Abstract
IntroductionHIV-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.MethodsData were drawn from a quantitative national cross-sectional survey of 5198 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 2760 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.ResultsOverall, 2104 (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).ConclusionNearly 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.
Highlights
Human Immunodeficiency Virus (HIV)-positive women who are still in the reproductive years need adequate sexual and reproductive health information to make informed reproductive health choices
Preventing unintended pregnancies among women living with HIV is one of the four comprehensive approaches for confronting unwanted pregnancy among People Living With HIV/AIDS (PLWHA), an approach that was adopted by the World Health Organization (WHO) to promote and prevent the transmission of HIV from mothers to their babies [2]
Our study of missed opportunities for Family Planning (FP) counselling among HIV-positive women receiving HIV care in Uganda highlights two important findings: a) up to 24% of HIVpositive women who interfaced with the healthcare system when they were pregnant, at the time of delivery or at the post-natal care visit did not receive any form of FP counselling; and b) receipt of any FP counselling at any of the three time points is associated with current use of modern contraception
Summary
HIV-positive women who are still in the reproductive years need adequate sexual and reproductive health information to make informed reproductive health choices. Provision of appropriate counselling and support as well as contraceptives to women living with HIV to meet their family planning needs is a cost-effective intervention to prevent mother-to-child transmission of HIV [3]. A recent systematic review and metaanalysis of unintended pregnancy among WLHIV in sub-Saharan Africa found a pooled proportion of unintended pregnancy of 55.9% with the magnitude of unwanted and mistimed pregnancy in six studies ranging from 14 to 59% and 9 to 47.2%, respectively [11] These studies show high rates of unwanted pregnancies for WLHIV implying that the unintended pregnancies could be substantially reduced if women used modern contraception.
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