Dual contraceptive utilization and associated factors among women living with the Human Immunodeficiency Virus (HIV) at Kawempe National Referral Hospital, Kampala Uganda

Abstract

Introduction: Dual contraceptive utilization (DCU) maximizes the prevention of unintended pregnancies and sexually transmitted infections including HIV infection. In Uganda DCU among women living with HIV (WLHIV) is low. In order to better understand this situation: this study was conducted to; determine factors associated with DCU, to describe experiences of DCU, client provider interractions and subsequent choice, access and satisfaction; and establish health providers’ perspectives on factors that scale up or lower DCU among WLHIV. Methods: The study employed a mixed methods design utilizing both quantitative and qualitative methods in the ART clinic at Kawempe National referral hospital among WLHIV of reproductive age 15-49 years. Furthermore, the quantitative part of the study used a cross sectional study design while the qualitative part utilized a phenomenological study design. In the quantitative part, 778 WLHIV were interviewed using a structured questionnaire. Bivariable and multivariable binary logistic regression models were used to determine 95% CI and p-values. In the qualitative part, a total of six focus group discussions (FGDs) were conducted. First the WLHIV were divided into dual users and non-dual users. In each of the groups, age stratification was done giving rise to three sub groups in each. Three Key informant interviews were conducted with midwives who were in-charge of family planning unit. All qualitative interviews and FGDs were audio recorded. Codes, categories and themes were used to perform preliminary analysis. Thematic analysis was done using Microsoft Excel. Results. In the quantitative part, women with multiple sexual partners (AOR: 4.19; 95% CI: 2.55, 6.87), women who had been on ART more than 1 year (AOR: 0.21; 95% CI: 0.12, 0.37), partners’ negative HIV status (AOR: 1.7; 95% CI: 1.02, 3.09), sole decision making regarding sexual issues/fertility preferences (AOR: 1.70; 95% CI: 1.03, 2.78), use of contraceptives before HIV diagnosis(AOR:1.77 95% CI: 1.21, 2.58) and religious acceptance of DCU(AOR:3.16 95% CI:1.97,5.10) were statistically significantly associated with DCU among WLHIV. In the qualitative part, both the FGDs and KIs revealed that Child spacing and protection against unwanted pregnancies, protection from HIV and other infections and health workers’ advice were the main facilitators of DCU. On the other hand, Male partners, negative messages and side effects were the main barriers to DCU. Conclusion: The study showed that the proportion of WLHIV who utilized dual contraception was 24.4% and this still showed a low prevalence. WLHIV with; multiple sexual partners, who had been on ART more than 1 year, whose partners’ HIV status was negative, sole decision making regarding sexual issues/fertility, use of contraceptives before HIV diagnosis and religious acceptance of DCU were more likely to utilize dual contraception. Furthermore, child spacing and protection against unwanted pregnancies, protection from HIV and other infections and health workers’ advice were the main facilitators of DCU while male partners, negative messages and side effects were the main barriers to DCU.