Longitudinal patterns of unmet need for contraception and the effect of fertility intentions on attendance at HIV clinical care visits among HIV-infected women on antiretroviral therapy in South Africa

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  • March 22, 2019
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  • Rucinski, Katherine
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Fertility intentions and contraceptive use are often not assessed in the context of HIV clinical care, representing a possible gap in many current programs if women’s family planning needs change over time. Additionally, women who are planning to conceive have different clinical needs than those what wish to prevent pregnancy, precipitating potential differences in the frequency with which women attend HIV clinical care visits. We used data from a prospective cohort study of 850 non-pregnant, HIV-infected women aged 18-35 on or initiating antiretroviral therapy (ART) in Johannesburg, South Africa between 2009 and 2010. In Aim 1, we used group-based trajectory modeling to identify distinct patterns of unmet need over the 12-month study period. Half of the enrolled women were predicted to have a consistently high probability of unmet need, 22.9% a consistently low probability, 16.7% a decreasing probability, and 10.4% an increasing probability over time. In Aim 2, we estimated the effect of fertility intentions on attendance at HIV clinical care visits. Women were classified as having either current fertility intentions (trying to conceive at time of interview), short-term fertility intentions (planning to conceive in the next 12 months), long-term fertility intentions (planning to conceive in the future) or having no plans to conceive. Attendance was assessed dichotomously (any attendance vs. none) in 90-day intervals. We used generalized estimating equations to estimate the effect of fertility intentions on the odds of attending clinic visits over the 12-month study period. We found no difference in clinic attendance by fertility intentions in the full cohort. Among women who had recently initiated ART, those that planned to conceive were more likely to attend HIV clinical care visits (aOR 2.95, 95% CI: 1.19, 7.30) than those with no plans to conceive. Through this research we have demonstrated that family planning needs can change over time and thus should be assessed more regularly in HIV-infected women.
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Advisor
  • Chi, Benjamin
  • Pettifor, Audrey
  • Schwartz, Sheree
  • Pence, Brian
  • Powers, Kimberly
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2018
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