Correlates of reported modern contraceptive use among postpartum HIV-positive women in rural Nigeria: an analysis from the MoMent prospective cohort study
Correlates of reported modern contraceptive use among postpartum HIV-positive women in rural Nigeria: an analysis from the MoMent prospective cohort study
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DOI：
10.1186/s12978-018-0663-8
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发表时间：
2019-01-08
影响因子：
3.4
通讯作者：
Sam-Agudu, Nadia A.
中科院分区：
文献类型：
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作者：
Chinaeke, Eric E.;Fan-Osuala, Chinenye;Sam-Agudu, Nadia A.
尼日利亚每年有大约20万孕妇和艾滋病毒阳性妇女。这一人群对计划生育的高度未满足需求可能导致意外怀孕，同时母婴传播艾滋病毒（MTCT）的风险增加。为了确定有效计划生育中可改变的障碍和促进因素，我们研究了尼日利亚中北部农村地区预防母婴传播（PMTCT）实施研究研究中参加的艾滋病毒阳性妇女使用现代避孕药具的相关性。方法本前瞻性队列研究纳入20个初级卫生保健中心的hiv阳性孕妇，随访至产后12个月。在入组时收集基线社会人口统计学、临床和产科数据。参与者在产后访问期间接受保健工作者的常规计划生育咨询。分析使用的基线数据与从每位妇女第一次产后就诊时收集的现有计划生育信息相关。进行多因素logistic回归以确定与现代避孕药具使用相关的因素。结果497名妇女中，399名（80.3%）妇女可获得计划生育资料，其中349名（87.5%）妇女接受计划生育咨询，321名（80.5%）妇女年龄在30岁及以下。三分之二（268,67.2%）的队列在基线时有1-2个孩子；24.8% （n=99）有3-4个孩子，8.0% （n=32）有4个孩子。大约一半（199,49.9%）的妇女报告在产后没有使用现代避孕措施。男性避孕套（116例，29.1%）是报告最多的避孕方法；其他方法包括口服激素（71例，17.8%）和宫内节育器（13例，3.2%）。只有向男性伴侣或亲属披露艾滋病毒状况（aOR=2.0, 95% CI: 1.2-3.3; p=0.01）和接受计划生育咨询（aOR=2.3, 95% CI: 1.1-4.8; p=0.03）与报告的现代避孕药具使用呈正相关。年龄、婚姻或教育状况、宗教信仰、就业状况、妊娠和胎次不相关。结论计划生育咨询和艾滋病毒状况的披露是尼日利亚农村产后艾滋病毒阳性妇女使用避孕药具的可修改的阳性预测因素。通过促进这些相关性的策略，可以显著降低意外怀孕率和MTCT的伴随风险。临床试验注册clinicaltrials .gov注册号：NCT 01936753；注册于2013年9月3日。
BackgroundNigeria has an annual population of similar to 200,000 women who are both pregnant and HIV-positive. High unmet need for family planning in this population could lead to unintended pregnancies, along with theincreased risk of mother-to-child transmission of HIV (MTCT). To identify modifiable barriers and facilitators in effective family planning, we examined correlates of modern contraceptive use among HIV-positive women enrolled in the MoMent prevention of MTCT (PMTCT) implementation research study in rural North-Central Nigeria.MethodsIn this prospective cohort study, HIV-positive pregnant women were enrolled at 20 Primary Healthcare Centers and followed up to 12months postpartum. Baseline socio-demographic, clinical and obstetric data were collected at enrollment. Participants were to receive routine family planning counselling from healthcare workers during postnatal visits. Analysis utilized baseline data linked to available family planning information collected from each woman at the first postpartum visit. Multivariate logistic regression was performed to determine factors associated with modern contraceptive use.ResultsOut of 497 women enrolled, family planning data was available for 399 (80.3%) women, of whom 349 (87.5%) received family planning counselling, and 321 (80.5%) were30years oldor less. Two-thirds (268, 67.2%) of the cohort analyzed had 1-2 children at baseline; 24.8% (n=99) had 3-4 children, and 8.0% (n=32) had >4 children. Approximately half (199, 49.9%) of the women reported no modern contraceptive use in the postpartum period. Male condoms (116, 29.1%) were the most reported method of contraception; other methods reported included oral hormones (71, 17.8%) and intrauterine devices (13, 3.2%). Only disclosure of HIV status to male partner or relative (aOR=2.0, 95% CI: 1.2-3.3; p=0.01) and receipt of family planning counselling (aOR=2.3, 95% CI: 1.1-4.8; p=0.03) were positively associated with reported modern contraceptive use. Age, marital or educational status, religious affiliation, employment status, gravidity and parity were non-correlates.ConclusionsFamily planning counselling and disclosure of HIV status are modifiable positive predictors of contraceptive use among our cohort of postpartum HIV-positive women in rural Nigeria. Rates of unintended pregnancy and concomitant risk of MTCT could be significantly reduced through strategies that facilitate these correlates.Clinical trials registrationClinicaltrials.gov registration number: NCT 01936753; registered September 3, 2013.