Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia

Abstract

Objective To describe predictors of contraceptive method discontinuation and switching behaviors among HIV positive couples receiving couples' voluntary HIV counseling and testing services in Lusaka, Zambia. Design Couples were randomized in a factorial design to two family planning educational intervention videos, received comprehensive family planning services, and were assessed every 3-months for contraceptive initiation, discontinuation and switching. Methods We modeled factors associated with contraceptive method upgrading and downgrading via multivariate Andersen-Gill models. Results Most women continued the initial method selected after randomization. The highest rates of discontinuation/switching were observed for injectable contraceptive and intrauterine device users. Time to discontinuing the more effective contraceptive methods or downgrading to oral contraceptives or condoms was associated with the women's younger age, desire for more children within the next year, heavy menstrual bleeding, bleeding between periods, and cystitis/dysuria. Health concerns among women about contraceptive implants and male partners not wanting more children were associated with upgrading from oral contraceptives or condoms. HIV status of the woman or the couple was not predictive of switching or stopping. Conclusions We found complicated patterns of contraceptive use. The predictors of contraception switching indicate that interventions targeted to younger couples that address common contraception-related misconceptions could improve effective family planning utilization. We recommend these findings be used to increase the uptake and continuation of contraception, especially long acting reversible contraceptive (LARC) methods, and that fertility-goal based, LARC-focused family planning be offered as an integral part of HIV prevention services.

Contraceptive uptake after training community health workers in couples counseling: A cluster randomized trial

“…This is contrary to the notion that couples counseling leads to high modern FP uptake as it leads to increased spousal communication, which could then lead to increased knowledge and comfort in communicating FP issues [20, 21]. Our results are, however, similar to results of studies done in Jordan and Zambia, which found that the effect of couples versus individual counseling was statistically not significant [6, 22]. The lack of difference in modern FP uptake in our study may be secondary to the fact that only those who agreed to FP counseling were included in our study, which may imply that they already had an interest in FP use, which then led to high FP uptake.…”

Integrating Prevention Interventions for People Living With HIV Into Care and Treatment Programs

“…98,99 All 12 intervention studies were conducted in sub-Saharan Africa. FP interventions included a facilitated referral model, 61 integration of FP services into HIV clinical care, 62,64–68 an education video to promote long-acting methods of contraception, 63,70,71 and group education sessions. 69 …”

Hormonal contraception does not increase women’s HIV acquisition risk in Zambian discordant couples, 1994–2012

“…We estimated HIV acquisition risk related to contraceptive implants. Contraception was provided at the research site and was measured frequently to capture high rates of stopping and switching; in our cohorts, we have observed that about 25% of women switch methods during follow-up, with most discontinuation/switching observed among injectable (34%) and IUD (33%) users [13,22]. This is one of few studies to differentiate between genetically linked versus unlinked infections, important when modeling index partner covariates.…”