title: The influence of partnership on contraceptive use among HIV-infected women accessing antiretroviral therapy in rural Uganda.
abstract: OBJECTIVE
  The objective was to determine individual and dyadic factors associated with effective contraceptive use among human immunodeficiency virus (HIV)-infected women accessing antiretroviral therapy (ART) in rural Uganda.
  
  
  METHODS
  HIV-infected women enrolled in the Uganda AIDS Rural Treatment Outcomes cohort completed questionnaires (detailing sociobehavioral characteristics, sexual and reproductive history, contraceptive use, fertility desires) and phlebotomy (October 2011-March 2013). We describe prevalence of effective contraceptive use (i.e., consistent condom use and/or oral contraceptives, injectable hormonal contraception, intrauterine device, female sterilization) in the previous 6 months among sexually active, nonpregnant women (18-40 years). We assessed covariates of contraceptive use using multivariable logistic regression.
  
  
  RESULTS
  A total of 362 women (median values: age 30 years, CD4 count 397 cells/mm(3), 4.0 years since ART initiation) were included. Among 284 sexually active women, 50% did not desire a(nother) child, and 51% had a seroconcordant partner. Forty-five percent (n=127) reported effective contraceptive use, of whom 57% (n=72) used condoms, 42% (n=53) injectables, 12% (n=15) oral contraceptives and 11% (n=14) other effective methods. Dual contraception was reported by 6% (n=8). Only "partnership fertility desire" was independently associated with contraceptive use; women who reported that neither partner desired a child had significantly increased odds of contraceptive use (adjusted odds ratio: 2.40, 95% confidence interval: 1.07-5.35) compared with women in partnerships where at least one partner desired a child.
  
  
  CONCLUSIONS
  Less than half of sexually active HIV-infected women accessing ART used effective contraception, of which 44% (n=56) relied exclusively on male condoms, highlighting a continued need to expand access to a wider range of longer-acting female-controlled contraceptive methods. Association with partnership fertility desire underscores the need to include men in reproductive health programming.
  
  
  CONCLUSIONS
  Less than half of sexually active HIV-infected women accessing ART in rural Uganda reported using effective contraception, of whom 44% relied exclusively on the male condom. These findings highlight the need to expand access to a wider range of longer-acting, female-controlled contraceptive methods for women seeking to limit or space pregnancies. Use of contraception was more likely when both the male and female partner expressed concordant desires to limit future fertility, emphasizing the importance of engaging men in reproductive health programming.
authors.affiliation: Harvard School of Public Health, Boston, United States.
authors.forename: Christina I
authors.initials: CI
authors.lastname: Nieves
authors.affiliation: Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Kaida
authors.affiliation: Harvard School of Public Health, Boston, United States.
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
authors.affiliation: Mbarara University of Science and Technology (MUST), Mbarara, Uganda.
authors.forename: Jerome
authors.initials: J
authors.lastname: Kabakyenga
authors.affiliation: Mbarara University of Science and Technology (MUST), Mbarara, Uganda.
authors.forename: Winnie
authors.initials: W
authors.lastname: Muyindike
authors.affiliation: Mbarara University of Science and Technology (MUST), Mbarara, Uganda; Epicentre Mbarara, Mbarara, Uganda.
authors.forename: Yap
authors.initials: Y
authors.lastname: Boum
authors.affiliation: University of California at San Francisco, San Francisco, United States.
authors.forename: A Rain
authors.initials: AR
authors.lastname: Mocello
authors.affiliation: University of California at San Francisco, San Francisco, United States.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.affiliation: University of California at San Francisco, San Francisco, United States.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
authors.affiliation: Massachusetts General Hospital, Center for Global Health & Department of Medicine, Boston, United States.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Haberer
authors.affiliation: Mbarara University of Science and Technology (MUST), Mbarara, Uganda; Massachusetts General Hospital, Center for Global Health & Division of Infectious Disease, Boston, United States.
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.affiliation: Massachusetts General Hospital, Center for Global Health & Division of Infectious Disease, Boston, United States. Electronic address: ltmatthews@partners.org.
authors.forename: Lynn T
authors.initials: LT
authors.lastname: Matthews
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D017280:Condoms; D003268:Contraception Behavior / Q000208:ethnology; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D000069216:Contraceptive Prevalence Surveys; D003430:Cross-Sectional Studies; D004343:Drug Implants / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D006679:HIV Seropositivity / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D012423:Rural Health / Q000208:ethnology; D012747:Sexual Partners; D014454:Uganda; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D003271:Contraceptive Agents, Female; D004343:Drug Implants
keywords: Antiretroviral therapy; Contraceptive use; Family planning; HIV; Uganda