire for fertility among people living with HIV/AIDS (PLHIV) may rise more due to the availability of antiretroviral therapy (ART) in most HIV-affected countries. This could, however, have the risk of passing on HIV to sexual partners and children. The aim of this study, therefore, was to determine the magnitude and factors associated with the fertility desire of reproductive-age PLHIV in Addis Ababa, Ethiopia, for research-based and timely actions. Methods A cross-sectional study was carried out from April to June 2016 among 442 randomly selected, reproductive-age PLHIV who had been attending ART clinics in Addis Ababa. Twelve experienced and trained nurses collected the data. The questionnaire was pretested and interviewer-administered, and the interview was executed after obtaining voluntary consent from each study subject. The data were then cleaned and analyzed by using Epi Info version 3.5.4 and SPSS version 20.0, respectively. Binary logistic regression was done in order to describe the association of fertility desire with some sociodemographic and sexual behavior-related factors. Results Among the total 441 respondents, 54.6% reported the desire for fertility, 87% disclosed their HIV status, 24.3% had two or more sexual partners in the earlier year, and only 55.6% used a condom during their last sexual intercourse. In addition, current health status (AOR=2.03; 95% CI: 1.01–4.07) and partner being tested for HIV (AOR=6.31; 95% CI: 1.35–29.64) showed statistically significant associations with fertility desire during multivariate logistic regression analysis. Conclusion A considerable number of PLHIV in the study area reported a desire for having children. Current health status and partner being tested for HIV were found to be factors associated with the fertility desire among PLHIV. Thus, more efforts to effectively address the health concerns related to fertility desire and risky sexual behavior among HIV-infected people of reproductive age could play a significant role in prevention and control measures against HIV/AIDS epidemic.
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Guillaine N, Mwizerwa W, Odhiambo J, Hedt-Gauthier BL, Hirschhorn LR, Mugwaneza P, Umugisha JP, Cyamatare FR, Mutaganzwa C, Gupta N. A Novel Combined Mother-Infant Clinic to Optimize Post-Partum Maternal Retention, Service Utilization, and Linkage to Services in HIV Care in Rural Rwanda. Int J MCH AIDS 2017; 6:36-45. [PMID: 28798892 PMCID: PMC5547224 DOI: 10.21106/ijma.186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite recent improvements in accessibility of services to prevent mother-to-child transmission of HIV, maternal retention in HIV care remains a challenge in the post-partum period. This study assessed service utilization, program retention, and linkage to routine services, as well as clinical outcomes for mothers and infants, following implementation of an integrated mother-infant clinic in rural Rwanda. METHODS We conducted a retrospective cohort study of all HIV-positive mothers and their infants enrolled in the integrated clinics in two rural districts between July 1, 2012, and June 30, 2013. At 18 months post-partum, data on mother-infant service utilization and program outcomes were reported. RESULTS Of the 185 mother-infant pairs in the clinics, 98.4% of mothers were on antiretroviral therapy (ART) and 30.3% used modern contraception at enrollment. At 18 months post-partum, 98.4% of mothers were retained and linked back to adult HIV program. All mothers were on ART and 72.0% on modern contraception. For infants, 93.0% completed follow-up. Two (1.1%) infants tested HIV positive. CONCLUSION AND GLOBAL HEALTH IMPLICATION An integrated clinic was successfully implemented in rural Rwanda with high mother retention in care and low mother to child HIV transmission rates. This model of integration of services may contribute to improved mother-infant retention in care during post-partum period and should be considered as one approach to addressing this challenge in similar settings.
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Affiliation(s)
| | | | | | - Bethany L Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02125, USA
| | - Lisa R Hirschhorn
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02125, USA.,Partners In Health, Boston, MA 02199, USA.,Ariadne Labs, Boston, MA 02215, USA
| | | | | | | | | | - Neil Gupta
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Division of Global Health Equity, Brigham & Women's Hospital, Boston, MA 02115, USA
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Factors Associated with Hormonal and Intrauterine Contraceptive Use among HIV-Infected Men and Women in Lilongwe, Malawi: A Cross-Sectional Study. Infect Dis Obstet Gynecol 2016; 2016:5429316. [PMID: 27642245 PMCID: PMC5013202 DOI: 10.1155/2016/5429316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Understanding the factors associated with the use of hormonal and intrauterine contraception among HIV-infected men and women may lead to interventions that can help reduce high unintended pregnancy rates. Materials and Methods. This study is a subanalysis of a cross-sectional survey of 289 women and 241 men who were sexually active and HIV-infected and were attending HIV care visits in Lilongwe, Malawi. We estimated adjusted prevalence ratios (PRs) to evaluate factors associated with hormonal and intrauterine contraceptive use for men and women in separate models. Results and Discussion. 39.8% of women and 33.2% of men (p = 0.117) reported that they were using hormonal or intrauterine contraception at last intercourse. Having greater than 3 children was the only factor associated with hormonal and intrauterine contraceptive use among men. Among women, younger age, not wanting a pregnancy in 2 years, being with their partner for more than 4 years, and being able to make family planning decisions by themselves were associated with hormonal and intrauterine contraceptive use. Conclusions. The men and women in our study population differed in the factors associated with hormonal and intrauterine contraceptive use. Understanding these differences may help decrease unmet FP needs among HIV-infected men and women.
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