Provider Counseling Can Help Prevent Unwanted Pregnancies in HIV Patients

Researchers surveyed patients receiving antiretroviral therapy (ART) in Lusaka, Zambia, and found that changes are necessary in order for family planning services to be effective among that population.

They found many unplanned and unwanted pregnancies among these patients and said that was likely related to the fact that the ART clinics provided only condoms, a less reliable method of birth control that other alternatives. The study, published in BMC Public Health on May 12, 2016, was conducted by Nancy L. Hancock, MD, of the Department of Obstetrics and Gynecology, UNC Global Women’s Health, North Carolina School of Medicine, and colleagues.

Women with HIV are more likely to get pregnant unintentionally, and those receiving ART have an even greater risk of unintended pregnancy. The researchers say that they conducted this study as a first step toward understanding how family planning (FP) and ART could be successfully integrated. More specifically, they say, “To inform FP-ART service integration planning in Lusaka, Zambia, we sought to determine the prevalence of modern contraception and dual method use among ART patients and to identify associated factors.”

This study was cross-sectional in design, and the participants were drawn from 18 public sector, government-supported ART clinics in Lusaka. There were 7046 participants who completed a 10-question survey between February and April of 2014.

The researchers describe the survey saying the questions were “designed to determine the patient’s current pregnancy status (or, for male respondents, that of the partner), HIV disclosure status, partner HIV status, contraceptive use including method(s) used, reasons for method non-use, and interest in accessing FP within ART clinics.”

Answers were not verified; all information was self-reported. Most of the respondents (69%) were women, and 463 were pregnant or were men who had a pregnant partner and 49% of those pregnancies were unplanned. Of all the respondents, 75% said they did not want a child in the next year. Most, (80%), said they would like to be able to access FB services at the ART clinic.

Nearly all (99%) of the women who reported using contraception (3138) said that they use modern methods: 60% used male condoms only, 15% used injectable contraception, and 11% used oral contraception. Only 25% reported using a dual method to prevent pregnancy and HIV transmission.

The researchers report, “In multivariable analysis, women who were older, did not desire a child in the next year, had disclosed their status to their partner, and were sexually active in the last six months had higher odds of using modern contraception.”

Those using highly effective contraceptive methods were similar in circumstances. Although most of the patients would like to access FP services in ART clinics, usually only condoms are available there. In order to use additional or different methods, patients must go to a separate facility.

Condoms are effective in preventing sexually transmitted diseases, but are less effective as contraceptives than other methods. The researchers suggest that “targeted interventions are needed” to make sure that ART patients are aware of and have access to those other methods. They conclude, “Collaborations between reproductive health service providers and ART providers are essential to ensure appropriate integration of FP-HIV care to achieve these objectives.”