High rate of unplanned pregnancy in the context of integrated family planning and HIV care services in South Africa

Adeniyi, Oladele Vincent; Ajayi, Anthony Idowu; Moyaki, Mayowa Gabriel; Goon, Daniel Ter; Avramovic, Gordana; Lambert, John S.

doi:10.1186/s12913-018-2942-z

Cited by 88 publications

(96 citation statements)

References 46 publications

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“…Similarly, researchers noted high rate of unplanned pregnancy among women living with HIV in South Africa 15. In contrast, Akelo, et al16 noted that majority of women living with HIV on ART in South Africa and Kenya planned their pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Reproductive Plans And Utilization of Contraceptives Among Women Living With HIV

Adeleye¹,

Akinwaare

Adejumo

2019

Int J MCH AIDS

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Background: Despite public health policies aimed at providing universal access to reproductive health care services, the reproductive health needs of women living with Human Immunodeficiency Virus (WLHIV) are not adequately met. This study assesses the reproductive plans and utilization of contraceptives among WLHIV. Methods: This was a cross sectional descriptive study, which adopted a mixed method approach. A total of 400 respondents were recruited from two tertiary health institutions in Nigeria using systematic sampling technique. A validated structured self-administered questionnaire developed by the researcher was used to collect quantitative data for the study. The questionnaire consists of close ended questions related to study objectives. Quantitative data collected were coded and analyzed using Statistical Package for Social Sciences (SPSS) windows version 22 and statistical significance was set at p <0.05. The qualitative aspect of the study utilized focus group discussion for data collection. Results: The mean and standard deviation (SD) age of enrolled respondents was 37.42

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Section: Introductionmentioning

confidence: 99%

Reproductive Plans And Utilization of Contraceptives Among Women Living With HIV

Adeleye¹,

Akinwaare

Adejumo

2019

Int J MCH AIDS

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“…The high uptake rate reported here should be interpreted with caution for two reasons. Given the high rate of unplanned pregnancies in women living with HIV in the region [5,6], a long-term follow up of this cohort is therefore recommended in order to gain broader understanding of contraception in women living with HIV in the region. Another plausible explanation could be that large proportion of women in need of contraception were accessible in the hospital in the immediate postpartum period.…”

Section: Discussionmentioning

confidence: 99%

“…Globally, about 36.9 million people are currently living with HIV/AIDS, 70% of them live in sub-Saharan Africa (SSA) [1,2], and the majority of them are females in their reproductive age [3]. Approximately 1.5 million pregnancies occurred in women living with HIV in developing countries [4], and most of these pregnancies are unplanned or unintended [5][6][7]. Given the adverse impacts of unintended pregnancy such as increased levels of stress, decreased quality of life, late initiation of antenatal care, and maternal deaths [8][9][10][11], prevention of unintended pregnancy is a priority among women living with HIV.…”

Section: Introductionmentioning

confidence: 99%

“…South Africa has a heavy burden of HIV [3,17], and an estimated 12,000 children were newly infected with HIV due to MTCT in 2016 [1]. The majority of pregnancies among women living with HIV in the country are unintended, [5,6] suggesting that prevention of unplanned and unwanted pregnancies could contribute to reducing MTCT of HIV. Family planning has been integrated into PMTCT programmes at all the primary health care centres in South Africa for over a decade in order to increase access to family planning service for people with HIV, reduce unplanned pregnancy, ensure optimal spacing of births and ultimately reduce MTCT of HIV.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of Immediate Postpartum Contraception among Parturient Women with HIV in the Eastern Cape, South Africa; A Prospective Cross-sectional Study

