Factors associated with uptake of contraceptives among HIV positive women on dolutegravir based anti-retroviral treatment-a cross sectional survey in urban Uganda.
Factors associated with uptake of contraceptives among HIV positive women on dolutegravir based anti-retroviral treatment-a cross sectional survey in urban Uganda.
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DOI：
10.1186/s12905-022-01842-7
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发表时间：
2022-06-27
影响因子：
2.5
通讯作者：
Castelnuovo, Barbara
中科院分区：
文献类型：
--
作者：
Mbabazi, Leah;Nabaggala, Mariah Sarah;Kiwanuka, Suzanne;Kiguli, Juliet;Laker, Eva;Kiconco, Arthur;Okoboi, Stephen;Lamorde, Mohammed;Castelnuovo, Barbara
2018年5月，博茨瓦纳一项研究的初步结果报告称，感染艾滋病毒的女性在服用多替拉韦药物后所生婴儿存在先天性异常，此后世界卫生组织发布了致畸警报。然而，关于这一指导意见对服用多替拉韦的女性采取避孕措施的影响，数据匮乏。我们评估了接受多替拉韦治疗方案的育龄艾滋病毒阳性女性采取避孕措施的情况。
2019年4月至7月，我们在乌干达中部的五家政府卫生机构进行了一项横断面调查，这些机构将基于多替拉韦的治疗方案作为首选的一线抗逆转录病毒治疗方案。我们随机选取了359名年龄在15 - 49岁之间、接受基于多替拉韦治疗方案的非怀孕女性，并使用半结构化的访谈员调查问卷对她们进行了访谈。我们收集了人口统计学、避孕措施使用情况以及个人、社会和卫生系统因素方面的数据。我们使用描述性统计方法描述了患者的特征，并使用修正的泊松回归模型评估了与采取避孕措施相关的因素。
共有359名女性被纳入研究。平均年龄为37岁（标准差 = 6.8），总体避孕措施采用率为38.4%。使用最多的方法是注射法，占58.4%，其次是避孕套（15%）、宫内节育器（10.7%）、避孕药（6.4%）、植入物（5.4%）和绝育（0.7%）。与有1 - 2个孩子的女性相比，有3 - 4个孩子的生育次数是采取避孕措施的预测因素（调整患病率比（APR）= 1.48，95%置信区间（CI）：1.14，1.92）。与年龄在15 - 24岁的女性相比，年龄在40 - 49岁的女性采取避孕措施的比例较低（APR = 0.45，CI：0.21 - 0.94）。与正式就业的女性相比，失业女性使用避孕措施的可能性较低（APR：0.6，CI：0.42 - 0.94）。与和伴侣讨论过计划生育的女性相比，没有和伴侣讨论过计划生育的女性采取避孕措施的比例较低（APR = 0.39，CI：0.29 - 0.52）；与接受过计划生育咨询的女性相比，没有接受过计划生育咨询的女性采取避孕措施的比例较低（APR = 0.56，CI：0.34 - 0.92）。
我们观察到避孕措施的采用率较低，注射法是最常用的方法。计划生育咨询以及伴侣间关于计划生育的讨论与使用基于多替拉韦治疗方案的女性采取避孕措施相关。需要更多策略来整合计划生育服务，并增加男性在艾滋病毒护理项目中的参与度。
In May 2018, following the preliminary results of a study in Botswana that reported congenital anomalies in babies born to HIV-positive women taking dolutegravir drug, the WHO issued a teratogenicity alert. However, there are scarce data on the impact of this guidance on contraceptive uptake among women taking dolutegravir. We assessed the uptake of contraceptives in HIV-positive women of reproductive age on dolutegravir regimens. We conducted a cross-sectional survey from April 2019 to July 2019 in five government health facilities in central Uganda, where dolutegravir-based regimens were offered as the preferred first-line antiretroviral treatment. We randomly selected 359 non-pregnant women aged 15–49 years taking dolutegravir-based regimens and interviewed them using semi-structured interviewer-administered questionnaires. We collected data on demographics, contraceptive use, individual, social, and health system factors. We described patients’ characteristics using descriptive statistics and assessed factors associated with contraceptive uptake using a modified Poisson regression model. A total of 359 women were included in the study. The mean age was 37 years (standard deviation = 6.8) and overall contraceptive uptake was 38.4%. The most utilized method was injectable method at 58.4% followed by condoms (15%), intrauterine device (10.7%), pills (6.4%), implants (5.4%), and sterilization (0.7%). Predictors for contraceptive uptake were parity of 3–4 children (Adjusted Prevalence Ratio (APR) = 1.48, 95% confidence interval (CI): 1.14, 1.92) in reference to those with 1–2 children. There was reduced contraceptive uptake in women of the age range 40–49 years (APR = 0.45, CI: 0.21–0.94) compared to those aged 15–24 years. Unemployed women were less likely to use contraceptives (APR: 0.6, CI: 0.42- 0.94) than the formally employed. Contraceptive uptake was lower among women who did not discuss family planning with their partners (APR = 0.39, CI: 0.29–0.52) than those who discussed family planning with their partners and women who did not receive family planning counseling (APR = 0.56, CI: 0.34–0.92) than those who received family planning counselling. We observed a low-level uptake of contraceptives, with injectables as the most used method. Family planning counseling and partner discussion on family planning were associated with contraceptive uptake among the women who used dolutegravir-based regimens. There is a need for more strategies to integrate FP services and increase male involvement in HIV care programs.
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