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.
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Women's Health
Abstract
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.
Description
Keywords
Contraceptives, Anti-Retroviral Treatment, Dolutegravir
Citation
Mbabazi, L., Nabaggala, M. S., Kiwanuka, S., Kiguli, J., Laker, E., Kiconco, A., ... & Castelnuovo, B. (2022). Factors associated with uptake of contraceptives among HIV positive women on dolutegravir based anti-retroviral treatment-a cross sectional survey in urban Uganda. BMC Women's Health, 22(1), 1-8. https://doi.org/10.21203/rs.3.rs-404132/v1