title: Fertility goal-based counseling increases contraceptive implant and IUD use in HIV-discordant couples in Rwanda and Zambia.
abstract: BACKGROUND
  HIV-discordant heterosexual couples are faced with the dual challenge of preventing sexual HIV transmission and unplanned pregnancies with the attendant risk of perinatal HIV transmission. Our aim was to examine uptake of two long-acting reversible contraceptive (LARC) methods--intrauterine devices (IUD) and hormonal implants--among HIV-discordant couples in Rwanda and Zambia.
  
  
  METHODS
  Women were interviewed alone or with their partner during routine cohort study follow-up visits to ascertain fertility goals; those not pregnant, not infertile, not already using LARC, and wishing to limit or delay fertility for ≥3 years were counseled on LARC methods and offered an IUD or implant on-site.
  
  
  RESULTS
  Among 409 fertile HIV-discordant Rwandan women interviewed (126 alone, 283 with partners), 365 (89%) were counseled about LARC methods, and 130 (36%) adopted a method (100 implant, 30 IUD). Of 787 fertile Zambian women interviewed (457 alone, 330 with partners), 528 (67%) received LARC counseling, of whom 177 (34%) adopted a method (139 implant, 38 IUD). In both countries, a woman's younger age was predictive of LARC uptake. LARC users reported fewer episodes of unprotected sex than couples using only condoms.
  
  
  CONCLUSIONS
  Integrated fertility goal-based family planning counseling and access to LARC methods with reinforcement of dual-method use prompted uptake of IUDs and implants and reduced unprotected sex among HIV-discordant couples in two African capital cities.
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA. nkhu@emory.edu
authors.forename: Naw H
authors.initials: NH
authors.lastname: Khu
authors.forename: Bellington
authors.initials: B
authors.lastname: Vwalika
authors.forename: Etienne
authors.initials: E
authors.lastname: Karita
authors.forename: William
authors.initials: W
authors.lastname: Kilembe
authors.forename: Roger A
authors.initials: RA
authors.lastname: Bayingana
authors.forename: Deborah
authors.initials: D
authors.lastname: Sitrin
authors.forename: Heidi
authors.initials: H
authors.lastname: Roeber-Rice
authors.forename: Emily
authors.initials: E
authors.lastname: Learner
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Tichacek
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Haddad
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Wall
authors.forename: Elwyn N
authors.initials: EN
authors.lastname: Chomba
authors.forename: Susan A
authors.initials: SA
authors.lastname: Allen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003268:Contraception Behavior / Q000208:ethnology; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D004343:Drug Implants; D005191:Family Characteristics / Q000208:ethnology; D005193:Family Planning Services; D005260:Female; D005500:Follow-Up Studies; D006040:Goals; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007434:Intrauterine Devices; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D057285:Precision Medicine; D012432:Rwanda; D047568:Unsafe Sex / Q000208:ethnology / Q000517:prevention & control; D055815:Young Adult; D015024:Zambia
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants