Effect of Anteritroviral Therapy (ART) on Fertility Intention and Contraceptive Prefernce of HIV Positive Women in Addis Ababa, Ethiopia

Mekonnen, Hussen (2015) Effect of Anteritroviral Therapy (ART) on Fertility Intention and Contraceptive Prefernce of HIV Positive Women in Addis Ababa, Ethiopia. PhD thesis, Addis Ababa University.

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Abstract

Background: The advent of antiretroviral therapy (ART) has improved quality of life and survival for people living with HIV (PLWH) and now days HIV infection can be seen as a chronic manageable disease, as a result many will contemplate child bearing. Although, ART has influence in improving quality of life and reduce mother to child transmission of HIV virus (MTCT) in developed countries, vertical transmission accounts for more than 90% of pediatric AIDS in prevalent areas, as a result, reproductive assistance to HIV positive women is important to have informed decision making about child bearing and child rearing. In Ethiopia, while anti-retroviral therapy (ART) services are increasingly available, information about fertility intentions, contraceptive use and method preference among women living with HIV in relation to ART use is scarce. Moreover, change in fertility intentions 12 months after ART intiation and reasons in selection of those options are lacking. Those factors raise concern on possible exposure of many HIV positive women to the potential risk of unintended pregnancy and hinder them from seeking options. Objectives: the purpose of the study was to assess effect of ART on the fertility intentions and contraceptive use and method preference of HIV positive women in Addis Ababa, Ethiopia. Methodology: Health facility based cross sectional quantitative and qualitative studies including follow up studies were conducted. For the quantitative part, a total of 1855 HIV positive women aged 15-49 years for cross sectional survey and 360 HIV positive women participated for the follow up study. Focus group discussion, in depth interviews and key informant interviews were done for the qualitative part. Data were collected from June 2012 to December 2013 using validated structured questionnaires for quantitative and semi structured questionnaires for qualitative part. Data were double entered in to epidemiological software (Epi Info version 3.5.1). Descriptive statistics, bivareate and multivariate statistical analysis were done using SPSS version 20 soft ware.Results: Overall, 44% of women reported childbearing intention and 71% women reported using contraception 75% (n=579) ART users and 65% (n=422) ART naïve women. Male condom and injectables were the most preferred contraceptive methods among both groups. The proportion of fertility intention 12 months after antiretroviral therapy (ART) initiation was higher among ART initiated 55.5% (n=106) than ART naïve 40% (n=68) women. The presence of ART, improvement of health condition and the influence of husband, family, community and associated stigma were the main reasons for childbearing intentions of women in the study area. In adjusted logistic regression analysis, ART users had higher fertility intention (AOR; 1.26, 95%CI; 1.01 to 1.60) than ART naïve. Furthermore, being in a sexual relationship, young age, being single and having fewer or no children were found to be predictors of fertility intentions. Women receiving ART reported more use of contraceptives (AOR 1.60, 95% CI, 1.30- 2.12) than ART naïve women. In addition to this, presence of partner (AOR 2.32, 95% CI, 1.60-3.40), disclosure of HIV status to husband (AOR 2.23, 95 % CI, 1.21-4.12), presence of living children: one (AOR 1.7, 95% C I, 1.03-2.40), two (AOR 2.6, 95% CI, 1.7-4.02) and three (AOR 3.3, 95% CI, 1.90-5.60) respectively were found to be predictors of contraceptive use among HIV positive women. Overall, 41.0 % (147/360) of the women reported fertility intentions at the baseline, while 48.3 %( 174/360) reported fertility intentions 12 months after follow up. The proportion of fertility intention 12 months after antiretroviral therapy (ART) initiation was higher among ART initiated 55.8% (106/190) than HAART naïve 40% (68/170) women. Furthermore, the need for more children 12 months after ART initiation was significantly associated with woman’s ART use (AOR, 2.46, 95%CI, 1.20-5.20). Single and married women (AOR, 5.32, 95%CI, 1.10-25.92) (AOR: 6.34, 95%CI, 1.43-27.99) respectively, were more likely to report fertility intention than divorced/ widowed women. Women who had at least one child (AOR, 0.32, 95% CI, 0.13-0.85) were less likely to change fertility intentions compared to women with no children. Conclusions: Fertility intentions are common among HIV positive women and change in intention for a child starts soon after initiation of ART. About three in four HIV positive women use contraceptive methods mainly condoms. Dual contraceptive method use was negligible among the study subjects.Fertility and contraceptive decisions of women are influenced by presence of ART, partner desire, family and community perception and associated stigma. Many participants indicated that health service providers are supportive in offering information more on preventive methods rather than discussing fertility and contraceptive options. Recommendations: It is necessary to strengthen an integrated sexual and reproductive health (SRH) service and HIV prevention, ART services to address the diverse SRH needs of HIV positive women in the study area. Furthermore, updating health care providers with fertility and contraceptive knowledge is valuable to enhance family planning and preventive practice of women.fertility intention, contraceptive use, method preference, HIV, ART, women, Addis Ababa, Ethiopia

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Africana
Depositing User:	Emmanuel Ndorimana
Date Deposited:	04 Jul 2018 09:02
Last Modified:	04 Jul 2018 09:02
URI:	http://thesisbank.jhia.ac.ke/id/eprint/6574

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