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Revathy R, Chaurasia H, Shetty S, Joshi B. Health facility-based interventions and the uptake of contraception among people living with HIV: A systematic review & meta-analysis. Indian J Med Res 2023; 158:483-493. [PMID: 38143434 PMCID: PMC10878490 DOI: 10.4103/ijmr.ijmr_2471_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND OBJECTIVES The prong 2 of 4 prong strategy introduced by the World Health Organization aims at averting unintended pregnancies among people living with HIV (PLHIV). This systematic review aimed to generate evidence on the effectuality of facility-based interventions in improving uptake of modern and dual contraception, for reducing unmet family planning (FP) needs and unintended pregnancies among PLHIV. METHODS Articles evaluating facility-based interventions to integrate human immunodeficiency virus (HIV) and FP published in English language were included. Eligible studies were identified from electronic and lateral search from three databases (PubMed, Cochrane Library and Web of Science) and grey literature. HIV care with no/minimal focus on FP was considered a comparator. Quality was assessed using design-appropriate tools. Descriptive analysis was presented in tables. Uptake of dual methods, unmet FP needs and unintended pregnancies were included in the meta-analysis to estimate pooled odds ratio (OR) with random effect model, P and I2 values. RESULTS The search yielded 2112 results. After excluding duplicates and unfit articles, 17 were found eligible for review and nine for meta-analysis. The pooled OR for uptake of dual contraception was 1.69 (1.14, 2.5) ( P =0.008; I2 =90%), for unmet FP needs was 0.58 (0487, 0.69) ( P <0.00001; I2 =0%) and for unintended pregnancies was 0.6 (0.32, 1.1) ( P =0.1, I2 =38%). INTERPRETATION CONCLUSIONS The results of this meta-analysis suggest that health facility-based interventions to integrate HIV and FP services do result in improved uptake of dual methods and reduce unmet need for contraception along with a protective trend on incidence of unintended pregnancies. Such facility-based integration would ensure universal access to effective contraception and facilitate in achieving Sustainable Development Goals that aim at ending epidemics like HIV.
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Affiliation(s)
- R Revathy
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Himanshu Chaurasia
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Siddesh Shetty
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Beena Joshi
- Department of Operational and Implementation Research, Regional Resource Hub-Health Technology Assessment, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
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Jemberie A, Aynalem BY, Zeleke LB, Alemu AA, Tiruye TY. Dual Contraceptive Method Utilization and Associated Factors Among HIV Positive Women Attending ART Clinic in Finote-Selam Hospital: Cross-Sectional Study. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2639-2646. [PMID: 37027108 PMCID: PMC10501923 DOI: 10.1007/s10508-023-02593-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 03/06/2023] [Accepted: 03/19/2023] [Indexed: 05/11/2023]
Abstract
Worldwide, the human immune deficiency virus is the leading cause of death for women of childbearing age. Around two-thirds of all pregnant women living with the human immune deficiency virus experience an unintended pregnancy. The correct and consistent use of dual contraceptive methods is important to prevent unintended pregnancy and transmission of sexually transmitted infections. However, little is known about the utilization of dual contraceptive methods among HIV-infected women. Thus, this study aimed to assess dual contraceptive utilization and associated factors among HIV-positive women attending antiretroviral therapy (ART) in Finote Selam Hospital, Northwest Ethiopia. Facility-based cross-sectional study design was conducted from September 1 to October 30, 2019, in Finote Selam Hospital among HIV-positive women. A systematic random sampling technique was used to select study participants and the data were gathered by an interviewer-administered structured pretested questionnaire. Factors associated with dual contraceptive use were identified through binary logistic regression. Finally, a p-value < 0.05 was taken as a cutoff point to declare a significant association, and the direction and strength of the association were determined by the adjusted odds ratio. The study showed that 21.8% of HIV-positive women attending ART care in Finote Selam Hospital utilize dual contraceptive methods. Dual contraceptive utilization was significantly associated with having a child (AOR: 3.29; CI 1.45, 7.47), having family support to use dual contraceptives (AOR: 3.02; CI 1.39, 6.54), having multiple sexual partners (AOR: 0.11; CI 0.05, 0.22), and urban residence (AOR: 3.64; 1.82, 7.3). The study revealed that low utilization of dual contraceptive methods. This will continue major public health problems in the study area unless future interventions conducted.
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Affiliation(s)
- Anteneh Jemberie
- Health Science College, Debre Markos University, Debre Markos, 269, Ethiopia
| | | | - Liknaw Bewket Zeleke
- Health Science College, Debre Markos University, Debre Markos, 269, Ethiopia
- School of Women's and Children's Health, University of New South Wales Sydney, Kensington, Australia
| | - Addisu Alehegn Alemu
- School of Women's and Children's Health, University of New South Wales Sydney, Kensington, Australia
| | - Tenaw Yimer Tiruye
- Health Science College, Debre Markos University, Debre Markos, 269, Ethiopia
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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Haile D, Lagebo B. Magnitude of dual contraceptive method utilization and the associated factors among women on antiretroviral treatment in Wolaita zone, Southern Ethiopia. Heliyon 2022; 8:e09595. [PMID: 35677405 PMCID: PMC9168601 DOI: 10.1016/j.heliyon.2022.e09595] [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: 07/08/2021] [Revised: 11/11/2021] [Accepted: 05/24/2022] [Indexed: 10/26/2022] Open
Abstract
Background Expanding the contraceptive options based on desires of families and personal context is critical to address the needs of users. For instance, dual contraceptive methods were recommended for people with the human immunodeficiency virus (HIV) patients to prevent HIV transmission, other sexually transmitted infections (STIs), and unintended pregnancies. Disclosure is one of the strategies to reduce the stigma related to HIV and use of contraception clandestinely. However, there is a dearth of evidence regarding the magnitude of and the factors affecting dual contraceptive method utilization among sexually active women on antiretroviral treatment (ART).There is limited evidence regarding the association between disclosure to community and dual contraceptive utilization. Thus, the aim of this study is to assess the magnitude of dual contraceptive utilization and its associated factors among ART patients in this study area. Objective the primary objective of this study was to assess the prevalence of the dual contraceptive use. Methods A facility-based cross-sectional study design was employed to collect data from a total of 556 respondents by using a semi-structured questionnaire. Data were entered in EpiData version 3.1 and exported to SPSS version 20 for analysis. Binary logistic regression was applied to determine the magnitude of dual contraceptive utilization and the factors associated with it. Variables with p-value<0.25 were considered as candidate for multivariable logistic regression. In multivariate logistic regression, variables with a p-value < 0.05 were reported to be statistically significant. Result The magnitude of dual contraceptive utilization was 28.6% (95%CI: 24.8, 32.4). HIV sero-status disclosure to community (AOR:7.1 (95%CI: 4.8,10.2)), disclosure to sexual partners (AOR:3.1 (95%CI:1.2,7.8)), sexual activity (AOR: 4.7 (95%CI: 2.5, 10.0)), fertility desire (AOR:4.3 (95%CI:2.4,7.5)), history of STI (AOR: 3.2 (95%CI: 1.6, 6.6)), partners' sero-HIV status (AOR:3.7 (95%CI:1.7,8.1)), and discussion with sexual partners about dual contraceptive methods (AOR:5.8 (95%CI:2.2,8.5)) were significantly associated with dual contraceptive utilization. Conclusion This study found that a substantial number of mothers did not use dual contraceptive methods. Disclosure to community increases the use of dual contraceptive methods. Integrating the family planning with STI and ART care, strengthening the partner involvement during posttest counseling is recommended to increase the uptake of dual contraceptive methods utilization. Moreover, encouraging PLWHIV to disclose their HIV status to the community should be advocated.
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Affiliation(s)
- Dereje Haile
- Reproductive Health and Nutrition Department, School of Public Health, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
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Joshi B, Girase B, Shetty S, Verma V, Acharya S, Deoraj P, Kulkarni R, Begum S. Improving public health service delivery response to address contraceptive needs of socio-economically disadvantaged HIV positive people in Maharashtra, India. Contracept Reprod Med 2021; 6:14. [PMID: 33934712 PMCID: PMC8091514 DOI: 10.1186/s40834-021-00159-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 03/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background People living with HIV (PLHIV) receive free antiretroviral treatment (ART) in public health facilities of India. With improved life expectancy, unmet sexual and reproductive health needs of PLHIV have to be addressed through a converged programmatic response strategy. Evidence shows that socioeconomically disadvantaged women are most vulnerable to high reproductive morbidities, especially HIV positive women with an unmet need of contraception. Methods Programmatic convergence by linking ART and family planning services were strengthened at two public health facilities (district hospitals) generally accessed by disadvantaged socio-economic sections of the society. Barriers to linking services including stigma and discrimination were addressed through analysis of existing linkage situation, sensitization and training of healthcare providers and system-level interventions. This facilitated provider-initiated assessment of contraceptive needs of PLHIV, counseling about dual contraception using a couple approach, linkage to family planning centers and maintaining data about these indicators. Six hundred eligible PLHIV seeking care at ART centers were enrolled and followed up for a duration of 6 months. Acceptance of family planning services as a result of the intervention, use of dual contraception methods and their determinants were assessed. Results Eighty-seven percent HIV couples reached FP centers and 44.6% accepted dual methods at the end of the study period. Dual methods such as oral contraceptive pills (56.2%), IUCDs (19.4%), female sterilization (11.6%), injectable contraception (9.9%) and vasectomy (2.9%) in addition to condoms were the most commonly accepted methods. Condom use remained regular and consistently high throughout. The study witnessed seven unintended pregnancies, all among exclusive condom users. These women availed medical abortion services and accepted dual methods after counseling. Female index participants, concordant couples, counseling by doctors and women with CD4 count above 741 had higher odds of accepting dual contraception methods. Standard operating procedures (SOP) were developed in consultation with key stakeholders to address operational linkage of HIV and family programs. Conclusion The study saw significant improvement in acceptance of dual contraception by PLHIV couples as a result of the intervention. Implementation of SOPs with supportive supervision can ensure efficient linkage of programs and provide holistic sexual and reproductive healthcare for PLHIV in India.
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Affiliation(s)
- Beena Joshi
- Indian Council of Medical Research- National Institute for Research in Reproductive Health (NIRRH), Mumbai, Maharashtra, India.
| | - Bhushan Girase
- Indian Council of Medical Research- National Institute for Research in Reproductive Health (NIRRH), Mumbai, Maharashtra, India.,Family Health Department, PATH India, New Delhi, India
| | - Siddesh Shetty
- Indian Council of Medical Research- National Institute for Research in Reproductive Health (NIRRH), Mumbai, Maharashtra, India
| | - Vinita Verma
- National AIDS Control Organization, New Delhi, India
| | - Shrikala Acharya
- Mumbai District AIDS Control Society, Mumbai, Maharashtra, India
| | - Pramod Deoraj
- Maharashtra State AIDS Control Society, Mumbai, Maharashtra, India
| | - Ragini Kulkarni
- Indian Council of Medical Research- National Institute for Research in Reproductive Health (NIRRH), Mumbai, Maharashtra, India
| | - Shahina Begum
- Indian Council of Medical Research- National Institute for Research in Reproductive Health (NIRRH), Mumbai, Maharashtra, India
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Amare G, Cherie N, Mekonen AM. Dual Contraceptive Use and Associated Factors Among Reproductive Age Group on Antiretroviral Therapy in Borena District, Northeast Ethiopia: A Cross-Sectional Study. HIV AIDS (Auckl) 2021; 13:107-114. [PMID: 33531844 PMCID: PMC7847380 DOI: 10.2147/hiv.s289045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Gashaw Amare
- Department of Reproductive Health and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, Ethiopia
| | - Niguss Cherie
- Department of Reproductive Health and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, Ethiopia
| | - Asnakew Molla Mekonen
