Correlates of reported modern contraceptive use among postpartum HIV-positive women in rural Nigeria: an analysis from the MoMent prospective cohort study

Abstract

BackgroundNigeria has an annual population of ~ 200,000 women who are both pregnant and HIV-positive. High unmet need for family planning in this population could lead to unintended pregnancies, along with the increased risk of mother-to-child transmission of HIV (MTCT). To identify modifiable barriers and facilitators in effective family planning, we examined correlates of modern contraceptive use among HIV-positive women enrolled in the MoMent prevention of MTCT (PMTCT) implementation research study in rural North-Central Nigeria.MethodsIn this prospective cohort study, HIV-positive pregnant women were enrolled at 20 Primary Healthcare Centers and followed up to 12 months postpartum. Baseline socio-demographic, clinical and obstetric data were collected at enrollment. Participants were to receive routine family planning counselling from healthcare workers during postnatal visits. Analysis utilized baseline data linked to available family planning information collected from each woman at the first postpartum visit. Multivariate logistic regression was performed to determine factors associated with modern contraceptive use.ResultsOut of 497 women enrolled, family planning data was available for 399 (80.3%) women, of whom 349 (87.5%) received family planning counselling, and 321 (80.5%) were 30 years old or less. Two-thirds (268, 67.2%) of the cohort analyzed had 1–2 children at baseline; 24.8% (n = 99) had 3–4 children, and 8.0% (n = 32) had > 4 children. Approximately half (199, 49.9%) of the women reported no modern contraceptive use in the postpartum period. Male condoms (116, 29.1%) were the most reported method of contraception; other methods reported included oral hormones (71, 17.8%) and intrauterine devices (13, 3.2%). Only disclosure of HIV status to male partner or relative (aOR = 2.0, 95% CI: 1.2–3.3; p = 0.01) and receipt of family planning counselling (aOR = 2.3, 95% CI: 1.1–4.8; p = 0.03) were positively associated with reported modern contraceptive use. Age, marital or educational status, religious affiliation, employment status, gravidity and parity were non-correlates.ConclusionsFamily planning counselling and disclosure of HIV status are modifiable positive predictors of contraceptive use among our cohort of postpartum HIV-positive women in rural Nigeria. Rates of unintended pregnancy and concomitant risk of MTCT could be significantly reduced through strategies that facilitate these correlates.Clinical trials registrationClinicaltrials.gov registration number: NCT 01936753; registered September 3, 2013.

Contraceptive use and associated factors among sexually active HIV positive women attending ART clinic in FHRH in Bahir Dar, north west, Ethiopia, 2018. Facility based cross-sectional study.

“…However, prevalence of this study was higher than the study done in Southwestern Uganda (27. positive women who disclosed their HIV status to their partners had higher odds of using contraception. Similar findings reported in studies from Ethiopia, Kenya, Nigeria and Zambia [17,21,31,32]. This highlights that disclosure of HIV status to a sexual partner might ease communication between sexual partners to make decision about reproductive issues including contraceptive use.…”

Contraceptive Use among sexually active reproductive age HIV Positive Women Attending ART Clinic at Felege Hiwot Referral Hospital, Northwest Ethiopia: A cross-sectional study 

“…HIV positive women who disclosed their HIV status to their partners had higher odds of using contraception. Previous studies from Ethiopia, Kenya, Nigeria and Zambia [24][25][26]32] have reported similar ndings. This highlights that disclosure of HIV status to a sexual partner might ease communication between sexual partners to make decision about reproductive issues including contraceptive use.…”

“…Economic factors, Cultural reasons, place of residence, education, attitude and knowledge about contraception, cultural beliefs, myths and misconceptions about contraception are some of the factors affecting contraceptive use [10,20]. Also, earlier studies done on HIV positive women showed that HIV status disclosure, previous contraceptive use, age, drinking habit, and sexual activity are determinant of contraceptive use [6,[21][22][23][24][25][26][27].…”

Association of age with healthcare needs and engagement among Nigerian men who have sex with men and transgender women: cross‐sectional and longitudinal analyses from an observational cohort

“…HIV care continuum outcome variables included lifetime history of ever having been tested for HIV prior to enrolment, ART initiation at enrolment and viral suppression at enrolment. Participants who initiated ART and had HIV RNA < 1000 copies/mL at six‐months after ART initiation were considered virally suppressed, consistent with WHO Health [29]. Other outcomes included disclosure of HIV status and same‐sex sexual practices to health care workers, avoidance of seeking healthcare, participation in HIV prevention meetings, receipt of HIV prevention education and sex in exchange for money.…”