Abstract
Objectives
To assess clinician provision of hormonal contraception for HIV-positive and at-risk
women in Southern Africa.
Study Design
We conducted a nationally representative survey of clinicians (n=1444) in HIV-prevalent settings in South Africa and Zimbabwe to evaluate evidence-based
contraceptive care and clinician views of hormonal contraceptives for HIV-positive
and at-risk women. Multivariable logistic regression was used to analyze differences
in contraceptive provision by professional training and practice setting.
Results
Most providers offered oral contraceptives (85%), but only a small minority considered
them appropriate for women at risk of HIV (27%) or HIV-positive women (25%). A higher
proportion of clinicians considered injections appropriate for women at risk of HIV
(42%) or HIV-positive women (46%). Very few considered emergency contraceptives appropriate
(13%). Multivariable results showed that family planning training and clinic as compared
to hospital practices were associated with evidence-based attitudes about contraception
for HIV-positive or at-risk women and greater provision. There were no differences,
however, between physicians and nurses or by HIV training.
Conclusions
These findings emphasize the need to improve clinicians' awareness of evidence-based
guidelines for hormonal contraception for women at high risk of HIV and HIV-positive
women. Evidence-based information that oral contraception and injections are appropriate
is essential. Contraceptive education should be integrated into HIV training to reach
at-risk populations.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Family planning: a political issue.Lancet. 2006; 368: 1810-1827
- Maternal deaths averted by contraceptive use: an analysis of 172 countries.Lancet. 2012; 380: 111-125
- Adding it up: costs and benefits of contraceptive services.Guttmacher Institute and United Nations Population Fund (UNFPA), New York2012 ([Available from: http://www.guttmacher.org/pubs/AIU-2012-estimates.pdf])
- What women already know: documenting the social and economic benefits of family planning.Guttmacher Policy Rev. 2013; 16: 8-12
- Family planning and U.S. foreign policy.Council on Foreign Relations, New York2011 ([April])
- Reaching the underserved: family planning for women with HIV.Stud Fam Plan. 2010; 41: 125-128
- Unmet need for contraception.The World Bank, Washington, DC2010 ([Available from: http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION/EXTPHAAG/0,,contentMDK:22546157~pagePK:64229817~piPK:64229743~theSitePK:672263,00.html])
- Willingness of clinicians to integrate microbicides into HIV prevention practices in Southern Africa.AIDS Behav. 2012; 16: 1821-1829
- Medical eligibility for contraceptive use.4th ed. WHO, Geneva, Switzerland2010 ([Available from: http://whqlibdoc.who.int/publications/2010/9789241563888_eng.pdf])
- Provision of long-acting reversible contraception in HIV prevalent countries: results from nationally representative surveys in Southern Africa.BJOG. 2013; 120: 1386-1394
- Hormonal contraception and HIV. Technical statement.WHO, Geneva, Switzerland2012 ([Available from: http://whqlibdoc.who.int/hq/2012/WHO_RHR_12.08_eng.pdf])
- Effect of hormonal contraceptive methods on HIV disease progression: a systematic review.AIDS. 2013; 27: 787-794
- Use of hormonal contraceptives and HIV acquisition in women; a systematic review of the epidemiological evidence.Lancet Infect Dis. 2013; 13: 797-808
- Contraceptive use among married women ages 15–49, by method mix.PRB Family Planning Worldwide, Washington, DC2008 ([Available from: www.prb.org/DataFinder/Topic/Rankings.aspx?ind=35])
- Uptake and continuous use of copper intrauterine device in a cohort of HIV-positive women.AIDS Care. 2013; 25: 710-714
- Complications of use of intrauterine devices among HIV-1-infected women.Lancet. 1998; 351: 1238-1241
- A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus.Am J Obstet Gynecol. 2007; 197: 144.e1-144.e8
- National Contraception and Fertility Planning Policy and Service Delivery Guidelines 2012.Department of Health, Pretoria2013
- National Contraception Clinical Guidelines 2012.Department of Health, Pretoria2013
- Newsletter of the HIV, TB and MNCWH cluster. HIV, TB and MNCWH News.2013 ([Available from: http://www.hst.org.za/sites/default/files/Branch%20newsletter%20final%20edit%2013%20August_1.pdf])
- Unplanned pregnancy common worldwide.Guttmacher Institute, New York, NY2013 ([Available from: http://www.guttmacher.org/media/nr/abortww_nr.html])
- Fertility intentions and interest in integrated family planning services among women living with HIV in Nyanza Province, Kenya: a qualitative study.Infect Dis Obstet Gynecol. 2012; 809682: 1-8
- The integration of family planning with other health services: a literature review.Int Perspect Sex Reprod Health. 2010; 36: 189-196
- Integration of family planning services into HIV care and treatment in Kenya: a cluster-randomized trial.AIDS. 2013; 27: S77-S78
- PEPFAR blueprint: creating an AIDS-free generation.The Office of the Global AIDS Coordinator, 2012 ([Available from: http://www.pepfar.gov/documents/organization/201386.pdf])
- The use of dual or two methods for pregnancy and HIV prevention amongst 18-24-year-olds in a cross-sectional study conducted in South Africa.Contraception. 2013; 87: 782-789
- How are condoms used in a family planning setting: evidence from Zimbabwe.Cent Afr J Med. 2005; 51: 79-84
- A nationally-representative survey of health care provider counseling and provision of the female condom in South Africa and Zimbabwe.BMJ Open. 2013; 3: 1-8
- Prevalence of HIV, total (% of population ages 15–49). UNAIDS and WHO’s Report on the Global AIDS Epidemic.The World Bank, Washington, DC2013 ([Available from: http://data.worldbank.org/indicator/SH.DYN.AIDS.ZS?order=wbapi_data_value_2011+wbapi_data_value+wbapi_data_value-last&sort=asc])
- ACOG recommendations on emergency contraception.Am Fam Physician. 2010; 82: 1278
- The intrauterine device (IUD) for emergency contraception.International Consortium for Emergency Contraception, New York, NY2012 ([Available from: http://www.cecinfo.org/custom-content/uploads/2012/12/IUD_FactSheet_2012.pdf])
Article info
Publication history
Published online: May 03, 2014
Accepted:
April 23,
2014
Received in revised form:
April 11,
2014
Received:
March 10,
2014
Footnotes
☆Funding: This project was funded by NIH/NICHD R01 HD046027. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
☆☆Disclosure of Interests: We have no relevant financial, personal, political, intellectual or religious interests to disclose.
★To assess clinician provision of hormonal contraception for HIV-positive and at-risk women in Southern Africa.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