Adeniyi

Ajayi

Somefun

et al. 2020

Preprint

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Background: Universal access to contraception is an important strategy adopted by the South African government in order to reduce the rate of unintended pregnancies in women with HIV. In this article, we describe the choices of contraception and also, examine the influencing factors of the choices of contraception in the immediate postpartum period in parturient women with HIV in the Eastern Cape, South Africa.Methods: In this prospective cross-sectional study, 1617 parturient women with HIV completed a survey on the choice of contraception received in the immediate postpartum period (within 72 hours) across three large maternity services in the Eastern Cape between September 2015 to May 2016. Additional information was extracted from their medical records. Choices of contraception were categorised as; short-acting, long-acting reversible and permanent contraception. Adjusted and unadjusted multinomial regression models were employed to determine the influencing factors of the choices of contraception received by the cohort. Results: Participants were predominantly single (69.1%), unemployed (75.1%), had a grade 7-12 level of education (88.4%) and were HIV positive before their index pregnancy (81.3%).The uptake rate of immediate postpartum contraception was high (n=1507; 93.2%) with injectables being the preferred choice in the majority of the participants (n= 1218; 75.3%). Caesarean delivery was associated with higher odds of initiating long-acting reversible (AOR: 7.79; 95% CI:4.04-15.04) and permanent contraception (AOR: 6.52; 95% CI: 3.48-12.22).Conclusions: We found a high uptake of immediate postpartum contraception with a preference for injectables in the study setting. Long-term monitoring of this cohort will elucidate on the loss to follow-up and risk of unintended pregnancies in the region.

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“…Unintended pregnancies are associated with economic disparity, maternal and fetal morbidity and mortality, and risk of perinatal HIV transmission. 3,4 Therefore, provision of effective contraception is an important component of comprehensive healthcare for people living with HIV who are of reproductive potential. Despite the benefits of hormonal contraceptives, drug-drug interactions (DDIs) represent a barrier to contraceptive options for women living with HIV, particularly with the most common global antiretroviral therapy (ART) regimen, efavirenz-based ART.…”

Section: Introductionmentioning

confidence: 99%

Antiretroviral therapy and vaginally administered contraceptive hormones: a three-arm, pharmacokinetic study

et al. 2019

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Drug-drug interactions between orally-administered antiretroviral therapy (ART) and hormones released from an intravaginal ring (IVR) are not known. We hypothesized that efavirenz-based ART and atazanavir/ritonavir-based ART would alter plasma concentrations of vaginally-administered etonogestrel/ethinyl estradiol, yet ART concentrations would be unchanged during IVR use. Methods: We conducted a parallel, three-group, pharmacokinetic evaluation at clinical research sites in Asia, South America, sub-Saharan Africa, and the United States between December 30, 2014 and September 12, 2016 (NCT01903031). We enrolled women with HIV who were either ART-naïve (Control group; n=25), receiving efavirenz-based ART (n=25), or receiving atazanavir/ritonavir-based ART (n=24). An IVR releasing etonogestrel/ethinyl estradiol was inserted at entry. Single plasma samples for hormone concentrations were collected 7, 14, and 21 days after IVR insertion. The primary outcome was the plasma concentration of etonogestrel and ethinyl estradiol on Day 21. Etonogestrel and ethinyl estradiol concentrations were compared between each ART group and the Control group by geometric mean ratio (GMR) with 90% confidence intervals (CI) and Wilcoxon Rank-Sum test. Secondarily, efavirenz or atazanavir/ritonavir concentrations were assessed by 8-hour intensive pharmacokinetic sampling at entry before IVR insertion and before IVR removal on Day 21. Antiretroviral areas under the concentrationtime curve (AUC0-8h) were compared before and after IVR insertion by GMR (90% CI) and Wilcoxon Signed-Rank test. Findings: On Day 21 of IVR use, participants receiving efavirenz had 79% lower etonogestrel [GMR 0•21 (0•16-0•28); p<0•0001] and 59% lower ethinyl estradiol [GMR 0•41 (0•32-0•52); p<0•0001] concentrations compared to the Control group. In contrast, participants receiving atazanavir/ritonavir had 71% higher etonogestrel [GMR 1•71 (1•37-2•14); p<0•0001], yet 38% lower ethinyl estradiol [GMR 0•62 (0•49-First Name (middle initial) Last Name

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High rate of unplanned pregnancy in the context of integrated family planning and HIV care services in South Africa

Cited by 88 publications

References 46 publications

Reproductive Plans And Utilization of Contraceptives Among Women Living With HIV

Reproductive Plans And Utilization of Contraceptives Among Women Living With HIV

Determinants of Immediate Postpartum Contraception among Parturient Women with HIV in the Eastern Cape, South Africa; A Prospective Cross-sectional Study

Antiretroviral therapy and vaginally administered contraceptive hormones: a three-arm, pharmacokinetic study

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