Dual contraception method utilization and associated factors among sexually active women on antiretroviral therapy in Gondar City, northwest, Ethiopia: a cross sectional study

Knowledge, attitude, practices and associated factors of family planning among women living with hiv at the university of Gondar specialized hospital: a cross sectional study

INTRODUCTION

HIV/AIDS poses a significant health challenge in sub-Saharan African countries, with a disproportionate impact on women of reproductive age. The disparities in knowledge, attitudes, and practices related to family planning among women living with HIV can be intricate and multi-faceted. This study aimed to assess the knowledge, attitude, practice, and associated factors regarding family planning among the women living with HIV at the University of Gondar specialized hospital, Gondar, Ethiopia.

METHOD

A cross-sectional study was carried out at the University of Gondar Teaching Referral Hospital, focusing on HIV-positive women of reproductive age who visited the ART unit from July 8-28, 2022. Data collection involved the use of pre-tested, structured questionnaires administered through interviews. The gathered data were entered into the electronic Kobo Collect platform and subsequently exported for analysis using SPSS version 26. Descriptive summaries, including frequencies, means, and percentages, were presented through tables and figures. Logistic regression was employed to identify potential predictors, presenting adjusted odds ratios with a 95% confidence interval and a significance level set at a P-value of 0.05.

RESULTS

A total of 328 study participants were included. About 93% of the study population had good knowledge about modern contraceptives, and about 94% of the study population had good knowledge about safer conception. Only 30.2% of the study population had knowledge of the dual contraceptive method. The attitude and practice of women towards family planning (FP) were 71.0% and 55.8%, respectively. The study revealed that the most commonly employed contraceptive method was injectable contraceptives, constituting 34.2% of usage. Having one and a greater number of children (AOR = 2.25, 95% CI: 1.10, 4.49), having discussions on fertility plans with healthcare providers (AOR = 2.20, 95% CI: 1.02, 4.761), and having good family planning practices (AOR = 2.15, 95% CI: 1.19, 3.87) were significantly associated with the attitude toward family planning. Married women (AOR = 1.88, 95% CI = 1.11, 3.1), able to read and write (AOR = 2.12, 95% CI:1.04,4.32), college and above educational level (AOR = 4.51, 95% CI:1.93,10.87), had discussion on fertility plan with healthcare providers (AOR = 5.09, 95% CI: 1.96, 13.24), knowledge about dual method (AOR = 1.95, CI: 1.08, 3.50), and knowledge about modern contraceptive methods (AOR = 7.24, 95% CI: 1.56, 33.58) were significantly associated with good practice of family planning.

CONCLUSION

Women living with HIV exhibited notably high levels of knowledge regarding modern contraceptive methods and safer conception. The knowledge of the dual method was low. More than half of the study population had good practice in family planning. More than two-thirds of HIV-positive reproductive-age women had a good attitude about family planning. Having one or a greater number of children, having a discussion on a fertility plan with a healthcare provider, and having a good practice of family planning were significantly associated with a good attitude toward family planning. Married women, education status, discussions on fertility plans with healthcare providers, knowledge about dual methods, and knowledge about modern contraceptive methods were significantly associated with good family planning practices. The stakeholders should design interventions based on the aforementioned factors to improve the attitude and practice of family planning.

Dual contraceptives and associated predictors in HIV positive women: a case-control study

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.

Women living with HIV and dual contraceptive use in Ethiopia: systematic review and meta-analysis

Background

Despite different preventive strategies that have been implemented in the country, the prevalence of HIV/AIDS is still significantly increasing in Ethiopia. The concurrence of HIV and unintended pregnancy makes the use of dual contraception a back bone for the simultaneous protection against HIV, and unintended pregnancy. As a result, this systematic review and meta-analysis aimed to assess the prevalence and associated factors of dual contraceptive use among women living with HIV in Ethiopia.

