title: Longitudinal study of correlates of modern contraceptive use and impact of HIV care programmes among HIV concordant and serodiscordant couples in Rakai, Uganda.
abstract: OBJECTIVE
  To assess trends and determinants of family planning use and impact of HIV serostatus among couples.
  
  
  METHODS
  Couples' data were retrospectively linked from cohort surveys in Rakai, Uganda between 1999 and 2011, and were classified by HIV status as concordant (M+F+/M-F-) or serodiscordant (M-F+/M+F-). HIV care (HIVC) was grouped into three periods, pre-antiretroviral therapy (pre-HIVC) (<2004), HIVC roll-out (2005-2007) and HIVC scale-up (≥ 2008). Trends in couple contraceptive use were assessed by chi-square test (χ(2)) for trend, and multinomial logistic regression was used to estimate adjusted odds ratios (ORs) of predictors of contraceptive use.
  
  
  RESULTS
  A total of 6139 couples contributed 13,709 observations. Hormonal contraception (HC) use increased over time from 22.9% to 33.9%, p<0.001), with significant increases among M-F- (23.2% to 34.8%, p<0.0001) and M+F+ (20.8% to 32.2%, p=0.0005), but not serodiscordant couples. Condom use significantly increased among M+F+ (30.3% to 48.0%, p<0.001) and serodiscordant couples (24.2% to 48.7%, p<0.001), but not among M-F- couples. Dual use of HC and condoms increased over time, irrespective of HIV status. Factors associated with increases in contraceptive use were: higher education, co-resident children, male non-marital relationship and scaled-up HIVC phase. Enrollment into HIVC was associated with increased HC and condom use among HIV+ concordant [adjusted OR (adjOR)=3.03; 95% confidence interval (CI) 1.69-5.44 and adjOR=4.46, 95% CI 2.53-7.86, respectively], and serodiscordant couples (adjOR=2.21; 95% CI 1.25-3.92 and adjOR=4.75; 95% CI 2.89-7.82, respectively).
  
  
  CONCLUSIONS
  Use of modern contraception and dual method use increased over time, particularly after enrollment into HIVC. Integration of HIV and reproductive health services is critical for prevention of unwanted pregnancies and HIV infection.
authors: Assistant Professor, Department of Population, Reproductive and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Heena
authors: H
authors: Brahmbhatt
authors: Lecturer, Makerere University, School of Public Health, Kampala, Uganda and Associate Professor, Population, Reproductive and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Fredrick
authors: F
authors: Makumbi
authors: Senior Researcher, Rakai Health Science Program, Entebbe, Uganda.
authors: Tom
authors: T
authors: Lutalo
authors: Statistician, Rakai Health Science Program, Entebbe, Uganda.
authors: Joseph
authors: J
authors: Sekasanvu
authors: Professor, Makerere University, School of Public Health, Kampala, Uganda.
authors: David
authors: D
authors: Serwadda
authors: Professor, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Maria J
authors: MJ
authors: Wawer
authors: Professor, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Ronald H
authors: RH
authors: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D017280:Condoms / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003267:Contraception / Q000379:methods*; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005191:Family Characteristics; D005193:Family Planning Services / Q000458:organization & administration; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016017:Odds Ratio; D011322:Primary Prevention / Q000458:organization & administration*; D012189:Retrospective Studies; D012698:Serologic Tests; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D014454:Uganda; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal
keywords: condom; family planning service provision; hormonal contraception; human immunodeficiency virus
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