- Department of Health Systems Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, 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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Gausi B, Chagomerana MB, Tang JH, Hosseinipour MC, Haddad LB, Hannock T, Phiri S. Human Immunodeficiency Virus Serodiscordance and Dual Contraceptive Method Use Among Human Immunodeficiency Virus-infected Men and Women in Lilongwe, Malawi. Sex Transm Dis 2019; 45:747-753. [PMID: 30303948 PMCID: PMC6200388 DOI: 10.1097/olq.0000000000000868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Some human immunodeficiency virus (HIV) serodiscordant couples are faced with the dual challenge of preventing HIV transmission to the uninfected partner and avoiding unintended pregnancy. Therefore, we hypothesized that serodiscordance is associated with dual method use at last sex. METHODS We analyzed data from a cross-sectional survey of HIV-infected men and women attending 2 ante-retroviral therapy clinics in Lilongwe, Malawi. We used Fisher exact test and Wilcoxon rank sum to assess for associations between serodiscordance, covariates, and dual method use. Multivariable logistic regression was used to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CI) of dual method use at last sex, comparing serodiscordant to seroconcordant relationships. Separate analyses were conducted for men and women. RESULTS We surveyed 253 HIV-infected men, of which 44 (17.4%) were in a known serodiscordant relationship and 63 (24.9%) were using dual methods at last sex. Likewise, among 302 HIV-infected women surveyed, 57 (18.9%) were in a known serodiscordant relationship, and 80 (26.5%) were using dual method at last sex. Serodiscordance was not significantly associated with dual method use at last sex for among HIV-infected men (aOR, 0.62; 95% CI, 0.27-1.44) or women (aOR, 1.21; 95% CI, 0.59-2.47). CONCLUSION Dual method use was low among all HIV-infected individuals, irrespective of their partner's HIV status. Given these findings, we recommend greater efforts to encourage HIV providers to counsel their patients about the importance of dual method use to prevent both unintended pregnancy and sexually transmitted infections.
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Affiliation(s)
| | | | | | | | - Lisa B Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Emory University, Atlanta GA
| | - Tweya Hannock
- The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Sam Phiri
- The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
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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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Pokharel R, Bhattarai G, Shrestha N, Onta S. Knowledge and utilization of family planning methods among people living with HIV in Kathmandu, Nepal. BMC Health Serv Res 2018; 18:836. [PMID: 30400972 PMCID: PMC6220510 DOI: 10.1186/s12913-018-3643-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Addressing family planning (FP) needs of people living with HIV is an effective response to HIV prevention. Healthy timing and spacing of births help ensure the health and well-being of all women and infants, regardless of their HIV-infection. In addition, preventing unintended pregnancies is an important strategy for prevention of mother to child transmission of HIV. The main purpose of this study was to explore the knowledge of family planning methods and identify factors affecting the utilization of such methods among HIV infected men and women attending two Anti-Retroviral Therapy (ART) sites of Kathmandu, Nepal. Methods This was a descriptive cross-sectional study. Two ART sites of Kathmandu were purposively chosen and a sample of 265 respondents (both men and women) was selected based on proportionate probability random sampling. A structured questionnaire was administered face to face to all of the eligible participants. Results The mean ± SD age of the participants was 36.62 ± 7.58 years. Sixty five percent of the respondents’ spouses were HIV positive. A majority of the respondents (72%) had heard of seven modern family planning methods. Considerably high number (72%) of the respondents or their spouses were using at least one of the method of family planning. The most common method was condom (83%) and the least common was IUCD (0.50%). The use of short acting (pills, depo-provera) and long acting (implant, IUCD) family planning methods other than condom dropped from 56.6 to 2% after diagnosis. Utilization of family planning methods was significantly associated with gender, education and HIV status of spouse. Males (Adjusted Odds Ratio (AOR) = 2.48, 95% CI = 1.20–5.07, p = 0.01) educated respondents (AOR = 3.27, 95% CI = 1.41–7.54, p = < 0.01) and individuals whose spouse were not infected with HIV (AOR = 4.70, 95% CI = 1.41–15.67, p = 0.01) were more likely to use FP methods. Conclusion The tendency for HIV infected men and women to avoid additional child bearing in Nepal is higher compared to sub-Saharan Africa. However, the use of effective methods of family planning is low. Therefore, more effective counselling sessions by service providers regarding the availability and use of alternative family planning methods besides condom is necessary.
