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Contraceptive Use and Method Preferences among HIV Positive Women in Ethiopia: A Systematic Review and Meta-analysis.

ABSTRACT: Background:Preventing unintended pregnancies among HIV positive women has a vital role to prevent mother to child transmission. Besides, increasing access to contraceptives has a number of economical importance and reducing the costs for mitigating the unintended pregnancy consequences. Therefore, this study is aimed at assessing the contraceptive use and method of preference among HIV positive women in Ethiopia. Methods:A systematic review and meta-analysis reporting guideline was applied. Articles searched from the Scopus, Pubmed/MEDLINE, EMBASE, AJOL, Hinari, and Google scholar were included in this review. The Stata 11 software was used to compute the analysis. Heterogeneity of the studies was detected using the Cochran Q test and I 2 test statistics. Egger's test was used to check the evidence of publication bias within the studies. Subgroup analysis and sensitivity analysis was computed with the evidence of heterogeneity. Results:Ten thousand one hundred twenty one (10121) women living with HIV/AIDS were recruited in this study. The national estimated prevalence of contraceptive use among HIV positive women in Ethiopia was 57.78% (95% CI: 48.53-67.03). Injectables and male condom were the most preferred contraceptives accounted for 36.00% (95% CI: 6.64-45.35) and 32.74% (95% CI: 21.08-44.40), respectively. Discussion with husband/partner (AOR: 4.70, 95% CI: 2.18-10.12), disclosure of HIV status to spouse/partner (AOR: 2.18, 95% CI: 1.55-3.06), ever counseled for modern contraceptives (AOR: 2.79, 95% CI: 2.01-3.88), attending secondary and above education (AOR: 3.12, 95% CI: 2.15-4.51), and having more than one live child (AOR: 2.61, 95% CI: 1.86-3.66) were increasing the likelihood of contraceptive use whereas not currently married women (AOR: 0.23, 95% CI: 0.16-0.34) was decreases the odds of contraceptive use. Conclusion:In Ethiopia, more than half of the women living with HIV/AIDS were using contraceptives. Discussion with husband/partner, disclosure of HIV status to spouse/partner, ever counseled for modern contraceptives, attending secondary and above education, and having more than one live child were increasing the uptake of contraceptives among HIV positive women. Partner discussion, having adequate information towards contraceptive use, and having desired number of child could increase the utilization; as a result, obstetric complication with HIV positive women due to unintended pregnancy is significantly decreasing.

SUBMITTER: Gedefaw G

PROVIDER: S-EPMC7520013 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Contraceptive Use and Method Preferences among HIV Positive Women in Ethiopia: A Systematic Review and Meta-analysis.

Gedefaw Getnet G Wondmieneh Adam A Demis Asmamaw A

BioMed research international 20200918

<h4>Background</h4>Preventing unintended pregnancies among HIV positive women has a vital role to prevent mother to child transmission. Besides, increasing access to contraceptives has a number of economical importance and reducing the costs for mitigating the unintended pregnancy consequences. Therefore, this study is aimed at assessing the contraceptive use and method of preference among HIV positive women in Ethiopia.<h4>Methods</h4>A systematic review and meta-analysis reporting guideline wa ...[more]

PMID: 33015174

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Project description:BackgroundDual contraceptive is the use of a barrier like condom along with any modern contraceptive methods which has double significance for the prevention STI including HIV and unintended pregnancy. The prevalence and determinants of dual contraceptive utilization described by different studies were highly inconsistent in Ethiopia. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and determinants of dual contraceptive utilization among HIV positive women in Ethiopia.MethodsInternational database mainly Pub Med, Google scholar, HINARI, EMBASE, Cochrane Library, AJOL was applied to identify original studies. STATA software version 14 was applied to analyze the pooled prevalence of dual contraceptive. I2 test statistics was computed to check the presence of heterogeneity across the studies and eggers test was used to identify publication bias. The pooled prevalence of dual contraceptive utilization was estimated by using a random effects model. The associations between determinants and dual contraceptive utilization were evaluated by using both random and fixed effect models.ResultA total 9 studies with 9168 HIV positive women were enrolled in this study. The pooled prevalence of dual contraceptive utilization among HIV positive women in Ethiopia was 26.14% (95% CI 21.20-31.08). Disclosure of HIV status (OR = 4.18,95%CI:2.26-7.72), partner involvement in post-test counselling (OR = 2.31,95%CI:1.63-3.25), open discussion about dual contraceptive with partner (OR = 4.27 95% CI:1.69-10.77), provision of counselling on dual contraceptives by health care provider (OR = 4.47,95% CI:3.81-5.24) and CD4 count > 350 cells/ mm3 (OR = 3.87,95%CI:3.53-4.23) were among the significant factors associated with dual contraceptive utilization.ConclusionThe overall prevalence of dual contraceptive utilization among HIV positive women was significantly low. Disclosure of HIV status, partner involvement in post-test counselling, open discussion about dual contraceptive with partner, counselling on dual contraceptive by health care provider and CD4 count > 350 cells/ mm3 were positively affect dual contraceptive utilization. This study implies the need to develop plans and policies to improve partner involvement posttest counseling, integrate the counseling and provision of dual contraceptive at ART clinic at each level of health system.

