Improved access increases postpartum uptake of contraceptive implants among HIV-positive women in Rwanda

Dhont, Nathalie; Ndayisaba, Gilles; Peltier, Cécile; Nzabonimpa, Aniceth; Temmerman, Marleen; Wijgert, Janneke van de

doi:10.3109/13625180903340584

Cited by 29 publications

(33 citation statements)

References 15 publications

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“…The proportion of women wanting to limit fertility is comparable to previously reported figures of 50-90% among women living with HIV or with HIV-positive partners [9, 10]. The very low proportion of women using LARC nationwide, <2% in Rwanda and <0.5% in Zambia [19, 21], confirms a substantial unmet need for long-acting methods.…”

Section: Discussionsupporting

confidence: 75%

“…Previous studies have demonstrated that increasing access to LARC methods improves their uptake among HIV-positive women. In Rwanda, providing information and access to hormonal contraceptives resulted in increased use among both HIV-positive and HIV-negative women [8], and when access to LARC was provided on-site, a substantial portion of HIV-positive women requested hormonal implants postpartum [9]. In Zambia, improving access to non-barrier methods among HIV-concordant-positive and HIV-discordant couples already using condoms increased dual-method use three-fold [10], and a video-based intervention resulted in significantly increased uptake of LARC in discordant and concordant HIV-positive couples [11].…”

Section: Introductionmentioning

confidence: 99%

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Fertility goal-based counseling increases contraceptive implant and IUD use in HIV-discordant couples in Rwanda and Zambia

et al. 2013

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Background HIV discordant heterosexual couples are faced with the dual challenge of preventing sexual HIV transmission and unplanned pregnancies with the attendant risk of perinatal HIV transmission. Our aim was to examine uptake of two long-acting reversible contraceptive (LARC) methods – intrauterine devices (IUDs) and hormonal implants – among HIV discordant couples in Rwanda and Zambia. Study Design Women were interviewed alone or with their partner during routine cohort study follow-up visits to ascertain fertility goals; those not pregnant, not infertile, not already using LARC, and wishing to limit or delay fertility for ≥3 years were counseled on LARC methods and offered an IUD and implant on-site. Results Among 409 fertile Rwandan women interviewed (126 alone, 283 with partners), 365 (89%) were counseled about LARC methods and 130 (36%) adopted a method (100 implant, 30 IUD). Of 787 fertile Zambian women interviewed (457 alone, 330 with partners), 528 (67%) received LARC counseling, of whom 177 (34%) adopted a method (139 implant, 38 IUD). In both countries, a woman’s younger age was predictive of LARC uptake. LARC users reported fewer episodes of unprotected sex than couples using only condoms. Conclusions Integrated fertility-goal based family planning counseling and access to LARC methods with reinforcement of dual-method use prompted uptake of IUDs and implants and reduced unprotected sex among HIV-discordant couples in two African capital cities.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Fertility goal-based counseling increases contraceptive implant and IUD use in HIV-discordant couples in Rwanda and Zambia

et al. 2013

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“…Among studies of adult HIV-seropositive women, the majority have been conducted in international settings, primarily in Africa [104–110], with few studies from the USA [111]. These reports highlight the importance of access to health care [104, 105], reporting women's concerns about contraceptive side effects [108] or potential interactions with ARVs [108], convenience of barrier contraceptive methods [104, 105, 111], and desire to have children [107–109] as determinants of contraceptive method use in women living with HIV [104]. Additionally, contraceptive use may differ by partner type; for instance, among a cohort of French women living with HIV, contraceptive use was more prevalent among women reporting recent sexual encounters with casual partners [112].…”

Section: Factors That Influence Contraceptive Choice May Impact Hiv Riskmentioning

confidence: 99%

Contraceptive Methods and Risk of HIV Acquisition or Female-to-Male Transmission

et al. 2014

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Effective family planning with modern contraception is an important intervention to prevent unintended pregnancies which also provides personal, familial, and societal benefits. Contraception is also the most cost-effective strategy to reduce the burden of mother-to-child HIV transmission for women living with HIV who wish to prevent pregnancy. There are concerns, however, that certain contraceptive methods, in particular the injectable contraceptive depot medroxyprogesterone acetate (DMPA), may increase a woman's risk of acquiring HIV or transmitting it to uninfected males. These concerns, if confirmed, could potentially have large public health implications. This paper briefly reviews the literature on use of contraception among women living with HIV or at high risk of HIV infection. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommendations place no restrictions on the use of hormonal contraceptive methods by women with or at high risk of HIV infection, although a clarification recommends that, given uncertainty in the current literature, women at high risk of HIV who choose progestogen-only injectable contraceptives should be informed that it may or may not increase their risk of HIV acquisition and should also be informed about and have access to HIV preventive measures, including male or female condoms.

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“…Exposure to a video highlighting IUD and contraceptive implants was associated with greater choice of those methods. Another study conducted in Rwanda showed high uptake of implants when this method was made available to postpartum PMTCT clients [18]. …”

Section: Introductionmentioning

confidence: 99%

Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa

et al. 2014

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BackgroundClients of prevention of mother-to-child transmission (PMTCT) services in South Africa who use contraception following childbirth rely primarily on short-acting methods like condoms, pills, and injectables, even when they desire no future pregnancies. Evidence is needed on strategies for expanding contraceptive options for postpartum PMTCT clients to include long-acting and permanent methods.MethodsWe examined the process of expanding contraceptive options in five health centers in Cape Town providing services to HIV-positive women. Maternal/child health service providers received training and coaching to strengthen contraceptive counseling for postpartum women, including PMTCT clients. Training and supplies were introduced to strengthen intrauterine device (IUD) services, and referral mechanisms for female sterilization were reinforced. We conducted interviews with separate samples of postpartum PMTCT clients (265 pre-intervention and 266 post-intervention) to assess knowledge and behaviors regarding postpartum contraception. The process of implementing the intervention was evaluated through systematic documentation and interpretation using an intervention tracking tool. In-depth interviews with providers who participated in study-sponsored training were conducted to assess their attitudes toward and experiences with promoting voluntary contraceptive services to HIV-positive clients.ResultsFollowing the intervention, 6% of interviewed PMTCT clients had the desired knowledge about the IUD and 23% had the desired knowledge about female sterilization. At both pre- and post-intervention, 7% of clients were sterilized and IUD use was negligible; by comparison, 75% of clients used injectables. Intervention tracking and in-depth interviews with providers revealed intervention shortcomings and health system constraints explaining the failure to produce intended effects.ConclusionsThe intervention failed to improve PMTCT clients’ knowledge about the IUD and sterilization or to increase use of those methods. To address the family planning needs of postpartum PMTCT clients in a way that is consistent with their fertility desires, services must expand the range of contraceptive options to include long-acting and permanent methods. In turn, to ensure consistent access to high quality family planning services that are effectively linked to HIV services, attention must also be focused on resolving underlying health system constraints weakening health service delivery more generally.

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Improved access increases postpartum uptake of contraceptive implants among HIV-positive women in Rwanda

Abstract: When access to LARC was provided, a substantial number of HIV-positive women started using hormonal implants, but not IUDs, in the postpartum period. HIV and FP services should consider improving access to implants to reduce the number of unintended pregnancies.

Cited by 29 publications

References 15 publications

Fertility goal-based counseling increases contraceptive implant and IUD use in HIV-discordant couples in Rwanda and Zambia

Fertility goal-based counseling increases contraceptive implant and IUD use in HIV-discordant couples in Rwanda and Zambia

Contraceptive Methods and Risk of HIV Acquisition or Female-to-Male Transmission

Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa

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