Longitudinal study of correlates of modern contraceptive use and impact of HIV care programmes among HIV concordant and serodiscordant couples in Rakai, Uganda
Journal of Family Planning and Reproductive Health Care
Department of Population, Reproductive and Family Health, Johns Hopkins Bloomberg School of Public Health, E4010, 615 North Wolfe Street, Baltimore, MD 21205, United States; Makerere University, School of Public Health, Kampala, Uganda; Rakai Health Science Program, Entebbe, Uganda; Department of Epidemiology, Johns Hopkins Bloomberg School of PublicHealth, Baltimore, MD, United States
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 chisquare test (χ2) for trend, and multinomial logistic regression was used to estimate adjusted odds ratios (ORs) of predictors of contraceptive use. Results A toal 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. Enrolment 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 enrolment into HIVC. Integration of HIV and reproductive health services is critical for prevention of unwanted pregnancies and HIV infection.
injectable contraceptive agent; levonorgestrel; oral contraceptive agent; adolescent; adult; article; cohort analysis; condom use; contraceptive behavior; educational status; family planning; female; health program; health survey; highly active antiretroviral therapy; hormonal contraception; human; Human immunodeficiency virus infection; longitudinal study; major clinical study; male; predictor variable; retrospective study; scale up; serodiagnosis; trend study; Uganda
# 22006.03, Bill and Melinda Gates Foundation; #U1AI51171, Bill and Melinda Gates Foundation; 1UO1AI075115-O1A1, Bill and Melinda Gates Foundation; NINR: 5R01NR011474-03, NIH, Bill and Melinda Gates Foundation