Missed Opportunities for Family Planning Counselling among HIV-Positive Women Receiving HIV Care in Uganda

Abstract Introduction HIV-positive women who are still in the reproductive years need adequate sexual and reproductive health information to make informed reproductive health choices. However, many HIV-positive women who interface with the health system continue to miss out on this information. We sought to: a) determine the proportion of HIV-positive women enrolled in HIV care who missed family planning (FP) counselling; and b) assess if any association existed between FP counseling and current use of modern contraception to inform programming. Methods Data were drawn from a quantitative national cross-sectional survey of 5,198 HIV-positive women receiving HIV care at 245 HIV clinics in Uganda; conducted between August and November 2016. Family planning counseling was defined as receipt of FP information by an HIV-positive woman during ANC, at the time of delivery or at the PNC visit. Analyses on receipt of FP counseling were done on 2,760 HIV-positive women aged 15-49 years who were not currently pregnant and did not intend to have children in the future. We used a modified Poisson regression model to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counseling and current use of modern contraception, controlling for potential confounders. Analyses were performed using STATA statistical software, version 14.1. Results Overall, 2,104 (76.2%) HIV-positive women reported that they received FP counseling at any of the three critical time-points. Of the 24% ( n =656) who did not, 37.9% missed FP counseling at ANC; 41% missed FP counseling during delivery; while 54% missed FP counseling at the post-natal care visit. HIV-positive women who received any FP counseling were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.21; 95% Confidence Interval [CI]: 1.10, 1.33). Conclusion Nearly one-quarter of HIV-positive women did not receive any form of FP counseling when they interfaced with the healthcare system. This presents a missed opportunity for prevention of unintended pregnancies, and suggests a need for the integration of FP counseling into HIV care at all critical time-points.

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Missed Opportunities for Family Planning Counselling among HIV-Positive Women Receiving HIV Care in Uganda

10.21203/rs.2.16340/v1 ◽

2019 ◽

Author(s):

JULIET NABIRYE ◽

Joseph KB Matovu ◽

John Baptist Bwanika ◽

Fredrick Makumbi ◽

Rhoda K. Wanyenze

Keyword(s):

Family Planning ◽

Reproductive Health ◽

Critical Time ◽

Hiv Care ◽

Hiv Positive ◽

Cross Sectional Survey ◽

Time Points ◽

Modern Contraception ◽

Unintended Pregnancies ◽

Hiv Positive Women

Abstract Introduction HIV-positive women who are still in the reproductive years need adequate sexual and reproductive health information to make informed reproductive health choices. However, many HIV-positive women who interface with the health system continue to miss out on this information. We sought to: a) determine the proportion of HIV-positive women enrolled in HIV care who missed family planning (FP) counselling; and b) assess if any association existed between FP counseling and current use of modern contraception to inform programming.Methods Data were drawn from a quantitative national cross-sectional survey of 5,198 HIV-positive women receiving HIV care at 245 HIV clinics in Uganda; conducted between August and November 2016. Family planning counseling was defined as receipt of FP information by an HIV-positive woman during ANC, at the time of delivery or at the PNC visit. Analyses on receipt of FP counseling were done on 2,760 HIV-positive women aged 15-49 years who were not currently pregnant and did not intend to have children in the future. We used a modified Poisson regression model to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counseling and current use of modern contraception, controlling for potential confounders. Analyses were performed using STATA statistical software, version 14.1.Results Overall, 2,104 (76.2%) HIV-positive women reported that they received FP counseling at any of the three critical time-points. Of the 24% ( n =656) who did not, 37.9% missed FP counseling at ANC; 41% missed FP counseling during delivery; while 54% missed FP counseling at the post-natal care visit. HIV-positive women who received any FP counseling were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.21; 95% Confidence Interval [CI]: 1.10, 1.33).Conclusion Nearly one-quarter of HIV-positive women did not receive any form of FP counseling when they interfaced with the healthcare system. This presents a missed opportunity for prevention of unintended pregnancies, and suggests a need for the integration of FP counseling into HIV care at all critical time-points.

