Longitudinal patterns of unmet need for contraception among women living with HIV on antiretroviral therapy in South Africa

Katherine B. Rucinski, Kimberly A. Powers, Sheree Schwartz, Brian W. Pence, Benjamin H. Chi, Vivian Black, Helen Rees, Audrey E. Pettifor

Research output: Contribution to journalArticle

Abstract

Objectives: Fertility intentions and contraceptive use are often not assessed in the context of clinical HIV care, representing a possible programming gap if women's family planning needs change over time. We aimed to identify longitudinal patterns of unmet need for contraception over a 12-month period among women living with HIV taking antiretroviral therapy (ART). Study design: 850 non-pregnant, HIV-positive women aged 18-35 on or initiating ART in Johannesburg, South Africa, were enrolled into a prospective cohort study in 2009-2010. Fertility intentions and contraceptive use were assessed during routine HIV care visits via an interviewer-administered questionnaire, and women were referred for on-site contraceptive counseling. We used group-based trajectory modeling to identify patterns of unmet need for contraception over 12 months, first in the entire population and then in a subset of recent ART initiators. Results: In the full population we identified four patterns of unmet need for contraception over one year. Half of the enrolled women were predicted to have a consistently high probability of unmet need, 22.9% a consistently low probability, 16.7% a decreasing probability, and 10.4% an increasing probability over time. Contraceptive method discontinuation and rapidly changing fertility intentions were the primary drivers of changing (increasing or decreasing) unmet need over follow-up. Results were similar in recent ART initiators. Conclusions: Half of women were estimated to have a high probability of unmet need that persisted over time, and more than a quarter were estimated to experience patterns of changing unmet need over 12 months. Family planning needs should be assessed more regularly in HIV-positive women to prevent unintended pregnancies and support safer conception among women trying to conceive.

Original languageEnglish (US)
Article numbere0209114
JournalPLoS One
Volume13
Issue number12
DOIs
StatePublished - Dec 1 2018

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contraception
South Africa
Contraception
Contraceptive Agents
HIV
therapeutics
contraceptives
family planning
Fertility
Family Planning Services
Therapeutics
Planning
Trajectories
counseling
cohort studies
Population
trajectories
Counseling
Cohort Studies
questionnaires

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Longitudinal patterns of unmet need for contraception among women living with HIV on antiretroviral therapy in South Africa. / Rucinski, Katherine B.; Powers, Kimberly A.; Schwartz, Sheree; Pence, Brian W.; Chi, Benjamin H.; Black, Vivian; Rees, Helen; Pettifor, Audrey E.

In: PLoS One, Vol. 13, No. 12, e0209114, 01.12.2018.

Research output: Contribution to journalArticle

Rucinski, Katherine B. ; Powers, Kimberly A. ; Schwartz, Sheree ; Pence, Brian W. ; Chi, Benjamin H. ; Black, Vivian ; Rees, Helen ; Pettifor, Audrey E. / Longitudinal patterns of unmet need for contraception among women living with HIV on antiretroviral therapy in South Africa. In: PLoS One. 2018 ; Vol. 13, No. 12.
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abstract = "Objectives: Fertility intentions and contraceptive use are often not assessed in the context of clinical HIV care, representing a possible programming gap if women's family planning needs change over time. We aimed to identify longitudinal patterns of unmet need for contraception over a 12-month period among women living with HIV taking antiretroviral therapy (ART). Study design: 850 non-pregnant, HIV-positive women aged 18-35 on or initiating ART in Johannesburg, South Africa, were enrolled into a prospective cohort study in 2009-2010. Fertility intentions and contraceptive use were assessed during routine HIV care visits via an interviewer-administered questionnaire, and women were referred for on-site contraceptive counseling. We used group-based trajectory modeling to identify patterns of unmet need for contraception over 12 months, first in the entire population and then in a subset of recent ART initiators. Results: In the full population we identified four patterns of unmet need for contraception over one year. Half of the enrolled women were predicted to have a consistently high probability of unmet need, 22.9{\%} a consistently low probability, 16.7{\%} a decreasing probability, and 10.4{\%} an increasing probability over time. Contraceptive method discontinuation and rapidly changing fertility intentions were the primary drivers of changing (increasing or decreasing) unmet need over follow-up. Results were similar in recent ART initiators. Conclusions: Half of women were estimated to have a high probability of unmet need that persisted over time, and more than a quarter were estimated to experience patterns of changing unmet need over 12 months. Family planning needs should be assessed more regularly in HIV-positive women to prevent unintended pregnancies and support safer conception among women trying to conceive.",
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