Abstract
BackgroundWhen integrated with couples’ voluntary HIV counselling and testing (CVCT), family planning including long acting reversible contraceptives (LARC) addresses prongs one and two of prevention of mother-to-child transmission (PMTCT).MethodsIn this observational study, we enrolled equal numbers of HIV concordant and discordant couples in four rural and four urban clinics, with two Catholic and two non-Catholic clinics in each area. Eligible couples were fertile, not already using a LARC method, and wished to limit or delay fertility for at least 2 years. We provided CVCT and fertility goal-based family planning counselling with the offer of LARC and conducted multivariate analysis of clinic, couple, and individual predictors of LARC uptake.ResultsOf 1290 couples enrolled, 960 (74%) selected LARC: Jadelle 5-year implant (37%), Implanon 3-year implant (26%), or copper intrauterine device (IUD) (11%). Uptake was higher in non-Catholic clinics (85% vs. 63% in Catholic clinics, p < 0.0001), in urban clinics (82% vs. 67% in rural clinics, p < 0.0001), and in HIV concordant couples (79% vs. 70% of discordant couples, p = .0005). Religion of the couple was unrelated to clinic religious affiliation, and uptake was highest among Catholics (80%) and lowest among Protestants (70%) who were predominantly Pentecostal. In multivariable analysis, urban location and non-Catholic clinic affiliation, Catholic religion of woman or couple, younger age of men, lower educational level of both partners, non-use of condoms or injectable contraception at enrollment, prior discussion of LARC by the couple, and women not having concerns about negative side effects of implant were associated with LARC uptake.ConclusionsFertility goal-based LARC recommendations combined with couples’ HIV counselling and testing resulted in a high uptake of LARC methods, even among discordant couples using condoms for HIV prevention, in Catholic clinics, and in rural populations. This model successfully integrates prevention of HIV and unplanned pregnancy.
Highlights
When integrated with couples’ voluntary HIV counselling and testing (CVCT), family planning including long acting reversible contraceptives (LARC) addresses prongs one and two of prevention of mother-tochild transmission (PMTCT)
Many African women could benefit from access to these long acting reversible contraceptive (LARC) methods but they require trained nurses to insert and male partners are usually not familiar with them
In government clinics in Kigali, the capital of Rwanda, couples who expressed a desire to wait at least 2 years before becoming pregnant were educated together about LARC methods first in a group and individually with a nurse trained to insert LARC methods
Summary
When integrated with couples’ voluntary HIV counselling and testing (CVCT), family planning including long acting reversible contraceptives (LARC) addresses prongs one and two of prevention of mother-tochild transmission (PMTCT). The modern contraceptive prevalence in married Rwandan women is estimated at 53.2% in 2015, with oral contraceptive pills (OCP) and progesterone-based injectables (usually depo-medroxyprogesterone acetate: DMPA or Depo-Provera) reported by most users (World Bank: https://data.worldbank.org/indicator/). For women who wish to end childbearing or delay pregnancy for more than 2 years, the most effective long-acting reversible contraceptives (LARC) available in Rwanda– the copper intrauterine device (IUD) and the hormonal contraceptive implant – are not subject to problems of user error or re-supply, and they are more effective and cost-efficient over the long term [1]. Many government health centers in Rwanda are affiliated with the Catholic Church and do not offer contraception
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