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Missed Opportunities for Family Planning Counselling among HIV-Positive Women Receiving HIV Care in Uganda

10.21203/rs.2.16340/v3 ◽

2020 ◽

Author(s):

JULIET NABIRYE(Former Corresponding Author) ◽

Joseph KB Matovu(New Corresponding Author) ◽

John Baptist Bwanika ◽

Fredrick Makumbi ◽

Rhoda K. Wanyenze

Keyword(s):

Family Planning ◽

Reproductive Health ◽

Critical Time ◽

Hiv Care ◽

Hiv Positive ◽

Cross Sectional Survey ◽

Time Points ◽

Modern Contraception ◽

Unintended Pregnancies ◽

Hiv Positive Women

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Missed Opportunities for Family Planning Counselling among HIV-Positive Women Receiving HIV Care in Uganda

10.21203/rs.2.16340/v4 ◽

2020 ◽

Author(s):

JULIET NABIRYE(Former Corresponding Author) ◽

Joseph KB Matovu(New Corresponding Author) ◽

John Baptist Bwanika ◽

Fredrick Makumbi ◽

Rhoda K. Wanyenze

Keyword(s):

Family Planning ◽

Reproductive Health ◽

Critical Time ◽

Hiv Care ◽

Hiv Positive ◽

Cross Sectional Survey ◽

Time Points ◽

Modern Contraception ◽

Unintended Pregnancies ◽

Hiv Positive Women

Abstract Introduction: HIV-positive women who are still in the reproductive years need adequate sexual and reproductive health information to make informed reproductive health choices. However, many HIV-positive women who interface with the health system continue to miss out on this information. We sought to: a) determine the proportion of HIV-positive women enrolled in HIV care who missed family planning (FP) counselling; and b) assess if any association existed between receipt of FP counselling and current use of modern contraception to inform programming. Methods: Data were drawn from a quantitative national cross-sectional survey of 5,198 HIV-positive women receiving HIV care at 245 HIV clinics in Uganda; conducted between August and November 2016. Family planning counselling was defined as provision of FP information (i.e. available FP methods and choices) to an HIV-positive woman by a health provider during ANC, at the time of delivery or at the PNC visit. Analyses on receipt of FP counselling were done on 2,760 HIV-positive women aged 15-49 years who were not currently pregnant and did not intend to have children in the future. We used a modified Poisson regression model to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counselling and current use of modern contraception, controlling for potential confounders. Analyses were performed using STATA statistical software, version 14.1.Results: Overall, 2,104 (76.2%) HIV-positive women reported that they received FP counselling at any of the three critical time-points. Of the 24% (n=656) who did not, 37.9% missed FP counselling at ANC; 41% missed FP counselling during delivery; while 54% missed FP counselling at the post-natal care visit. HIV-positive women who received any FP counselling were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.21; 95% Confidence Interval [CI]: 1.10, 1.33). Conclusion: Nearly one-quarter of HIV-positive women did not receive any form of FP counselling when they interfaced with the healthcare system. This presents a missed opportunity for prevention of unintended pregnancies, and suggests a need for the integration of FP counselling into HIV care at all critical time-points.

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Unintended Repeat Pregnancies Among HIV Positive Women in Rio De Janeiro, Brazil

The Open AIDS Journal ◽

10.2174/1874613601812010174 ◽

2018 ◽

Vol 12 (1) ◽

pp. 174-180

Author(s):

Bernardo B. Wittlin ◽

Alice W. Carvalho ◽

Giulia P. Lima ◽

Rune Andersson ◽

Susanne Johansson ◽

...

Keyword(s):

Viral Load ◽

Family Planning ◽

Antenatal Care ◽

Unintended Pregnancy ◽

Rio De Janeiro ◽

Hiv Positive ◽

Continuous Family ◽

Unintended Pregnancies ◽

Illegal Abortion ◽

Hiv Positive Women

Introduction: High rates of unintended pregnancies among HIV positive women have been reported by several studies. Among repeated pregnancies, these rates may be higher. Our aim was to describe the unintended pregnancy rate in repeat gestations of the same group of HIV-positive women. Methodology: From a prospective cohort of HIV-infected pregnant women followed-up from 1995 to 2013 in an Antenatal Clinic (ANC) in Rio de Janeiro, we selected women who had at least two consecutive pregnancies. Patient data were prospectively obtained from standardized questionnaires. The main dependent variable was if the pregnancy was intended or unintended. Some of the other variables were: age, the interval between pregnancies, household income, CD4 cells count at admission in the ANC and at delivery, viral load<1000 copies/ml at admission and close to delivery, and attempts to illegal abortion. Results: From a total of 287 women included, the number of unintended pregnancies increased from 138 (63.6%) at first pregnancy to 198 (81.8%) at second pregnancy (p < 0.01). At first pregnancy, we observed 8 women who had made an attempt to illegal abortion (7 with an unintended pregnancy and 1 with a wanted pregnancy, p = 0.06), while at second pregnancy, 34 of them had made an attempt (33 with unintended pregnancy and 1 with a wanted pregnancy, p < 0.01). Regarding viral load suppression close to delivery, there was no statistic difference between first and second pregnancies (72,7% vs. 70,5%, p = 0.36) as well as between intended and unintended pregnancies (in first pregnancy: 80% vs. 86%, p = 0.4; in second pregnancy: 72% vs. 83%, p = 0,1). Conclusion: High rates of unintended pregnancies and illegal abortion attempts, along with their increase from one pregnancy to the subsequent, reinforce the need for continuous family planning practices in HIV-infected patients. The majority of the women were able to reach undetectable viral load at the end of the pregnancy, including those with unintended pregnancies. Implications: HIV infected patients presenting in antenatal care for sequential unintended pregnancies. Despite the fact that abortion is illegal in this country, a substantial number of women, still attempt it before attending antenatal care. Family planning actions should be performed during the antenatal care.

