About this item:

666 Views | 336 Downloads

Author Notes:

E-mail: kmwall@emory.edu

Conceived and designed the experiments: BV WK EC CV AT SA. Performed the experiments: BV WK EC CV AT SA. Analyzed the data: KW LH NHK IB RS SA. Wrote the paper: KW LH BV NHK IB WK RS EC CV AT SA. Contributed to the conception and design of the study: BV WK EC CV AT SA. Contributed to the analysis and interpretation of data: KW LH NHK IB RS.

Drafted the article: KW LH NHK IB RS. Revised article critically for important intellectual content and gave final approval of the version to be published: KW LH NHK IB RS BV WK EC CV AT SA

The authors have declared that no competing interests exist.


Research Funding:

This work was supported by funding from the National Institutes of Child Health and Development (NICHD RO1 HD40125); National Institute of Mental Health (NIMH R01 66767); the AIDS International Training and Research Program Fogarty International Center (D43 TW001042); the Emory Center for AIDS Research (P30 AI050409); National Institute of Allergy and Infectious Diseases (NIAID R01 AI51231); and the International AIDS Vaccine Initiative.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Trial registration: ClinicalTrials.gov NCT00067522

Unintended Pregnancy among HIV Positive Couples Receiving Integrated HIV Counseling, Testing, and Family Planning Services in Zambia

Show all authors Show less authors


Journal Title:



Volume 8, Number 9


, Pages e75353-e75353

Type of Work:

Article | Final Publisher PDF


Objective We describe rates of unintended pregnancy among HIV positive couples in Lusaka, Zambia. We also identify factors associated with unintended pregnancy among oral contraceptive pill (OCP) using couples in this cohort. Design Data were analyzed from couples randomized in a factorial design to two family planning intervention videos. Methods Rates of unintended pregnancy were stratified by contraceptive method used at time of pregnancy. Predictors of time to unintended pregnancy among OCP users were determined via multivariate Cox modeling. Results The highest rates of unintended pregnancy were observed among couples requesting condoms only (26.4/100CY) or OCPs (20.7/100CY); these rates were not significantly different. OCP users accounted for 37% of the couple-years (CY) observed and 87% of unintended pregnancies. Rates of unintended pregnancy for injectable (0.7/100CY) and intrauterine device (1.6/100CY) users were significantly lower relative to condom only users. No pregnancies occurred among contraceptive implant users or after tubal ligation. Factors associated (p<0.05) with time to unintended pregnancy among OCP users in multivariate analysis included the man wanting more children, the woman being HIV negative versus having stage IV HIV disease, and the woman reporting: younger age, no previous OCP use, missed OCPs, or sex without a condom. Conclusions Long-acting reversible contraceptive methods were effective in the context of integrated couples HIV prevention and contraceptive services. Injectable methods were also effective in this context. Given the high user failure rate of OCPs, family planning efforts should promote longer-acting methods among OCP users wishing to avoid pregnancy. Where other methods are not available or acceptable, OCP adherence counseling is needed, especially among younger and new OCP users.

Copyright information:

© 2013 Wall et al.

This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 Unported License ( http://creativecommons.org/licenses/by/3.0/), which permits making multiple copies, distribution, public display, and publicly performance, distribution of derivative works, provided the original work is properly cited. This license requires credit be given to copyright holder and/or author, copyright and license notices be kept intact.

Creative Commons License

Export to EndNote