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Affiliation(s)
- Rajani Pokharel
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Geeta Bhattarai
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
| | - Namuna Shrestha
- School of Public Health and Department of Community Medicine, Chitwan Medical College, Bharatpur, Nepal
| | - Sharad Onta
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Abstract
PURPOSE OF REVIEW Contraception is a vital component of medical care for women with HIV or at high risk of acquiring HIV. Over the last several years, there has been emerging evidence regarding the safety and effectiveness of various contraceptive methods, ultimately leading to a revision in the WHO Medical Eligibility Criteria for contraceptive use. RECENT FINDINGS Progestogen-only injectables may be associated with an increased risk of HIV acquisition and its use has been revised to category 2 from category 1. Etonogestrel and levonorgestrel levels are lower in women who concurrently use contraceptive implant and efavirenz-based antiretroviral therapy. Multipurpose technology, aimed at providing antiretroviral medication and contraception, is an area of ongoing research but is not yet clinically available. SUMMARY It is important for providers who care for women with HIV or at high risk of HIV to inquire about pregnancy intentions. If contraception is desired, these women should be offered all available methods, with counseling regarding possible risks of contraceptive failure or HIV acquisition.
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Patel RC, Bukusi EA, Baeten JM. Current and future contraceptive options for women living with HIV. Expert Opin Pharmacother 2017; 19:1-12. [PMID: 28891343 DOI: 10.1080/14656566.2017.1378345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Among women living with HIV, half of the pregnancies are unintended. Effective contraception can prevent unintended pregnancies and consequently reduce maternal mortality and perinatal transmission of HIV. While contraceptive options available for all women also apply to women living with HIV, specific considerations exist to the use of contraception by women living with HIV. AREAS COVERED First, general principles guiding the use of contraception among women living with HIV are discussed, such as choice, method mix, relative effectiveness, and drug-drug interactions. Second, a detailed discussion of each contraceptive method and issues surrounding the use of that method, such as drug-drug interactions, follows. Third, future contraceptive options in advanced development for use by women or men are briefly discussed. EXPERT OPINION Contraceptive methods available to all women should also be accessible to women living with HIV. When the relative effectiveness of a contraceptive method is reduced, for example due to drug-drug interactions with antiretrovirals, the method should still be made available to women living with HIV with the appropriate information sharing and counseling. Greater research on various aspects of contraceptive use by women living with HIV and more comprehensive testing of co-administration of hormonal contraceptives and common medications used by these women are warranted.
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Affiliation(s)
- Rena C Patel
- a Division of Allergy and Infectious Diseases, Department of Medicine , University of Washington , Seattle , WA , USA
| | - Elizabeth A Bukusi
- b Centre for Microbiologic Research , Kenya Medical Research Institute ; Nairobi , Kenya.,c Departments of Obstetrics and Gynecology and Global Health , University of Washington ; Seattle , WA , USA
| | - Jared M Baeten
- d Departments of Epidemiology, Global Health, and Medicine , University of Washington ; Seattle , WA , USA
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Abstract
In 1988, the generalised HIV/AIDS epidemic in Thailand began and in the same year the first HIV-exposed infant in Thailand was born at King Chulalongkorn Memorial Hospital, Bangkok. From the early to mid-1990s, an epidemic wave of HIV-infected women and infants occurred. Heterosexual HIV transmission, as described in the Asian Epidemic Model, was the major mode of spread in Thailand, causing an increasing number of HIV-infected pregnant women. The early and concerted multi-sectoral response of Thai society reduced the prevalence of HIV infection in pregnant women from 2% in the mid-1990s to 0.6% in 2015 and mother-to-child transmission of HIV (MTCT) from an estimated 20-40% to 1.9%. Thus, Thailand became the first Asian country to achieve the World Health Organization's (WHO) targets for the elimination of MTCT. In this narrative review, the key historic evolutions of the science and policy of prevention of mother-to-child transmission of HIV (PMTCT) in Thailand that addressed the four prongs of the recommended WHO PMTCT strategy are described, and the lessons learned are discussed.