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Missed opportunities for family planning counselling among HIV-positive women receiving HIV Care in Uganda

BMC Women s Health ◽

10.1186/s12905-020-00942-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Juliet Nabirye ◽

Joseph K. B. Matovu ◽

John Baptist Bwanika ◽

Fredrick Makumbi ◽

Rhoda K. Wanyenze

Keyword(s):

Family Planning ◽

Hiv Care ◽

Hiv Positive ◽

Missed Opportunities ◽

Hiv Positive Women

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Providers’ Perspectives on Provision of Family Planning to HIV-Positive Individuals in HIV Care in Nyanza Province, Kenya

AIDS Research and Treatment ◽

10.1155/2013/915923 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 10

Author(s):

Sara J. Newmann ◽

Kavita Mishra ◽

Maricianah Onono ◽

Elizabeth A. Bukusi ◽

Craig R. Cohen ◽

...

Keyword(s):

Family Planning ◽

Patient Flow ◽

Healthcare Providers ◽

Hiv Care ◽

Hiv Positive ◽

Cultural Issues ◽

Structured Interviews ◽

Nyanza Province ◽

Attitudes And Practices ◽

Hiv Positive Women

Objective. To inform an intervention integrating family planning into HIV care, family planning (FP) knowledge, attitudes and practices, and perspectives on integrating FP into HIV care were assessed among healthcare providers in Nyanza Province, Kenya.Methods. Thirty-one mixed-method, structured interviews were conducted among a purposive sample of healthcare workers (HCWs) from 13 government HIV care facilities in Nyanza Province. Structured questions and case scenarios assessed contraceptive knowledge, training, and FP provision experience. Open-ended questions explored perspectives on integration. Data were analyzed descriptively and qualitatively.Results. Of the 31 HCWs interviewed, 45% reported previous FP training. Few providers thought long-acting methods were safe for HIV-positive women (19% viewed depot medroxyprogesterone acetate as safe and 36% viewed implants and intrauterine contraceptives as safe); fewer felt comfortable recommending them to HIV-positive women. Overall, providers supported HIV and family planning integration, yet several potential barriers were identified including misunderstandings about contraceptive safety, gendered power differentials relating to fertility decisions, staff shortages, lack of FP training, and contraceptive shortages.Conclusions. These findings suggest the importance of considering issues such as patient flow, provider burden, commodity supply, gender and cultural issues affecting FP use, and provider training in FP/HIV when designing integrated FP/HIV services in high HIV prevalence areas.

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Factors Associated with Uptake of Contraceptives among HIV Positive Women on Dolutegravir based Anti-Retroviral Treatment at Health Centres of Kampala Capital City Authority. A cross sectional study in Uganda.

10.21203/rs.3.rs-404132/v1 ◽

2021 ◽

Author(s):

Leah Mbabazi ◽

Mariah Sarah Nabaggala ◽

Suzanne Kiwanuka ◽

Juliet Kiguli ◽

Stephen Okoboi ◽

...