Project description:IntroductionContraception can help to meet family planning goals for women living with HIV (WLHIV) as well as to support the prevention of mother to child transmission of HIV (PMTCT). However, there is little research into the contraceptive practice among sexually active WLHIV in Ethiopia. Therefore, we aimed to examine contraceptive practice among sexually active WLHIV in western Ethiopia and identify the factors that influenced such practice using the Health Belief Model (HBM).MethodsA facility-based cross-sectional survey of 360 sexually active WLHIV was conducted from 19th March to 22nd June 2018 in western Ethiopia. The eligible participants were WLHIV aged between 18 and 49 years who reported being fecund and sexually active within the previous six months but were not pregnant and not wanting to have another child within two years. Modified Poisson regression analyses were conducted to identify factors that influenced contraceptive practice among sexually active WLHIV in western Ethiopia.ResultsAmong sexually active WLHIV (n = 360), 75% used contraception with 25% having unmet needs. Of the contraceptive users, 44.8% used injectables, 37.4% used condoms and 28.5% used implants. Among 152 recorded births in the last five years, 17.8% were reported as mistimed and 25.7% as unwanted. Compared to WLHIV having no child after HIV diagnosis, having two or more children after HIV diagnosis (Adjusted Prevalence Ratio [APR] = 1.31; 95%CI 1.09-1.58) was associated with increased risk of contraceptive practice. However, sexually active unmarried WLHIV (APR = 0.69; 95%CI 0.50-0.95) were less likely to use any contraception compared to their sexually active married counterparts. Importantly, high perceived susceptibility (APR = 1.49; 95%CI 1.20-1.86) and medium perceived susceptibility (APR = 1.55; 95%CI 1.28-1.87) towards unintended pregnancy were associated with higher risk of contraceptive use than WLHIV with low perceived susceptibility.ConclusionsAlthough contraceptive use amongst sexually active WLHIV was found to be high, our findings highlight the need for strengthening family planning services given the high rate of unintended pregnancies, the high rate of unmet needs for contraception, as well as the lower efficacy with some of the methods. Our findings also suggest that the HBM would be a valuable framework for healthcare providers, programme planners and policymakers to develop guidelines and policies for contraceptive counselling and choices.

Project description:Among 230,360 women with diagnosed HIV in the United States (U.S.), ~ 8,500 give birth annually, and unplanned pregnancies (as with HIV-negative women) are prevalent. However, unplanned pregnancies and contraceptive use among HIV-positive women have been understudied. To examine unplanned pregnancies and contraceptive use among HIV-positive women, we used 2013-2014 data from the Medical Monitoring Project (MMP), an HIV surveillance system that produces national estimates for HIV-positive adults in care in the U.S. (Pregnancy outcome dates were from years 1986-2015 for this cohort of women who were interviewed during 2013-2014; median year of reported pregnancy outcome was year 2003). Women in HIV care and diagnosed with HIV before age 45 (reproductive age) were included. We calculated adjusted prevalence ratios (aPR) of unplanned pregnancies with 95% confidence intervals (CI). For women who were aged 18-44 years at time of interview, we computed weighted prevalences of contraceptive use (previous 12 months) by method, including permanent (i.e., sterilization), short-acting (i.e., pills, depo-progesterone acetate (DMPA)), long-acting reversible contraceptives (LARC) (i.e., implants), and barriers (i.e., condoms). Six hundred seventy-one women met criteria for the unplanned pregnancy analysis; median age at HIV diagnosis = 24.6 years, and 78.1% (CI:74.5-81.7) reported ? 1 unplanned pregnancy. Women reporting unplanned pregnancies were more likely to be non-Hispanic white (aPR = 1.20; CI 1.05-1.38) or non-Hispanic black (aPR = 1.14; CI 1.01-1.28) than Hispanic, to be above the poverty level (aPR = 1.09; CI 1.01-1.18), and to have not received care from an OB/GYN in the year before interview (aPR = 1.13; CI 1.04-1.22). Among 1,142 total pregnancies, 795 (69.6%) were live births; 70 (7.8%) were born HIV-positive; 42 (60%) of those born HIV-positive were unplanned pregnancies. For the contraceptives analysis (n = 957 women who were aged 18-44 at time of interview), 90.5% reported using at least one contraceptive, including 59.7% reporting barrier methods, 29.9% reporting permanent sterilization, and 22.8% reporting short-term methods in the previous year. LARC was used by only 5.3% of women. Women who reported use of LARC or DMPA were more likely to be aged 18-29 years (aPR = 3.08; CI 1.61-5.89) or 30-39 years (aPR = 2.86; CI 1.76-4.63) compared with women aged 40-44 years. Unplanned pregnancies were prevalent and LARC use was low; prevention efforts should strengthen pregnancy planning and contraceptive awareness for HIV-positive women during clinical visits.

