Among 1985 women living with HIV on lifelong antiretroviral therapy (ART) from eight sites in Uganda, Zimbabwe, Malawi and South Africa, overall half (49.9%) said their last pregnancy was unintended with over half not wanting to have more children. Dr Jim Aizire, reported on behalf of the long-term PEPFAR-PROMOTE cohort study, at the conference. The study, an extension of a completed mother-to-child transmission prevention trial, enrolled mothers and their children from December 2016 to June 2017.
Differences in unintended pregnancies varied considerably by site, from over 80% in Durban, South Africa, to close to 30% in Kampala, Uganda, and Harare, Zimbabwe, (p < 0.001).
79.9% of sexually active, non-pregnant women reported using effective contraceptive methods (injectable, oral, intra-uterine device (IUD), implant or tubal ligation). Among women without permanent contraception, 18.8% reported using long-acting reversible contraceptives (LARC) including implants or IUDs.
Injectables and implants were the most common methods reported overall, 40.6% and 19.3%, respectively.
An estimated 90% of unintended pregnancies among African women are associated with not using effective contraception. Over 60% of women have an unmet need for effective family planning methods in the region, and for women living with HIV it is estimated to be considerably higher.
Reasons most often cited for not using modern family planning include infrequent sex, safety, postpartum and breastfeeding, partner’s opposition and access issues.
Studies suggest that choice of contraception can influence the sexual health of a women and/or her male partner. Limited data exist on specific contraceptive use and sexual health in sub-Saharan Africa, a region with the highest burden of HIV, of which women of reproductive age account for over 60%.
LARC is the most effective reversible contraceptive for extended periods of time, not needing any user action. For many countries in the region, injectables account for over 50% of all reported family planning methods.
Age, marital status, having the desired number of children, clinic travel time, household water and electricity in all multivariable models were not associated with contraceptive choice.
Unemployed women, p = 0.008, those on ART, p = 0.001, and those with a viral load >1000 copies/ml, p = 0.003 were less likely to report LARC use.
Dr Aizire concluded while unintended pregnancy is common among women living with HIV in sub-Saharan Africa, LARC do offer acceptable contraceptive choices in this context. These findings, he added, support further programmatic research for an integrated approach of delivering ART and LARC for African women living with HIV who face unique reproductive health challenges.