Method

We used databases; (PubMed, Google Scholar, EMBASE, Cochrane Library, African Online Journals, and Hinary), other gray and online repository accessed studies were searched using different search engines. For critical appraisal of studies Newcastle-Ottawa Quality Assessment Scale (NOS) was used. The analysis was done using STATA 11 software. The Cochran Q test and I² test statistics were used to assess the heterogeneity. To detect publication bias funnel plot and Egger’s test were used. The pooled prevalence of dual contraception use and the odds ratio (OR) with a 95% confidence interval was presented by using forest plots.

Result

Eleven studies were included in this review, with a total of 4083 women living with HIV in Ethiopia. The pooled prevalence of dual contraception use in Ethiopia was 34.08% (95%CI: 20.77–47.38). Having open partner discussion (OR = 3.96, 95%CI:2.3,6.8), provision of post test counseling (AOR = 4.38, 95%CI:2.93,6.54), disclosed HIV status to sexual partners (OR = 5.9, 95%CI:4.19,8.33), partner involvement in post-test counseling (OR = 3.52, 95%CI:2.37,5.23), and being on highly active antiretroviral therapy (HAART) (OR = 2.9, 95%CI:1.56,5.46) were the determinant factors of dual contraceptive use in Ethiopia.

Conclusion

The overall prevalence of dual contraceptive use among women living with HIV in Ethiopia was low. Having open partner discussion, provision of post-test counseling, disclosed HIV status to sexual partner, partner involvement in post-test counseling, and currently on highly active antiretroviral therapy (HAART) were the associated factors of dual contraceptive use. Therefore, efforts should be made to provide post-test counseling, and initiate partner involvement in post-test counseling. Moreover, promoting open partner discussion, counseling to disclose HIV status to their sexual partner and to start HAART will be helpful in enhancing the use of dual contraceptive method use.

Dual contraceptive utilization and determinant factors among HIV positive women in Ethiopia: a systematic review and meta-analysis, 2020

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.

Dual Contraceptive Utilization and Associated Factors Among Reproductive-Age Women on Anti-Retroviral Therapy at Hospitals in Central Ethiopia

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.

Dual Contraceptive Use and Associated Factors Among Reproductive Age Group on Antiretroviral Therapy in Borena District, Northeast Ethiopia: A Cross-Sectional Study

Background

Dual contraceptive method use is defined as the use of any modern contraceptive method with a condom for the reduction of mother-to-child transmission of HIV and sexually transmitted infections between sexual partners. The goal of this study was to assess the proportion and factors associated with dual contraceptive use among reproductive age women on antiretroviral therapy in Borena district, Northeast Ethiopia.

Objective

To assess the proportion of dual contraceptive use and associated factors among the reproductive age women on antiretroviral therapy in Borena district, Northeast Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among HIV positive reproductive age group women on antiretroviral therapy in Borena district from February 1 to March 1, 2020. A systematic random sampling technique was used to include 417 study participants. A structured interviewer-administered questionnaire was used to collect the data. A binary logistic regression model was used to identify the factors associated with dual contraceptive use. Odds ratio with 95% confidence interval (CI) and P-value were calculated to assess the strength of association.

Results

The results showed that 19.4% of the HIV positive reproductive age group on antiretroviral therapy were using dual contraceptive method. Urban area (AOR=3.66, 95% CI=1.66-8.09), educated to secondary education and above (AOR=3.54, 95% CI=1.29-9.76), those who have no desire to have a child (AOR=4.41, 95% CI=2.66-7.59), those with partners whose HIV status was negative (AOR=4.96, 95% CI=2.66-12.02) and those with partners whose HIV status was positive (AOR=2.45, 95% CI=1.25-4.81) were more likely to use the dual contraception method.

Conclusion

This study showed that the proportion of dual contraceptive use was found to be low in accordance with the WHO recommendation. Therefore increased awareness on the advantages of dual contraception and knowing partner's HIV status is important.