Contraceptive Service Uptake and Delivery Preferences in Perinatally and Horizontally Infected Female Adolescents Living with HIV: Results from a South Africa-Based Mixed-Methods Study'

Abstract

To investigate whether contraceptive service uptake (including current contraceptive use), unmet need for contraception, unintended pregnancy, preferences for service provision, and providers among female adolescents living with HIV (ALHIV) vary with HIV-acquisition route, that is, perinatal HIV acquisition vs horizontal HIV acquisition. Mixed methods including exit and in-depth interviews SETTING: Multicenter, public sector primary health care facilities, Cape Town, South Africa PARTICIPANTS: Sexually experienced female ALHIV aged 14-19 years (n=303) including both peri/postnatally infected ALHIV (pALHIV) and horizontally infected ALHIV (hALHIV) and health care providers involved in HIV care and treatment services (n=19) MAIN OUTCOME MEASURES: Current contraceptive use, unintended pregnancy, and preferences for service provision and providers RESULTS: The association between HIV-acquisition route and current use of any contraceptive method (aOR=1.23; 95% CI, 0.52-2.92) and unintended pregnancy (aOR=1.02; 95% CI, 0.39-2.67) was not significant. In contrast, pALHIV had significantly decreased odds of receiving dual-method contraception (aOR=0.02; 95% CI, 0.00-0.38) and significantly increased odds of preferences for younger providers (aOR=4.45; 95% CI, 2.84-6.97), female providers (aOR=5.11; 95% CI, 1.25-20.91), and standalone youth clinics (aOR=7.01; 95% CI, 2.39-20.55) compared with female hALHIV. Qualitative findings indicate that provider positive attitudes, as opposed to judgmental attitudes, encourage pALHIV acceptance of care from any provider regardless of, for example, the provider's age. Current contraceptive use and unintended pregnancies were similar between pALHIV and hALHIV, but the 2 distinct groups of ALHIV were heterogeneous in terms of dual-method contraception and preferences for type of clinic model and providers. Promoting positive provider attitudes could improve ALHIV's contraceptive uptake.