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Clinicians' perceptions and provision of hormonal contraceptives for HIV-positive and at-risk women in Southern Africa: an original research article

      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

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      References

        • Cleland J.
        • Bernstein S.
        • Ezeh A.
        • Faundes A.
        • Glasier A.
        • Innis J.
        Family planning: a political issue.
        Lancet. 2006; 368: 1810-1827
        • Ahmed S.
        • Li Q.
        • Liu L.
        • Tsui A.O.
        Maternal deaths averted by contraceptive use: an analysis of 172 countries.
        Lancet. 2012; 380: 111-125
        • Singh S.
        • Darroch J.E.
        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])
        • Sonfield A.
        What women already know: documenting the social and economic benefits of family planning.
        Guttmacher Policy Rev. 2013; 16: 8-12
        • Coleman I.
        • Lemmon G.T.
        Family planning and U.S. foreign policy.
        Council on Foreign Relations, New York2011 ([April])
        • Wilcher R.
        • Cates W.
        Reaching the underserved: family planning for women with HIV.
        Stud Fam Plan. 2010; 41: 125-128
        • The World Bank
        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])
        • Harper C.C.
        • Holt K.
        • Nhemachena T.
        • Chipato T.
        • Ramjee G.
        • Stratton L.
        • et al.
        Willingness of clinicians to integrate microbicides into HIV prevention practices in Southern Africa.
        AIDS Behav. 2012; 16: 1821-1829
        • World Health Organization (WHO)
        Medical eligibility for contraceptive use.
        4th ed. WHO, Geneva, Switzerland2010 ([Available from: http://whqlibdoc.who.int/publications/2010/9789241563888_eng.pdf])
        • Morse J.
        • Chipato T.
        • Blanchard K.
        • Nhemachena T.
        • Ramjee G.
        • McCulloch C.
        • et al.
        Provision of long-acting reversible contraception in HIV prevalent countries: results from nationally representative surveys in Southern Africa.
        BJOG. 2013; 120: 1386-1394
        • World Health Organization (WHO)
        Hormonal contraception and HIV. Technical statement.
        WHO, Geneva, Switzerland2012 ([Available from: http://whqlibdoc.who.int/hq/2012/WHO_RHR_12.08_eng.pdf])
        • Phillips S.J.
        • Curtis K.M.
        • Polis C.B.
        Effect of hormonal contraceptive methods on HIV disease progression: a systematic review.
        AIDS. 2013; 27: 787-794
        • Polis C.B.
        • Curtis K.M.
        Use of hormonal contraceptives and HIV acquisition in women; a systematic review of the epidemiological evidence.
        Lancet Infect Dis. 2013; 13: 797-808
        • Population Reference Bureau (PRB)
        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])
        • Kancheva Landolt N.
        • Phanuphak N.
        • Teeratakulpisarn N.
        • Kriengsinyot R.
        • Ahluwalia J.
        • Pinyakorn S.
        • et al.
        Uptake and continuous use of copper intrauterine device in a cohort of HIV-positive women.
        AIDS Care. 2013; 25: 710-714
        • Sinei S.K.
        • Morrison C.S.
        • Sekadde-Kigondu C.
        • Allen M.
        • Kokonya D.
        Complications of use of intrauterine devices among HIV-1-infected women.
        Lancet. 1998; 351: 1238-1241
        • Stringer E.M.
        • Kaseba C.
        • Levy J.
        • Sinkala M.
        • Goldenberg R.L.
        • Chi B.H.
        • et al.
        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 Department of Health
        National Contraception and Fertility Planning Policy and Service Delivery Guidelines 2012.
        Department of Health, Pretoria2013
        • National Department of Health
        National Contraception Clinical Guidelines 2012.
        Department of Health, Pretoria2013
        • National Department of Health: Republic of South Africa
        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])
        • Guttmacher Institute
        Unplanned pregnancy common worldwide.
        Guttmacher Institute, New York, NY2013 ([Available from: http://www.guttmacher.org/media/nr/abortww_nr.html])
        • Harrington E.K.
        • Newmann S.J.
        • Onono M.
        • Schwartz K.D.
        • Bukusi E.A.
        • Cohen C.R.
        • et al.
        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
        • Kuhlmann A.S.
        • Gavin L.
        • Galavotti C.
        The integration of family planning with other health services: a literature review.
        Int Perspect Sex Reprod Health. 2010; 36: 189-196
        • Grossman D.
        • Onono M.
        • Newmann S.J.
        • Blat C.
        • Bukusi E.A.
        • Shade S.B.
        • et al.
        Integration of family planning services into HIV care and treatment in Kenya: a cluster-randomized trial.
        AIDS. 2013; 27: S77-S78
        • The President’s Emergency Plan for AIDS Relief
        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])
        • Seutlwadi L.
        • Peltzer K.
        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
        • Magwali T.L.
        • Steiner M.J.
        • Toms H.
        • Brown J.M.
        How are condoms used in a family planning setting: evidence from Zimbabwe.
        Cent Afr J Med. 2005; 51: 79-84
        • Holt K.
        • Blanchard K.
        • Chipato T.
        • Nhemachena T.
        • Blum M.
        • Stratton L.
        • et al.
        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
        • The World Bank
        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])
        • Armstrong C.
        ACOG recommendations on emergency contraception.
        Am Fam Physician. 2010; 82: 1278
        • International Consortium for Emergency Contraception
        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])