title: Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania.
abstract: OBJECTIVE
  To describe factors associated with pregnancy desire and dual method use among people living with HIV in clinical care in sub-Saharan Africa.
  
  
  METHODS
  Sexually active HIV-positive adults were enrolled in 18 HIV clinics in Kenya, Namibia and Tanzania. Demographic, clinical and reproductive health data were captured by interview and medical record abstraction. Correlates of desiring a pregnancy within the next 6 months, and dual method use [defined as consistent condom use together with a highly effective method of contraception (hormonal, intrauterine device (IUD), permanent)], among those not desiring pregnancy, were identified using logistic regression.
  
  
  RESULTS
  Among 3375 participants (median age 37 years, 42% male, 64% on antiretroviral treatment), 565 (17%) desired a pregnancy within the next 6 months. Of those with no short-term fertility desire (n=2542), 686 (27%) reported dual method use, 250 (10%) highly effective contraceptive use only, 1332 (52%) condom use only, and 274 (11%) no protection. Respondents were more likely to desire a pregnancy if they were from Namibia and Tanzania, male, had a primary education, were married/cohabitating, and had fewer children. Factors associated with increased likelihood of dual method use included being female, being comfortable asking a partner to use a condom, and communication with a health care provider about family planning. Participants who perceived that their partner wanted a pregnancy were less likely to report dual method use.
  
  
  CONCLUSIONS
  There was low dual method use and low use of highly effective contraception. Contraceptive protection was predominantly through condom-only use. These findings demonstrate the importance of integrating reproductive health services into routine HIV care.
authors.affiliation: Research and Evaluation Director (Tanzania), ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Antelman
authors.affiliation: Behavioral Scientist, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Medley
authors.affiliation: Executive Director, Tanzania Health Promotion Support, Dar es Salaam, United Republic of Tanzania.
authors.forename: Redempta
authors.initials: R
authors.lastname: Mbatia
authors.affiliation: Mathematical Statistician, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Sherri
authors.initials: S
authors.lastname: Pals
authors.affiliation: Associate Director of Science, CTS Global Inc., assigned to US Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania.
authors.forename: Gilly
authors.initials: G
authors.lastname: Arthur
authors.affiliation: Science Office Team Lead, CTS Global Inc., assigned to US Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania.
authors.forename: Sabina
authors.initials: S
authors.lastname: Haberlen
authors.affiliation: HIV Care and Treatment Branch Chief, US Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Marta
authors.initials: M
authors.lastname: Ackers
authors.affiliation: Director of Strategic Information (ICAP) and Assistant Professor of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Batya
authors.initials: B
authors.lastname: Elul
authors.affiliation: Study Coordinator, Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Julie
authors.initials: J
authors.lastname: Parent
authors.affiliation: Pediatrician, Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania.
authors.forename: Anath
authors.initials: A
authors.lastname: Rwebembera
authors.affiliation: Senior Care and Treatment Medical Officer, US Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Lucy
authors.initials: L
authors.lastname: Wanjiku
authors.affiliation: Director of Medical Services, Ministry of Health, Nairobi, Kenya.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Muraguri
authors.affiliation: Chief Medical Officer and National Programme Manager, Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Justice
authors.initials: J
authors.lastname: Gweshe
authors.affiliation: Senior M&E Officer, Research and Evaluation, The International Center for AIDS Care and Treatment Programs (ICAP), Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Mudhune
authors.affiliation: Behavioral Scientist, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Bachanas
mesh_terms: D000328:Adult; D003142:Communication; D017280:Condoms; D003267:Contraception / Q000379:methods; D003268:Contraception Behavior / Q000523:psychology; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009276:Namibia; D011247:Pregnancy; D034121:Reproductive Health Services; D013636:Tanzania
keywords: condom; counselling; family planning service provision; hormonal contraception; human immunodeficiency virus; service delivery