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Key Words
- AEM, Asian Epidemic Model
- ANC, antenatal care
- ART, anti-retroviral therapy
- Asian epidemic model
- CDC, communicable disease control
- CMR, child mortality rate
- EID, early infant diagnosis
- EPP, Estimation and Projection Package
- FSW, female commercial sex worker
- HAART, highly active anti-retroviral therapy
- HIV
- HSM, heterosexual men
- IDU, intravenous drug users
- MOPH, Ministry of Public Health
- NGO, non-government organisation
- PACTG, Paediatric AIDS Clinical Trials Group
- PCR, polymerase chain reaction
- PHIMS, Perinatal HIV Intervention Monitoring System
- PHOMS, Perinatal HIV Outcome Monitoring System
- PLWHA, people living with HIV/AIDS
- PROM, premature rupture of membranes
- STI, sexually transmitted infection
- TDR, triple-drug regimen
- TRCS, Thai Red Cross Society
- Thailand
- WLWHA, women living with HIV/AIDS
- elimination
- mother-to-child
- policy
- transmission
- vertical
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Baipluthong B, Anekthananon T, Munsakul W, Jirajariyavej S, Asavapiriyanont S, Hancharoenkit U, Roongpisuthipong A, Pattanasin S, Martin M, Guntamala L, Lolekha R. Implementation and assessment of a prevention with positives intervention among people living with HIV at five hospitals in Thailand. PLoS One 2017; 12:e0170558. [PMID: 28158210 PMCID: PMC5291364 DOI: 10.1371/journal.pone.0170558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 01/07/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND We implemented a hospital-based prevention with positives (PwP) intervention among people living with HIV (PLHIV) that included HIV transmission risk screening, short HIV prevention messages, family planning, HIV disclosure counseling, and partner HIV testing at five hospitals in Thailand. We assessed changes in sexual risk behaviors among PLHIV who received the PwP services at the hospitals. METHODS From January 2008-March 2009, we systematically selected a subset of PLHIV receiving care at the five hospitals to offer participation in the PwP intervention. We collected demographic, risk behavior, and laboratory data using a standardized questionnaire. We analyzed data from PLHIV who completed at least four visits, using generalized estimating equations to identify baseline participant characteristics that were associated with adopting sexual practices less likely to be associated with HIV transmission during follow-up. RESULTS A total of 830 PLHIV were interviewed and 756 (91.1%) completed four visits. The median age of these 756 participants was 37 years, 400 (52.9%) were women, and 475 (62.8%) had a steady partner. At baseline, 353 (74.3%) of the steady partners had been tested for HIV and 132 (37.4%) had tested negative. Among the 756 PLHIV, 427 (56.5%) reported having sex in the 3 months before enrollment and 413 (54.6%) in the 3 months before the fourth visit. The proportion reporting having vaginal or anal sex without a condom decreased from 20.8% at baseline to 5.1% at the fourth visit (p<0.001). Factors associated (p<0.05) with abstinence or 100% condom use at follow-up visits included: completing ≥ two visits, being diagnosed with HIV for longer than 3 months, and receiving HIV prevention messages from a doctor (versus a nurse or counselor). CONCLUSION Safe sex behaviors increased among PLHIV receiving PwP services, suggesting that expansion of hospital-based PwP services may reduce the number of new HIV infections in Thailand.
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Affiliation(s)
- Benjamas Baipluthong
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | | | - Warangkana Munsakul
- Faculty of Medicine, Vajira Hospital, Navamindharadhiraj University, Bangkok, Thailand
| | | | | | | | | | - Sarika Pattanasin
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Michael Martin
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Lisa Guntamala
- Bureau of AIDS, TB and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Rangsima Lolekha
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
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