Contraceptive use following unintended pregnancy among Ugandan women living with HIV

Jana Jarolimova, Jerome Kabakyenga, Kara Bennett, Winnie Muyindike, Annet Kembabazi, Jeffrey N. Martin, Peter W. Hunt, Yap Boum, Jessica E. Haberer, David Bangsberg, Angela Kaida, Lynn T. Matthews

Research output: Contribution to journalArticle

Abstract

Background Preventing unintended pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals. Family planning services should support WLWH at risk of repeat unintended pregnancies. We examined the relationship between unintended pregnancy and subsequent contraception use among WLWH in Uganda. Study design This was a retrospective analysis of data from a longitudinal cohort of individuals initiating antiretroviral therapy (ART), restricted to women with pregnancy (confirmed via urine β-hcg testing) between 2011–2013. The exposure of interest was intended vs unintended pregnancy, and the outcome was self-report of modern contraceptive use (hormonal methods, intrauterine device, sterilization, and/or consistent condom use) at 12 (range 6–18) months post-partum. A log-binomial model was used to estimate relative risks of modern contraceptive use post-partum based on intent of the index pregnancy, adjusted for age, socioeconomic status, education, relationship and HIV status of pregnancy partner, contraceptive use prior to pregnancy, years since HIV diagnosis, ART regimen, and CD4 cell count. Results Among 455 women, 110 women reported 110 incident pregnancies with report on intent. Women had a baseline median age of 29 years, baseline CD4 count 403 cells/mm3, and were living with HIV for 3.8 years. Fifty pregnancies (45%) were reported as unintended and 60 (55%) as intended. Postpartum, 64% of women with unintended and 51% with intended pregnancy reported modern contraception (p = 0.24). In adjusted models, there was no association between pregnancy intent and post-partum contraception. However, contraceptive use prior to the referent pregnancy was positively associated with post-partum contraceptive use (aRR 1.97 (95% CI 1.12–3.48, p = 0.02), while higher baseline CD4 cell count was associated with lower post-partum contraceptive use (aRR 0.95, 95% CI 0.90–0.99, p = 0.02). Conclusions Almost half of incident pregnancies among WLWH in this cohort were unintended. Experiencing an unintended pregnancy was not associated with post-partum contraceptive use. Creative strategies to support contraceptive uptake for birth spacing and prevention of unintended pregnancies in the post-partum period are needed.

Original languageEnglish (US)
Article numbere0206325
JournalPLoS One
Volume13
Issue number10
DOIs
StatePublished - Oct 1 2018

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contraceptives
Contraceptive Agents
HIV
pregnancy
Pregnancy
contraception
CD4 Lymphocyte Count
Contraception
Education
family planning
Birth Intervals
therapeutics
Intrauterine Devices
Planning
Uganda
postpartum period
Condoms
Family Planning Services
Statistical Models
cells

ASJC Scopus subject areas

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

Cite this

Jarolimova, J., Kabakyenga, J., Bennett, K., Muyindike, W., Kembabazi, A., Martin, J. N., ... Matthews, L. T. (2018). Contraceptive use following unintended pregnancy among Ugandan women living with HIV. PLoS One, 13(10), [e0206325]. https://doi.org/10.1371/journal.pone.0206325

Contraceptive use following unintended pregnancy among Ugandan women living with HIV. / Jarolimova, Jana; Kabakyenga, Jerome; Bennett, Kara; Muyindike, Winnie; Kembabazi, Annet; Martin, Jeffrey N.; Hunt, Peter W.; Boum, Yap; Haberer, Jessica E.; Bangsberg, David; Kaida, Angela; Matthews, Lynn T.

In: PLoS One, Vol. 13, No. 10, e0206325, 01.10.2018.

Research output: Contribution to journalArticle

Jarolimova, J, Kabakyenga, J, Bennett, K, Muyindike, W, Kembabazi, A, Martin, JN, Hunt, PW, Boum, Y, Haberer, JE, Bangsberg, D, Kaida, A & Matthews, LT 2018, 'Contraceptive use following unintended pregnancy among Ugandan women living with HIV', PLoS One, vol. 13, no. 10, e0206325. https://doi.org/10.1371/journal.pone.0206325
Jarolimova J, Kabakyenga J, Bennett K, Muyindike W, Kembabazi A, Martin JN et al. Contraceptive use following unintended pregnancy among Ugandan women living with HIV. PLoS One. 2018 Oct 1;13(10). e0206325. https://doi.org/10.1371/journal.pone.0206325
Jarolimova, Jana ; Kabakyenga, Jerome ; Bennett, Kara ; Muyindike, Winnie ; Kembabazi, Annet ; Martin, Jeffrey N. ; Hunt, Peter W. ; Boum, Yap ; Haberer, Jessica E. ; Bangsberg, David ; Kaida, Angela ; Matthews, Lynn T. / Contraceptive use following unintended pregnancy among Ugandan women living with HIV. In: PLoS One. 2018 ; Vol. 13, No. 10.
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abstract = "Background Preventing unintended pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals. Family planning services should support WLWH at risk of repeat unintended pregnancies. We examined the relationship between unintended pregnancy and subsequent contraception use among WLWH in Uganda. Study design This was a retrospective analysis of data from a longitudinal cohort of individuals initiating antiretroviral therapy (ART), restricted to women with pregnancy (confirmed via urine β-hcg testing) between 2011–2013. The exposure of interest was intended vs unintended pregnancy, and the outcome was self-report of modern contraceptive use (hormonal methods, intrauterine device, sterilization, and/or consistent condom use) at 12 (range 6–18) months post-partum. A log-binomial model was used to estimate relative risks of modern contraceptive use post-partum based on intent of the index pregnancy, adjusted for age, socioeconomic status, education, relationship and HIV status of pregnancy partner, contraceptive use prior to pregnancy, years since HIV diagnosis, ART regimen, and CD4 cell count. Results Among 455 women, 110 women reported 110 incident pregnancies with report on intent. Women had a baseline median age of 29 years, baseline CD4 count 403 cells/mm3, and were living with HIV for 3.8 years. Fifty pregnancies (45{\%}) were reported as unintended and 60 (55{\%}) as intended. Postpartum, 64{\%} of women with unintended and 51{\%} with intended pregnancy reported modern contraception (p = 0.24). In adjusted models, there was no association between pregnancy intent and post-partum contraception. However, contraceptive use prior to the referent pregnancy was positively associated with post-partum contraceptive use (aRR 1.97 (95{\%} CI 1.12–3.48, p = 0.02), while higher baseline CD4 cell count was associated with lower post-partum contraceptive use (aRR 0.95, 95{\%} CI 0.90–0.99, p = 0.02). Conclusions Almost half of incident pregnancies among WLWH in this cohort were unintended. Experiencing an unintended pregnancy was not associated with post-partum contraceptive use. Creative strategies to support contraceptive uptake for birth spacing and prevention of unintended pregnancies in the post-partum period are needed.",
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AU - Martin, Jeffrey N.

