The journal of family planning and reproductive health care · 2013
Longitudinal study of correlates of modern contraceptive use and impact of HIV care programmes among HIV concordant and serodiscordant couples in Rakai, Uganda.
Сравнительное исследованиеСтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Brahmbhatt Heena, Makumbi Fredrick, Lutalo Tom, Sekasanvu Joseph, Serwadda David, Wawer Maria J, Gray Ronald H
Аннотация
OBJECTIVE: To assess trends and determinants of family planning use and impact of HIV serostatus among couples.
METHODS: Couples' data were retrospectively linked from cohort surveys in Rakai, Uganda between 1999 and 2011, and were classified by HIV status as concordant (M+F+/M-F-) or serodiscordant (M-F+/M+F-). HIV care (HIVC) was grouped into three periods, pre-antiretroviral therapy (pre-HIVC) (<2004), HIVC roll-out (2005-2007) and HIVC scale-up (≥ 2008). Trends in couple contraceptive use were assessed by chi-square test (χ(2)) for trend, and multinomial logistic regression was used to estimate adjusted odds ratios (ORs) of predictors of contraceptive use.
RESULTS: A total of 6139 couples contributed 13,709 observations. Hormonal contraception (HC) use increased over time from 22.9% to 33.9%, p<0.001), with significant increases among M-F- (23.2% to 34.8%, p<0.0001) and M+F+ (20.8% to 32.2%, p=0.0005), but not serodiscordant couples. Condom use significantly increased among M+F+ (30.3% to 48.0%, p<0.001) and serodiscordant couples (24.2% to 48.7%, p<0.001), but not among M-F- couples. Dual use of HC and condoms increased over time, irrespective of HIV status. Factors associated with increases in contraceptive use were: higher education, co-resident children, male non-marital relationship and scaled-up HIVC phase. Enrollment into HIVC was associated with increased HC and condom use among HIV+ concordant [adjusted OR (adjOR)=3.03; 95% confidence interval (CI) 1.69-5.44 and adjOR=4.46, 95% CI 2.53-7.86, respectively], and serodiscordant couples (adjOR=2.21; 95% CI 1.25-3.92 and adjOR=4.75; 95% CI 2.89-7.82, respectively).
CONCLUSIONS: Use of modern contraception and dual method use increased over time, particularly after enrollment into HIVC. Integration of HIV and reproductive health services is critical for prevention of unwanted pregnancies and HIV infection.
METHODS: Couples' data were retrospectively linked from cohort surveys in Rakai, Uganda between 1999 and 2011, and were classified by HIV status as concordant (M+F+/M-F-) or serodiscordant (M-F+/M+F-). HIV care (HIVC) was grouped into three periods, pre-antiretroviral therapy (pre-HIVC) (<2004), HIVC roll-out (2005-2007) and HIVC scale-up (≥ 2008). Trends in couple contraceptive use were assessed by chi-square test (χ(2)) for trend, and multinomial logistic regression was used to estimate adjusted odds ratios (ORs) of predictors of contraceptive use.
RESULTS: A total of 6139 couples contributed 13,709 observations. Hormonal contraception (HC) use increased over time from 22.9% to 33.9%, p<0.001), with significant increases among M-F- (23.2% to 34.8%, p<0.0001) and M+F+ (20.8% to 32.2%, p=0.0005), but not serodiscordant couples. Condom use significantly increased among M+F+ (30.3% to 48.0%, p<0.001) and serodiscordant couples (24.2% to 48.7%, p<0.001), but not among M-F- couples. Dual use of HC and condoms increased over time, irrespective of HIV status. Factors associated with increases in contraceptive use were: higher education, co-resident children, male non-marital relationship and scaled-up HIVC phase. Enrollment into HIVC was associated with increased HC and condom use among HIV+ concordant [adjusted OR (adjOR)=3.03; 95% confidence interval (CI) 1.69-5.44 and adjOR=4.46, 95% CI 2.53-7.86, respectively], and serodiscordant couples (adjOR=2.21; 95% CI 1.25-3.92 and adjOR=4.75; 95% CI 2.89-7.82, respectively).
CONCLUSIONS: Use of modern contraception and dual method use increased over time, particularly after enrollment into HIVC. Integration of HIV and reproductive health services is critical for prevention of unwanted pregnancies and HIV infection.
Предметные рубрики MeSH
AdolescentAdultAttitude to HealthCondomsConfidence IntervalsContraceptionContraceptives, Oral, HormonalCross-Sectional StudiesDeveloping CountriesFamily CharacteristicsFamily Planning ServicesFemaleHIV InfectionsHumansLongitudinal StudiesMaleOdds RatioPrimary PreventionRetrospective StudiesSerologic TestsSexual BehaviorSexually Transmitted DiseasesUgandaYoung Adult