Contraceptive use and pregnancy rates among women receiving antiretroviral therapy in Malawi: a retrospective cohort study

Abstract

BackgroundIn 2011, family planning (FP) services were integrated at Martin Preuss Centre (MPC), in urban Lilongwe, Malawi. To date, no previous study evaluated pregnancy rates among HIV-positive women after the integration of FP services into HIV care at the facility. In this study, we investigated whether integration of FP services into HIV clinical care led to increased use of contraceptives and decreased pregnancy rates.MethodsThis was a retrospective cohort analysis of HIV-positive women from 15 to 49 years of age who accessed antiretroviral therapy (ART) services at MPC. Ascertainment of FP needs, contraceptive methods and pregnancy status were done at ART initiation, and at each ART follow-up visit. Women were offered a wide range of contraceptive methods. Outcomes of interest were contraceptive use and rate of pregnancy. Incident pregnancy was ascertained through patient self-reports during clinic consultation. Trends of contraceptive use and pregnancy rates were analyzed using chi-square (χ2).ResultsA total of 10,472 women were included in the analysis and contributed 15,700 person-years of observation. Contraceptive use among all women receiving ART increased from 28% in 2012 to 62% in 2016 (p < 0.001). A total of 501 pregnancies occurred, including 13 multiple pregnancies, resulting in an overall pregnancy rates of 3.2 per 100 person-years. Rates of pregnancy decreased from 6.8 per 100 person-years in 2012 to 1.3 per 100 person-years in 2016 (p < 0.001).ConclusionIntegration of FP services into HIV care resulted in increased contraceptive use and, subsequently, decreased pregnancy rates in women receiving ART. HIV programs should consider offering FP services to women who are receiving ART.

Emerging priorities for HIV service delivery

“…The high proportion of women who became pregnant while using contraception was ascribed to inconsistent condom usage or poor patient adherence to hormonal contraception [65]. In a partnersupported clinic in Malawi that integrated family planning into ART services, uptake of family planning increased from 28% to 62% [66].…”

Pregnancy intention and contraceptive use among HIV-positive Malawian women at 4-26 weeks post-partum: A nested cross-sectional study

“…Such interventions may improve access to comprehensive antenatal, PMTCT and family planning services, thereby preventing unwanted pregnancies as well as MTCT. Integration of family planning services into HIV care services has also shown to increase access to a wider range of family planning methods [12,14,31]. However, the potential negative unintended consequences of integration on health care systems must be acknowledged and addressed [14,15].…”

“…To improve access to and uptake of family planning and contraceptives among women living with HIV, the integration of family planning into HIV care and treatment services has been proposed. Pilot studies in Malawi, Kenya, Tanzania, Swaziland, Nigeria, South Africa, and Uganda have shown that this is acceptable, feasible and cost-effective [12–16]. In 2011, the Malawi HIV programme integrated family planning into HIV care and treatment services in all ART facilities [17,18].…”

HIV Status and Contraceptive Utilization among Women in Cameroon

“…Women living with HIV theoretically should have ongoing contact with their health care system, and this routine engagement may improve access to contraception counseling and services, resulting in increased contraceptive utilization. 37,38 Previous studies (as well as this study) have found evidence in support of coupling HIV treatment services and contraception counseling 37,38 ; however, the benefits and challenges of comprehensive women's health care in global settings are not fully understood and warrant further examination. For example, a recent study from South Africa found women living with HIV (these are women who are likely to be engaged in health care) were more likely to have an unplanned pregnancy than their uninfected peers, which is both surprising and worrisome.…”