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Fertility goal-based counseling increases contraceptive implant and IUD use in HIV-discordant couples in Rwanda and Zambia

  • Naw H. Khu
    Correspondence
    Corresponding author. Tel.: +1 404 712 8840; fax: +1 404 727 5764.
    Affiliations
    Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
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  • Bellington Vwalika
    Affiliations
    Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA

    Zambia Emory HIV Research Project, B 22/737 Mwembelelo Road, Postnet Box 412, P/Bag E891, Emmasdale, Lusaka, Zambia

    University Teaching Hospital and University of Zambia School of Medicine, P.O. Box 50001, Lusaka, Zambia
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  • Etienne Karita
    Affiliations
    Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA

    Projet San Francisco, 169 Blvd de la Revolution, BP 780, Kigali, Rwanda
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  • William Kilembe
    Affiliations
    Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA

    Zambia Emory HIV Research Project, B 22/737 Mwembelelo Road, Postnet Box 412, P/Bag E891, Emmasdale, Lusaka, Zambia
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  • Roger A. Bayingana
    Affiliations
    Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA

    Projet San Francisco, 169 Blvd de la Revolution, BP 780, Kigali, Rwanda
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  • Deborah Sitrin
    Affiliations
    Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA

    Zambia Emory HIV Research Project, B 22/737 Mwembelelo Road, Postnet Box 412, P/Bag E891, Emmasdale, Lusaka, Zambia
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  • Heidi Roeber-Rice
    Affiliations
    Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA

    Projet San Francisco, 169 Blvd de la Revolution, BP 780, Kigali, Rwanda
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  • Emily Learner
    Affiliations
    Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA

    Zambia Emory HIV Research Project, B 22/737 Mwembelelo Road, Postnet Box 412, P/Bag E891, Emmasdale, Lusaka, Zambia
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  • Amanda C. Tichacek
    Affiliations
    Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
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  • Lisa B. Haddad
    Affiliations
    Department of Obstetrics and Gynecology, School of Medicine, Emory University, Atlanta, GA 30322, USA
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  • Kristin M. Wall
    Affiliations
    Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA

    Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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  • Elwyn N. Chomba
    Affiliations
    Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA

    Zambia Emory HIV Research Project, B 22/737 Mwembelelo Road, Postnet Box 412, P/Bag E891, Emmasdale, Lusaka, Zambia

    University Teaching Hospital and University of Zambia School of Medicine, P.O. Box 50001, Lusaka, Zambia
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  • Susan A. Allen
    Affiliations
    Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
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      Abstract

      Background

      HIV-discordant heterosexual couples are faced with the dual challenge of preventing sexual HIV transmission and unplanned pregnancies with the attendant risk of perinatal HIV transmission. Our aim was to examine uptake of two long-acting reversible contraceptive (LARC) methods ��� intrauterine devices (IUD) and hormonal implants ��� among HIV-discordant couples in Rwanda and Zambia.

      Study Design

      Women were interviewed alone or with their partner during routine cohort study follow-up visits to ascertain fertility goals; those not pregnant, not infertile, not already using LARC, and wishing to limit or delay fertility for ���3 years were counseled on LARC methods and offered an IUD or implant on-site.

      Results

      Among 409 fertile HIV-discordant Rwandan women interviewed (126 alone, 283 with partners), 365 (89%) were counseled about LARC methods, and 130 (36%) adopted a method (100 implant, 30 IUD). Of 787 fertile Zambian women interviewed (457 alone, 330 with partners), 528 (67%) received LARC counseling, of whom 177 (34%) adopted a method (139 implant, 38 IUD). In both countries, a woman's younger age was predictive of LARC uptake. LARC users reported fewer episodes of unprotected sex than couples using only condoms.

      Conclusions

      Integrated fertility goal-based family planning counseling and access to LARC methods with reinforcement of dual-method use prompted uptake of IUDs and implants and reduced unprotected sex among HIV-discordant couples in two African capital cities.

      Keywords

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