Fertility goal-based counseling increases contraceptive implant and IUD use in HIV discordant couples in Rwanda and Zambia

• Type of Material: Article
• Authors: Naw H. Khu, Emory University; Bellington Vwalika, Emory University; Etienne Karita, Emory University; William Kilembe, Emory University; Roger A. Bayingana, Emory University; Deborah Sitrin, Emory University; Heidi Roeber-Rice, Emory University; Emily Learner, Emory University; Amanda Tichacek, Emory University; Lisa Haddad, Emory University; Kristin Wall, Emory University; Elwyn Chomba, Emory University; Susan A Allen, Emory University
• Language: English
• Date: 2013-07
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1016/j.contraception.2012.10.004
• Title of Journal or Parent Work: Contraception
• ISSN: 0010-7824
• Volume: 88
• Issue: 1
• Start Page: 74
• End Page: 82
• Grant/Funding Information: Funding was used for employment, travel, and provision of writing assistance, surgical instruments, equipment, and/or administrative support related to the study.; This work was supported by ongoing funding from the US National Institutes of Health (RO1: MH066767, AI040951, HD040125), the AIDS International Training and Research Program (AITRP: FIC D43 TW001042), the Center for AIDS Research at Emory (P30 AI050409), and the International AIDS Vaccine Initiative.
• Keywords: HIV; intrauterine devices; contraception; implant; family planning
• Research Categories: Health Sciences, Public Health; Health Sciences, Pathology; Health Sciences, Epidemiology; Health Sciences, Obstetrics and Gynecology

Abstract

Background HIV discordant heterosexual couples are faced with the dual challenge of preventing sexual HIV transmission and unplanned pregnancies with the attendant risk of perinatal HIV transmission. Our aim was to examine uptake of two long-acting reversible contraceptive (LARC) methods – intrauterine devices (IUDs) and hormonal implants – among HIV discordant couples in Rwanda and Zambia. Study Design Women were interviewed alone or with their partner during routine cohort study follow-up visits to ascertain fertility goals; those not pregnant, not infertile, not already using LARC, and wishing to limit or delay fertility for ≥3 years were counseled on LARC methods and offered an IUD and implant on-site. Results Among 409 fertile Rwandan women interviewed (126 alone, 283 with partners), 365 (89%) were counseled about LARC methods and 130 (36%) adopted a method (100 implant, 30 IUD). Of 787 fertile Zambian women interviewed (457 alone, 330 with partners), 528 (67%) received LARC counseling, of whom 177 (34%) adopted a method (139 implant, 38 IUD). In both countries, a woman’s younger age was predictive of LARC uptake. LARC users reported fewer episodes of unprotected sex than couples using only condoms. Conclusions Integrated fertility-goal based family planning counseling and access to LARC methods with reinforcement of dual-method use prompted uptake of IUDs and implants and reduced unprotected sex among HIV-discordant couples in two African capital cities.