AU - Hunt, Peter W.

AU - Boum, Yap

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N2 - Background Preventing unintended pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals. Family planning services should support WLWH at risk of repeat unintended pregnancies. We examined the relationship between unintended pregnancy and subsequent contraception use among WLWH in Uganda. Study design This was a retrospective analysis of data from a longitudinal cohort of individuals initiating antiretroviral therapy (ART), restricted to women with pregnancy (confirmed via urine β-hcg testing) between 2011–2013. The exposure of interest was intended vs unintended pregnancy, and the outcome was self-report of modern contraceptive use (hormonal methods, intrauterine device, sterilization, and/or consistent condom use) at 12 (range 6–18) months post-partum. A log-binomial model was used to estimate relative risks of modern contraceptive use post-partum based on intent of the index pregnancy, adjusted for age, socioeconomic status, education, relationship and HIV status of pregnancy partner, contraceptive use prior to pregnancy, years since HIV diagnosis, ART regimen, and CD4 cell count. Results Among 455 women, 110 women reported 110 incident pregnancies with report on intent. Women had a baseline median age of 29 years, baseline CD4 count 403 cells/mm3, and were living with HIV for 3.8 years. Fifty pregnancies (45%) were reported as unintended and 60 (55%) as intended. Postpartum, 64% of women with unintended and 51% with intended pregnancy reported modern contraception (p = 0.24). In adjusted models, there was no association between pregnancy intent and post-partum contraception. However, contraceptive use prior to the referent pregnancy was positively associated with post-partum contraceptive use (aRR 1.97 (95% CI 1.12–3.48, p = 0.02), while higher baseline CD4 cell count was associated with lower post-partum contraceptive use (aRR 0.95, 95% CI 0.90–0.99, p = 0.02). Conclusions Almost half of incident pregnancies among WLWH in this cohort were unintended. Experiencing an unintended pregnancy was not associated with post-partum contraceptive use. Creative strategies to support contraceptive uptake for birth spacing and prevention of unintended pregnancies in the post-partum period are needed.

AB - Background Preventing unintended pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals. Family planning services should support WLWH at risk of repeat unintended pregnancies. We examined the relationship between unintended pregnancy and subsequent contraception use among WLWH in Uganda. Study design This was a retrospective analysis of data from a longitudinal cohort of individuals initiating antiretroviral therapy (ART), restricted to women with pregnancy (confirmed via urine β-hcg testing) between 2011–2013. The exposure of interest was intended vs unintended pregnancy, and the outcome was self-report of modern contraceptive use (hormonal methods, intrauterine device, sterilization, and/or consistent condom use) at 12 (range 6–18) months post-partum. A log-binomial model was used to estimate relative risks of modern contraceptive use post-partum based on intent of the index pregnancy, adjusted for age, socioeconomic status, education, relationship and HIV status of pregnancy partner, contraceptive use prior to pregnancy, years since HIV diagnosis, ART regimen, and CD4 cell count. Results Among 455 women, 110 women reported 110 incident pregnancies with report on intent. Women had a baseline median age of 29 years, baseline CD4 count 403 cells/mm3, and were living with HIV for 3.8 years. Fifty pregnancies (45%) were reported as unintended and 60 (55%) as intended. Postpartum, 64% of women with unintended and 51% with intended pregnancy reported modern contraception (p = 0.24). In adjusted models, there was no association between pregnancy intent and post-partum contraception. However, contraceptive use prior to the referent pregnancy was positively associated with post-partum contraceptive use (aRR 1.97 (95% CI 1.12–3.48, p = 0.02), while higher baseline CD4 cell count was associated with lower post-partum contraceptive use (aRR 0.95, 95% CI 0.90–0.99, p = 0.02). Conclusions Almost half of incident pregnancies among WLWH in this cohort were unintended. Experiencing an unintended pregnancy was not associated with post-partum contraceptive use. Creative strategies to support contraceptive uptake for birth spacing and prevention of unintended pregnancies in the post-partum period are needed.

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