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Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Longitudinal study of correlates of modern contraceptive use and impact of HIV care programmes among HIV concordant and serodiscordant couples in Rakai, Uganda

TitleLongitudinal study of correlates of modern contraceptive use and impact of HIV care programmes among HIV concordant and serodiscordant couples in Rakai, Uganda
Publication TypeJournal Article
Year of Publication2014
AuthorsBrahmbhatt, H, Makumbi, F, Lutalo, T, Sekasanvu, J, Serwadda, D, Wawer, MJ, Gray, RH
JournalJ Fam Plann Reprod Health Care
Volume40
Pagination208-16
Date PublishedJul
ISBN Number1471-1893
Accession Number23955379
KeywordsSexual and Reproductive Health
Abstract

OBJECTIVE: To assess trends and determinants of family planning use and impact of HIV serostatus among couples. METHODS: Couples' data were retrospectively linked from cohort surveys in Rakai, Uganda between 1999 and 2011, and were classified by HIV status as concordant (M+F+/M-F-) or serodiscordant (M-F+/M+F-). HIV care (HIVC) was grouped into three periods, pre-antiretroviral therapy (pre-HIVC) (<2004), HIVC roll-out (2005-2007) and HIVC scale-up (>/= 2008). Trends in couple contraceptive use were assessed by chi-square test (chi(2)) for trend, and multinomial logistic regression was used to estimate adjusted odds ratios (ORs) of predictors of contraceptive use. RESULTS: A total of 6139 couples contributed 13,709 observations. Hormonal contraception (HC) use increased over time from 22.9% to 33.9%, p<0.001), with significant increases among M-F- (23.2% to 34.8%, p<0.0001) and M+F+ (20.8% to 32.2%, p=0.0005), but not serodiscordant couples. Condom use significantly increased among M+F+ (30.3% to 48.0%, p<0.001) and serodiscordant couples (24.2% to 48.7%, p<0.001), but not among M-F- couples. Dual use of HC and condoms increased over time, irrespective of HIV status. Factors associated with increases in contraceptive use were: higher education, co-resident children, male non-marital relationship and scaled-up HIVC phase. Enrollment into HIVC was associated with increased HC and condom use among HIV+ concordant [adjusted OR (adjOR)=3.03; 95% confidence interval (CI) 1.69-5.44 and adjOR=4.46, 95% CI 2.53-7.86, respectively], and serodiscordant couples (adjOR=2.21; 95% CI 1.25-3.92 and adjOR=4.75; 95% CI 2.89-7.82, respectively). CONCLUSIONS: Use of modern contraception and dual method use increased over time, particularly after enrollment into HIVC. Integration of HIV and reproductive health services is critical for prevention of unwanted pregnancies and HIV infection.

PMCID

Pmc4078711