Optimizing Prevention of HIV and Unplanned Pregnancy in Discordant African Couples
Year: 2017
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Dual method use, which combines condoms with a more effective modern contraceptive to optimize prevention of HIV and unplanned pregnancy, is underutilized in high-risk heterosexual couples. MATERIALS AND METHODS: Heterosexual HIV-discordant Zambian couples were enrolled from couples' voluntary HIV counseling and testing services into an open cohort with 3-monthly follow-up (1994-2012). Relative to dual method use, defined as consistent condom use plus modern contraception, we examine predictors of (1) condom-only use (suboptimal pregnancy prevention) or (2) modern contraceptive use with inconsistent condom use (effective pregnancy prevention and suboptimal HIV prevention). RESULTS: Among 3,049 couples, dual method use occurred in 28% of intervals in M+F- and 23% in M-F+, p < 0.01; condom-only use in 56% in M+F- and 61% in M-F+, p < 0.01; and modern contraceptive use with inconsistent condom use in 16% regardless of serostatus. Predictors (p < 0.05) of condom-only use included the man being HIV+ (adjusted hazard ratio, aHR = 1.15); baseline oral contraceptive pill (aHR = 0.76), injectable (aHR = 0.48), or implant (aHR = 0.60) use; woman's age (aHR = 1.04 per 5 years) and lifetime number of sex partners (aHR = 1.01); postpartum periods (aHR = 1.25); and HIV stage of the index partner III/IV versus I (aHR = 1.10). Predictors (p < 0.05) of modern contraceptive use with inconsistent condom use included woman's age (aHR = 0.94 per 5 years) and HIV+ male circumcision (aHR = 1.51), while time-varying implant use was associated with more consistent condom use (aHR = 0.80). CONCLUSIONS: Three-quarters of follow-up intervals did not include dual method use. This highlights the need for counseling to reduce unintended pregnancy and HIV transmission and enable safer conception.
Source: Journal of Women s Health
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: United States Agency for International Development, International AIDS Vaccine Initiative, Emory University, Centers for Disease Control and Prevention, Center for AIDS Research, University of Washington, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, Fogarty International Center
Awards: G1313733282, Virologic Correlates of Heterosexual Transmission, G1879488458, G1913134163, G2675028044, G3144852840, HETEROSEXUAL TRANSMISSION AND THE NATURAL HISTORY OF HIV, G3926223904, G4124378290, HETEROSEXUAL TRANSMISSION AND THE NATURAL HISTORY OF HIV, G5192338916, Emory AIDS International Training and Research Program, G6113675784, CTL and HIV Polymorphisms in Heterosexual Transmission, Virologic Correlates of Heterosexual Transmission, G8072403121, G813243856, G8393116989, G873043076, Center for AIDS Research at Emory University
OpenAlex ID: W2747721848