Longitudinal study of correlates of modern contraceptive use and impact of HIV care programmes among HIV concordant and serodiscordant couples in Rakai, Uganda
- Heena Brahmbhatt1,
- Fredrick Makumbi2,
- Tom Lutalo3,
- Joseph Sekasanvu4,
- David Serwadda5,
- Maria J Wawer6,
- Ronald H Gray7
- 1Assistant Professor, Department of Population, Reproductive and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 2Lecturer, Makerere University, School of Public Health, Kampala, Uganda and Associate Professor, Population, Reproductive and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 3Senior Researcher, Rakai Health Science Program, Entebbe, Uganda
- 4Statistician, Rakai Health Science Program, Entebbe, Uganda
- 5Professor, Makerere University, School of Public Health, Kampala, Uganda
- 6Professor, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 7Professor, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Correspondence to Dr Heena Brahmbhatt, Johns Hopkins Bloomberg School of Public Health, E4010, 615 North Wolfe Street, Baltimore, MD 21205, USA;
- Received 15 January 2013
- Revised 13 May 2013
- Accepted 29 June 2013
- Published Online First 16 August 2013
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 (χ2) for trend, and multinomial logistic regression was used to estimate adjusted odds ratios (ORs) of predictors of contraceptive use.
Results A toal 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. Enrolment 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 enrolment into HIVC. Integration of HIV and reproductive health services is critical for prevention of unwanted pregnancies and HIV infection.
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