Medical eligibility, contraceptive choice, and intrauterine device acceptance among HIV-infected women receiving antiretroviral therapy in Lilongwe, Malawi

• Type of Material: Article
• Authors: Lisa Haddad, Emory University; Caryl Feldacker, Lighthouse Trust; Denise Jamieson, Emory University; Hannock Tweya, Lighthouse Trust; Carrie Cwiak, Emory University; Amy G. Bryant, University of North Carolina; Mica C. Hosseinipour, University of North Carolina; Thomas Chaweza, Lighthouse Trust; Linly Mlundira, Lighthouse Trust; Fanny Kachale, Ministry of Health; Gretchen S. Stuart, University of North Carolina; Irving Hoffman, University of North Carolina; Sam Phiri, Lighthouse Trust
• Language: English
• Date: 2014-09-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 International Federation of Gynecology and Obstetrics.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijgo.2014.03.026
• Title of Journal or Parent Work: International Journal of Gynecology and Obstetrics
• ISSN: 0020-7292
• Volume: 126
• Issue: 3
• Start Page: 213
• End Page: 216
• Grant/Funding Information: The present study was funded by an anonymous foundation and the Center for AIDS Research at Emory University, Atlanta, USA.; C.F. is supported with funding from Cooperative Agreement U91HA06801 from the US Department of Health and Human Services, Health Resources and Services Administration.; H.T. is supported under the Operational Research Fellowship Program of the International Union Against Tuberculosis and Lung Disease, Paris, France.
• Keywords: ACQUISITION; HORMONAL CONTRACEPTION; Life Sciences & Biomedicine; PREGNANCY; Science & Technology; HIV; RANDOMIZED CONTROLLED-TRIAL; AFRICA; Malawi; Intrauterine contraception; Obstetrics & Gynecology; RISK; Intrauterine device; TRANSMISSION; Antiretroviral therapy; Contraception; Medical eligibility
• Research Categories: Health Sciences, Public Health; Health Sciences, Obstetrics and Gynecology

Abstract

Objective To determine medical eligibility for contraceptive use, contraceptive preference, and acceptance of a copper intrauterine device (IUD) among a cohort of HIV-infected women receiving antiretroviral therapy (ART). Methods All HIV-infected women who received ART and sought contraceptive services at the Lighthouse clinic, an integrated HIV/ART clinic in Lilongwe, Malawi, between August and December 2010 were invited to participate in a structured interview. Eligibility and preference for the following contraceptive methods were assessed: combined hormonal contraceptives, progestogen-only pills, copper IUD, injectable depot medroxyprogesterone acetate (DMPA), and contraceptive implants. Results The final sample included 281 women; five were pregnant. The remaining 276 women were eligible for at least three contraceptive methods, with 242 (87.7%) eligible for all five methods evaluated. After counseling, 163 (58.0%) selected DMPA and 98 (34.9%) selected an IUD as their preferred contraceptive method. Regardless of their method of choice, 222 (79.0%) women agreed to have an IUD placed on the same day. Conclusion Most methods of contraception are safe for use by HIV-infected women. Approximately 80% of the women were willing to receive an IUD. Efforts must be made to increase education about, and access to, long-acting reversible methods that may be acceptable and appropriate contraceptive options for HIV-infected women.