Background: Women living with HIV (WLHIV) in sub-Saharan Africa on average desire fewer children than HIV-negative women. An enhanced model of family planning and HIV (FP/HIV) service integration aimed at increasing uptake of effective contraception among WLHIV not desiring pregnancy is being implemented at six HIV clinics in Lusaka. This initial analysis presents demographic and FP uptake data among women attending these clinics prior to implementation of this enhanced model.
Methods: From May-July 2018, 629 WLHIV were enrolled and interviewed about their fertility desires and contraceptive use. Information about their clinical status was abstracted from medical charts. Women were classified as having an unmet FP need if they reported not wanting to get pregnant in the next two years and did not report current use of an effective contraceptive method. Multivariable logistic regression model, accounting for clustering by site, was used to identify factors associated with unmet FP need.
Results: The majority of women were married (72%), had 3-5 children (50%), and were aged 35+ years (54%). Women had been on antiretroviral therapy for a median of 4.6 years (interquartile range=2.2, 8). One-third of women reported currently using an effective contraceptive method: injectables (14%), pills (10%), implants (5%), and intra-uterine devices (IUDs) (1%). Half of the participants reported condom use as a FP method, while 8% reported dual method use (condoms plus another effective method). Unmet FP need, reported by 38% of women, was associated with younger and older age [(15-19 years adjusted odds ratio [aOR]=12.1, 95% confidence interval (CI)=1.9-77.4); 40-49 years (aOR=3.2, 95% CI=1.6-6.5) compared to 25-29 years]; being divorced, separated or widowed [aOR=2.0, 95% CI=1.2-3.3] compared to married, and having ≥3 children compared to no children [aOR=4.8, 95% CI=1.3-18.2].
Conclusions: Results suggest a high unmet FP need among WLHIV in HIV care, particularly among younger (< 20 years) and older women (40-49 years). Dual method use was low, potentially placing WLHIV at risk for acquiring other sexually transmitted infections that could compromise their health and contribute to ongoing HIV transmission. These findings highlight the need to improve integration of FP/HIV services to improve WLHIV''s access to effective contraception.

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