factors associated with uptake of contraceptives among hiv positive women on dolutegravir based anti-retroviral treatment at health centres of kampala capital city authority-uganda

Description

The burden of unintended pregnancies problem is global, although it mostly lies in low income countries with an unmet need for effective contraception of over 222 million women including 17.8 million HIV+ women worldwide. Dolutegravir (DTG) is a highly active drug antiretroviral treatment (ART) that could be unsafe in pregnancy as it may result in congenital anomalies for the newborn. This study aimed to investigate the uptake of contraceptive services and the factors affecting the uptake of contraceptive services among HIV positive women of reproductive age who are on DTG. This was a crossectional study of quantitative and qualitative research methods. It was conducted at 5 KCCA health ercenters that offer DTG ART. We included 359 HIV+ women aged 15-49 years who were taking DTG, excluding the pregnant ones. Data was collected by using interviewer administered questionnaires and 12 in-depth interviews. Quantitative Data was cleaned and analysed using STATA version 14 and Poisson regression was done at multivariate. Qualitative data were analysed using thematic analysis. Of the 359 participants, the mean age was 37(SD=6.8), half 50.7% had attained primary level of education and average monthly income <100,000Ushs. The overall level of Contraceptive uptake was 38.4%, modern contraceptive uptake was 37.6% and 96.4% of the participants had knowledge of contraceptives. The most utilised method was the injectable at 58.4% followed by condoms 15%, IUD 10.7%, pills 6.4%, implants 5.4%, and least used was sterilization at 0.7%. According to the qualitative interviews, ‘women chose to use injectable because it was safe, effective, reversible and the partners could not easily find out about it”. Predictor factors that increased likelihood of contraceptive uptake were; religion of others category AIRR=1.53(95% CI: 1.01, 2.29) and parity 3-4 children AIRR=1.48(95% CI: 1.14, 1.92). Reduced rates were observed for age 40-49 years AIRR=0.45(95% CI: 0.21, 0.94), unemployment AIRR 0.63(95% CI: 0.42, 0.94), not discussing FP with partner AIRR=0.39(95% CI: 0.29, 0.52) and not receiving FP counselling AIRR=2.86 (95% CI: 0.12, 0.73). Non-significant variables were facility, education level, marital status, sexual activity, experienced side effects of FP and knowledge on both contraceptives and DTG. This study shows a low-level uptake of contraceptives and injectable was the most used method. It also indicated that FP counseling and partner discussion on FP increased contraceptive uptake. Therefore, more strategies should be put in place to increase male involvement in family planning programs and scale up the integration of family planning services into HIV care and management programs.