Keyword(s):

Family Planning ◽

World Health ◽

Hiv Care ◽

Hiv Positive ◽

Modern Contraceptive ◽

Cross Sectional ◽

Factors Associated ◽

Hiv Positive Women ◽

The Impact ◽

Contraceptive Uptake

Abstract Background In May 2018, the World Health Organisation issued a teratogenicity alert for HIV positive women using dolutegravir (DTG) and emphasised increased integration of sexual and reproductive services into HIV care to meet contraceptive needs of HIV positive women. However, there are scarce data on the impact of this guidance on contraceptive uptake. Objective To investigate the uptake of contraceptives and the factors affecting the uptake of contraceptive services among the HIV positive women of reproductive age who use DTG.Methods A cross-sectional survey was conducted from April 2019 to July 2019, in five government clinics in central Uganda where DTG was offered as the preferred first-line antiretroviral treatment (ART) regimen. We randomly selected 359 non-pregnant women aged 15-49 years using DTG-based regimens. We used interviewer administered questionnaires to collect data on demographics, contraceptive use, social and health system factors. We defined contraceptive uptake as the proportion of women using any method of contraception divided by the total number of women on DTG during the review period. We described patients’ characteristics using descriptive statistics. Factors associated with contraceptive uptake were investigated using Poisson regression at multivariable analysis (STATA 14).Results Of the 359 participants, the mean age was 37(SD=6.8), half 50.7% had attained primary level of education and average monthly income <100,000Ushs. The overall level of Contraceptive uptake was 38.4%, modern contraceptive uptake was 37.6% and 96.4% of the participants had knowledge of contraceptives. The most utilised method was the injectable at 58.4% followed by condoms 15%, IUD 10.7%, pills 6.4%, implants 5.4%, and least used was sterilization at 0.7%. Predictor factors that increased likelihood of contraceptive uptake were; religion of others category AIRR=1.53(95% CI: 1.01, 2.29) and parity 3-4 children AIRR=1.48(95% CI: 1.14, 1.92). Reduced rates were observed for age 40-49 years AIRR=0.45(95% CI: 0.21, 0.94), unemployment AIRR 0.63(95% CI: 0.42, 0.94), not discussing FP with partner AIRR=0.39(95% CI: 0.29, 0.52) and not receiving FP counselling AIRR=2.86 (95% CI: 0.12, 0.73). Non-significant variables were facility, education level, marital status, sexual activity, experienced side effects of FP and knowledge on both contraceptives and DTG.Conclusion This study shows a low-level uptake of contraceptives and injectable was the most used method. It also indicated that FP counselling and partner discussion on FP increased contraceptive uptake. Therefore, more strategies should be put in place to increase male involvement in family planning programs and scale up the integration of family planning services into HIV care and management programs.

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Predictors of Unmet Need for Family Planning among HIV Positive Women in Care in Federal Teaching Hospital Gombe, Nigeria

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2020/v18i330191 ◽

2020 ◽

pp. 26-33

Author(s):

A. Mohammed ◽

D. Chiroma ◽

C. H. Laima ◽

M. A. Danimoh ◽

P. A. Odunze

Keyword(s):

Family Planning ◽

Unmet Need ◽

Hiv Care ◽

Hiv Positive ◽

P Value ◽

Mother To Child Transmission ◽

Child Transmission ◽

Hiv Positive Women ◽

History Of ◽

Mother To Child

Background: Elimination of mother-to-child transmission (EMTCT) of Human Immunodeficiency Virus (HIV) requires adequate and continuous use of family planning commodities among women of reproductive age. This can be made possible by reducing the proportion of HIV positive women with unmet need for family planning. The study aims to determine the factors associated with having unmet need among women in HIV care. Methods: A cross sectional study was conducted using an interviewer administered questionnaire to study 325 women on HIV care. Cluster sampling technique was used to select the study respondents from the clinic. Results: Less than half of the respondents (40%) were currently using family planning, 35% had unmet need for family planning with 53.6% having unmet need for spacing while 46.4% having unmet need for limiting. Women with no history of previous use of family planning were fifteen times more likely to have unmet need for family planning than those with history of previous use of family planning (p value <0.001, CI 2.511-15.770). Also women with more than five deliveries were eight times more likely to have unmet need for family planning (p value 0.004, CI 0.001-0.279) while women with 2-5 deliveries are four times likely to have unmet need for family planning (p value 0.035, CI 0.005-0.832). Conclusion: A high proportion of women receiving ART care still have unmet need for family planning despite incorporating this service in HIV care. It is therefore important to target high risk groups to reduce the proportion of women with unmet need for family planning which will invariable reduce mother to child transmission of HIV.

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Factors Associated with Uptake of Contraceptives Among HIV Positive Women on Dolutegravir Based Anti-Retroviral Treatment - A Crossectional Survey in Urban Uganda.

