Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda

• Type of Material: Article
• Authors: Jeannine Mukamuyango, Rwanda Zambia HIV Research Group; Rosine Ingabire, Rwanda Zambia HIV Research Group; Rachel Parker, Emory University; Julien Nyombayire, Rwanda Zambia HIV Research Group; Andrew Abaasa, London School of Hygiene and Tropical Medicine; Gershim Asiki, Uganda Vaccine Research Institute; Sarah Rae Easter, Harvard Medical School; Kristin Wall, Emory University; Laetitia Nyirazinyoye, University of Rwanda; Amanda Tichacek, University of Rwanda; Nadine Kaslow, Emory University; Matt A. Price, International AIDS Vaccine Initiative; Susan Allen, Emory University; Etienne Karita, Rwanda Zambia HIV Research Group
• Language: English
• Date: 2020-08-17
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12978-020-00981-0
• Title of Journal or Parent Work: REPRODUCTIVE HEALTH
• Volume: 17
• Issue: 1
• Start Page: 126
• End Page: 126
• Grant/Funding Information: This work was supported by National Institutes of Health (https://www.nih.gov/) grants [R01 MH66767, R01 HD40125, and R01 MH95503; K01 MH107320, R01 AI051231]; the AIDS International Training and Research Program Fogarty International Center [D43 TW001042]; and the Emory Center for AIDS Research [P30 AI050409]. Additional support was provided by the International AIDS Vaccine Initiative (https://www.iavi.org/).; This work was also supported through the Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE), a DELTAS Africa Initiative [grant # DEL-15-006].; The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)‘s Alliance for Accelerating Excellence in Science in Africa (EASA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from Wellcome Trust [grant # 107752/Z/15/Z] and the UK government.
• Keywords: NATIONAL-SURVEY; Public, Environmental & Occupational Health; Life Sciences & Biomedicine; CARE; REPRODUCTIVE HEALTH; DISCORDANT COUPLES; SEXUALLY-TRANSMITTED-DISEASES; HUMAN-IMMUNODEFICIENCY-VIRUS; GENITOURINARY MEDICINE; PREVENTION; SERVICES; Science & Technology; WOMEN
• Research Categories: Health Sciences, Public Health

Abstract

Background: When integrated with couples' voluntary HIV counselling and testing (CVCT), family planning including long acting reversible contraceptives (LARC) addresses prongs one and two of prevention of mother-to-child transmission (PMTCT). Methods: In this observational study, we enrolled equal numbers of HIV concordant and discordant couples in four rural and four urban clinics, with two Catholic and two non-Catholic clinics in each area. Eligible couples were fertile, not already using a LARC method, and wished to limit or delay fertility for at least 2 years. We provided CVCT and fertility goal-based family planning counselling with the offer of LARC and conducted multivariate analysis of clinic, couple, and individual predictors of LARC uptake. Results: Of 1290 couples enrolled, 960 (74%) selected LARC: Jadelle 5-year implant (37%), Implanon 3-year implant (26%), or copper intrauterine device (IUD) (11%). Uptake was higher in non-Catholic clinics (85% vs. 63% in Catholic clinics, p < 0.0001), in urban clinics (82% vs. 67% in rural clinics, p < 0.0001), and in HIV concordant couples (79% vs. 70% of discordant couples, p =.0005). Religion of the couple was unrelated to clinic religious affiliation, and uptake was highest among Catholics (80%) and lowest among Protestants (70%) who were predominantly Pentecostal. In multivariable analysis, urban location and non-Catholic clinic affiliation, Catholic religion of woman or couple, younger age of men, lower educational level of both partners, non-use of condoms or injectable contraception at enrollment, prior discussion of LARC by the couple, and women not having concerns about negative side effects of implant were associated with LARC uptake. Conclusions: Fertility goal-based LARC recommendations combined with couples' HIV counselling and testing resulted in a high uptake of LARC methods, even among discordant couples using condoms for HIV prevention, in Catholic clinics, and in rural populations. This model successfully integrates prevention of HIV and unplanned pregnancy.