Docstoc

AEGIS birth control

Document Sample
AEGIS birth control Powered By Docstoc
					Pregnancy Intention and Contraceptive
 Use Among Malawian Women Before
 and After Notification of Positive HIV
                 Status


                Irving Hoffman
       Division of Infectious Diseases
      University of North Carolina, USA
                  Background
• Most efforts for the prevention of mother-to- child-
  transmission emphasize post-pregnancy prevention

• Thus limited resources/efforts have been allocated to
  improve access to contraceptive counseling and family
  planning services for HIV infected women

• Improved services would reduce unintended
  pregnancies among HIV infected women, reduce the
  number of HIV infected infants and improve the long-
  term heath status of these women
         Goal of Activities
Use longitudinal observational data
regarding pregnancy intention and
contraceptive use among newly
discovered HIV positive women to inform
policy makers about improving
reproductive health services especially in
the context of HIV care delivery
                   Design
• Prospective, observational cohort study of HIV+
  women
• Documented pre-HIV testing, then periodically
  for 1 year after the women received their HIV
  positive status results, information regarding:
   – Intentions to become pregnant
   – Birth control practices
   – Pregnancy rate
   – Differences in the above by immune status
     (CD4)
                   Methods
• Women recruited and offered VCT from a
  variety of clinical settings at Kamuzu Central
  Hospital in Lilongwe, Malawi
• Identical assessment of sexual activity,
  contraceptive practices and intentions to
  become pregnant collected at:
  –   Screening (prior to HIV results)
  –   Enrollment (one week later, CD4 conducted)
  –   Quarterly for 1 year
  –   Primary HIV care (including ART) was provided
      when appropriate at all visits
                 Results
               VCT Uptake

•   1709 women recruited and offered VCT
•   816 (47.7%) HIV tested
•   261 HIV positives (32.0%)
•   227 enrolled (87.0%)
     Socio-demographic Results
•   N=227
•   Mean age                26 (IQR 23, 30)
•   Median CD4 count        295(IQR 145,499)
•   Married                 72%
•   Electricity in house    27%
•   Functional Illiteracy   43%
          Lost to follow-up
• 37/227 (16.3%) did not have a 1 year
  follow-up visit
• Including 17/227 (7.5%) deaths (median
  CD4 128)
• There was no demographic difference
  between those who were retained and
  those lost to follow up
                Longitudinal Results-All
                Pre-HIV   1 week    6 mo      12 mo       P-value
                test      post test post test post test
                (227)     (227)     (183)     (171)
Desires         76        35        35        24          <0.0001
pregnancy       (33%)     (15%)     (18%)     (14%)

Birth Control   78        104       78        73          0.41
(non-           (34%)     (46%)     (41%)     (43%)
condom)

Condom use 8              17        17        7           0.77
           (3.5%)         (7.5%)    (9%)      (4%)
  Longitudinal Results By CD4
                Pre-HIV test      12 months      p-value
                                   post-test
               <200     >200    <200     >200
               (76)     (151)   (37)     (134)
Desires         13 *     63*     3**      21**   *<0.001
Pregnancy      (17%)    (42%)   (8%)     (16%)    **0.17

FP use          18*      60*     11**     62**   *0.02
(non-condom)   (24%)    (40%)   (30%)    (46%)   **0.07


Condom use      3*        5*     1**      6**    *0.81
               (4%)      (3%)   (3%)     (4%)    **0.63
                   Pregnancy Incidence
            # at       #             #             Incidence   p-
            enrollment pregnancies   pregnancies   Per         value
                       0-6 months    >6-12         100 PY
                                     months
Total       227        16            13            15.5

Wants       35         5             4             *32.0
pregnancy

Doesn’t want 172       10            8             *12.8       *0.02
pregnancy
Undecided   19         1             1             12.3
about
pregnancy
CD4 >200    151        13            11            **18.7

CD4<200     76         3             2             **8.6       **0.12
 Pregnancies averted among this program of
 VCT and HIV care that included contraceptive
    counseling and FP services: A model

• With program:
Wanted pregnancy=     9/35
Unwanted pregnancy= 18/172
Undecided =          2/19
                     29
• Without program:
Wanted pregnancy=    20/76
Unwanted pregnancy= 13/122
Undecided=            3/26
                     36
7 (19%) of pregnancies averted
  Results Summary and Discussion
Results:
  The desire to become pregnant was 33% before HIV
  positive results were known, and 14%, 12 months after.
  The pregnancy incidence (after results were known) was
  13 among women not wanting to get pregnant, and 32
  among women wanting to get pregnant
Discussion:
  Knowledge of a woman’s HIV positive status, plus
  appropriate contraceptive counseling and HIV care
  follow-up, resulted in fewer pregnancies among HIV
  positive women. We predict a 19% reduction in
  pregnancies.
       Results Summary and
            Discussion
Results:
 Contraceptive use was 34% before HIV
 status was known and 43% 1 year after
 learning their HIV positive status (a trend)
Discussion:
 Providing contraceptive services within the
 context of HIV care is likely to improve
 contraceptive service uptake among HIV
 positive women
        Results Summary and
             Discussion
Results:
 Before knowing their HIV results, the desire to
 become pregnant was 17% in the CD4 <200
 group and 42% in the >200 group. 12 months
 after receiving their results, pregnancy desire
 was 8% and 16%respectively (not significant)

Discussion: As found in other studies,
  symptomatic women (<200) are less likely to
  want to become pregnant, however, even
  asymptomatic women reduce their desire for
  pregnancy once their positive status is known.
          Recommendations
• Integrate contraceptive counseling and FP
  services into HIV care services
• Develop a community-based program to
  educate about pregnancy in HIV infected
  women that includes “male involvement”
• Implement routine opt-out HIV VCT in
  STD, FP and other clinical settings
           Acknowledgements
• Kamuzu Central Hospital, Lilongwe
  Administration and staff of STD, FP and
  Lighthouse HIV clinic
• UNC Project and UNC
  Harriet Chanza, Francis Martinson, David
  Chilongozi, Mina Hosseinipour, Cecelia
  Kanyama, Kim Powers
• Johns Hopkins University
  Amy Tsui
• Funding
  Bill and Melinda Gates Institute for Population
  and Reproductive Health, USA

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:1
posted:2/26/2012
language:
pages:17