Preventing unintended pregnancy and HIV transmission: Effects of the HIV treatment cascade on contraceptive use and choice in rural Kwa Zulu-Natal

Raifman, J., Chetty, T., Tanser, F. , Mutevedzi, T., Matthews, P., Herbst, K., Pillay, D. and Bärnighausen, T. (2014) Preventing unintended pregnancy and HIV transmission: Effects of the HIV treatment cascade on contraceptive use and choice in rural Kwa Zulu-Natal. Journal of Acquired Immune Deficiency Syndromes, 67 . S218-S227. ISSN 1525-4135

Full content URL: https://doi.org/10.1097/QAI.0000000000000373

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Item Type:Article
Item Status:Live Archive

Abstract

Background: For women living with HIV, contraception using
condoms is recommended because it prevents not only unintended
pregnancy but also acquisition of other sexually transmitted
infections and onward transmission of HIV. Dual-method dualprotection contraception (condoms with other contraceptive methods) is preferable over single-method dual-protection contraception
(condoms alone) because of its higher contraceptive effectiveness.
We estimate the effect of progression through the HIV treatment
cascade on contraceptive use and choice among HIV-infected
women in rural South Africa.
Methods: We linked population-based surveillance data on contraception collected by the Wellcome Trust Africa Centre for Health and
Population Studies to data from the local antiretroviral treatment
(ART) program in Hlabisa subdistrict, KwaZulu-Natal. In bivariate
probit regression, we estimated the effects of progressing through the
cascade on contraceptive choice among HIV-infected sexually active
women aged 15–49 years (N = 3169), controlling for a wide range of
potential confounders.
Findings: Contraception use increased across the cascade from ,40%
among HIV-infected women who did not know their status to .70%
among women who have been on ART for 4–7 years. Holding other
factors equal (1) awareness of HIV status, (2) ART initiation, and (3)
being on ART for 4–7 years increased the likelihood of single-method/
dual-method dual protection by the following percentage points (pp),
compared with women who were unaware of their HIV status: (1) 4.6
pp (P = 0.030)/3.5 pp (P = 0.001), (2) 10.3 pp (P = 0.003)/5.2 pp (P =
0.007), and (3) 21.6 pp (P , 0.001)/11.2 pp (P , 0.001).
Conclusions: Progression through the HIV treatment cascade
significantly increased the likelihood of contraception in general
and contraception with condoms in particular. ART programs are
likely to contribute to HIV prevention through the behavioral
pathway of changing contraception use and choice.

Additional Information:cited By 15
Divisions:College of Social Science > Lincoln Institute of Health
ID Code:37552
Deposited On:09 Oct 2019 15:12

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