10.21203/rs.3.rs-1109814/v1 ◽

2021 ◽

Author(s):

Leah Mbabazi ◽

Mariah Sarah Nabaggala ◽

Suzanne Kiwanuka ◽

Juliet Kiguli ◽

Eva Laker ◽

...

Keyword(s):

Family Planning ◽

Intrauterine Device ◽

Reproductive Age ◽

Hiv Care ◽

Hiv Positive ◽

Factors Associated ◽

Hiv Positive Women ◽

Family Planning Counseling ◽

The Impact ◽

Contraceptive Uptake

Abstract Background In May 2018, following the preliminary results of a study in Botswana that reported congenital anomalies in babies born to HIV-positive women taking dolutegravir drug, the WHO issued a teratogenicity alert. However, there are scarce data on the impact of this guidance on contraceptive uptake among women taking dolutegravir. We assessed the uptake of contraceptives in HIV-positive women of reproductive age on dolutegravir regimens. Methods We conducted a cross-sectional survey from April 2019 to July 2019 in five government health facilities in central Uganda, where dolutegravir-based regimens were offered as the preferred first-line antiretroviral treatment. We randomly selected 359 non-pregnant women aged 15-49 years taking dolutegravir-based regimens and interviewed them using semi-structured interviewer-administered questionnaires. We collected data on demographics, contraceptive use, individual, social, and health system factors. We described patients’ characteristics using descriptive statistics and assessed factors associated with contraceptive uptake using a modified Poisson regression model. Results A total of 359 women were included in the study. The mean age was 37 years (standard deviation=6.8) and overall contraceptive uptake was 38.4%. The most utilized method was injectable method at 58.4% followed by condoms (15%), intrauterine device (10.7%), pills (6.4%), implants (5.4%), and sterilization (0.7%) Predictors for contraceptive uptake were parity of 3-4 children (Adjusted Prevalence Ratio (APR) =1.48, 95% confidence interval (CI): 1.14, 1.92). There was reduced uptake in the age range of 40-49 years (APR=0.45, CI: 0.21-0.94), unemployed (APR: 0.6, CI: 0.42- 0.94), women not discussing family planning with their partner (APR=0.39, CI: 0.29-0.52) and not receiving family planning counseling (APR= 0.56, CI: 0.34-0.92). Conclusion We observed a low-level uptake of contraceptives, with injectables as the most used method. Family planning counseling and partner discussion on family planning were associated with contraceptive uptake among the women who used dolutegravir based regimens. There is a need for more strategies to integrate FP services and increase male involvement in HIV care programs.

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Postpartum Contraceptive Use Among HIV Positive Women in Cipto Mangunkusumo Hospital Jakarta, Indonesia: A Cross Sectional Study

KnE Medicine ◽

10.18502/kme.v1i1.552 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Merry Amelya

Keyword(s):

Family Planning ◽

Unintended Pregnancy ◽

Contraceptive Use ◽

Elective Caesarean Section ◽

Hiv Positive ◽

Potential Contribution ◽

Original Cohort ◽

Unintended Pregnancies ◽

Hiv Positive Women ◽

Long Acting

Background: Prevention of unintended pregnancy among HIV positive women is the second element of prevention of mother to child transmission of HIV. Contraceptive use in Indonesia remains low, despite the potential contribution of family planning (FP) to the prevention of HIV infection and unintended pregnancy. It is anticipated that this research will update existing knowledge, inform policy makers and programmers to support safer and healthier reproductive options among HIV positive women in the study area.Methods: The study was conducted in Cipto Mangunkusumo Hospital Jakarta, Indonesia, since January 1st 2013 until December 31st 2014. Of the original cohort of 5499 women delivered in 2013-2014, 65 were HIV positive. The 58 subjects in this study were selected from each group of HIV positive women and HIV negative who had delivery in this hospital either by emergency admission or elective caesarean section. Results: There were a total of 5449 deliveries, during the study period, out of which 65 were HIV positive women (1,2%). From 58 randomly selected patients, the mean age of HIV positive mothers was 27,74 ± 4,73 years. Their parity ranged from zero to five. With significantly uses of long acting contraception as IUD and sterilization on HIV-positive women as well as booked cased patients.Conclusions: The high rates of unintended pregnancies in the sample of HIV positive women suggest that the WHO’s strategy of preventing unintended pregnancies amongst HIV positive women to minimise vertical transmission of HIV must be reinforced. Long acting and permanent methods could fill an important gap in family planning services in Indonesia given women’s stated fertility preferences indicating a strong desire to either not have a future pregnancy or to wait several years before the birth of their next child.

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