Project description:BackgroundPostpartum contraceptive use is defined as the avoidance of short spaced pregnancies and unintended pregnancy through the first 12 months after delivery. In Ethiopia, different studies have been conducted to assess the prevalence of postpartum contraceptive use and associated factors. The findings of these studies were inconsistent and characterized by great variability. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence of postpartum contraceptive use and determinants in Ethiopia using the accessible studies.MethodsThe articles were identified through electronic search of reputable databases (MEDLINE through PubMed, EMBASE, HINARI, Science Direct, and Cochrane Library) and the hand search of reference listed in previous prevalence studies to retrieve more. 18 articles are included based on a comprehensive list of inclusion and exclusion criteria. Two authors independently extracted all necessary data using a standardized data extraction format. STATA 14 statistical software was used to analyze the data. The Cochrane Q and I 2 test were used to assess the heterogeneity between the studies. A random effects model was calculated to estimate the pooled prevalence of postpartum contraceptive use. Moreover, the determinants for family planning use were reviewed.ResultsThe pooled prevalence of family planning use among mothers during the postpartum period in Ethiopia was 48.11% (95% CI: 36.96, 59.27). Besides, subgroup analysis revealed that the highest family planning use prevalence among postpartum mothers was observed in Addis Ababa, 65.41 (95% CI: 48.71, 82.11). Resumed sexual activity: 7.91 (95% CI: 4.62, 13.55), antenatal care: 4.98 (95% CI: 2.34, 10.21), secondary school and above level of maternal education: 3.53 (95% CI: 1.67, 7.45), postnatal care: 3.16 (95% CI: 1.7, 5.88), menses resumption: 3.12 (95% CI: 1.52, 6.39), and ≥6 months of postpartum period: 2.78 (95% CI: 1.97, 3.93) have shown a positive association with the use of family planning among mothers in the postpartum epoch.ConclusionsIn this study, family planning use among mothers of the postpartum period in Ethiopia was significantly low compared to the existing global commendation on postpartum contraceptive use. Resumed sexual activity, antenatal care, secondary and above level of maternal education, postnatal care, menses resumption, and postpartum period ≥ 6 months were found to be significantly associated with postpartum contraceptive use.

Project description:INTRODUCTION:Ethiopia is one of the Sub-Saharan African countries with high unintended pregnancy rate. Every woman in Ethiopia experiences at least one unintended birth. Although there were some studies about contraceptive use among all women in Ethiopia, evidence about contraceptive use among women with no fertility intention was limited. Therefore, this analysis was performed to assess the prevalence of contraceptive use and associated factors among fecund, married reproductive-age women who intended no more children. METHODS:We used the 2016 Ethiopian Demography and Health Survey (EDHS) data collected through a two-stage stratified cluster sampling technique. EDHS was a community based, cross-sectional study conducted from January 18, 2016, to June 27, 2016. A total of 2,859 fecund married reproductive age women with no desire to have more children were included in this study. Both descriptive and logistic regression analysis were performed using STATA V.14. A 95% confidence interval was used to declare statistical significance. RESULTS:Contraceptive use among fecund married reproductive-age women who want no more children was 51.1% (95%CI: 47.0-55.24%). Visit by health workers at home (AOR = 1.37, 95%CI: 1.02, 1.83), living in Addis Ababa (AOR = 3.38 95%CI: 1.76, 6.37) and having better wealth index (middle (AOR = 1.76, 95%CI: 1.25, 2.47) and being rich (AOR = 1.96, 95%CI: 1.40, 2.74)) were found positively associated with contraceptive use. On the other hand, living in the Somali region (AOR = 0.10, 95%CI: 0.01, 0.85), and being Muslim (AOR = 0.45, 95%CI: 0.30, 0.67) were found negatively associated with contraceptive use. CONCLUSION:Contraceptive use among fecund married reproductive-age women with no fertility intention was low compared to their demand. Therefore, to improve contraceptive use, the provision of family planning counseling and information should be strengthened. Further intervention is needed to narrow disparities in contraceptive use among regions and different population groups.

Dataset Information

Contraceptive Use and Method Preferences among HIV Positive Women in Ethiopia: A Systematic Review and Meta-analysis.

Publications

Contraceptive Use and Method Preferences among HIV Positive Women in Ethiopia: A Systematic Review and Meta-analysis.

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