Dhont Nathalie, Ndayisaba Gilles François, Peltier Cécile Alexandra, Nzabonimpa Aniceth, Temmerman Marleen, van de Wijgert Janneke
International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
Eur J Contracept Reprod Health Care. 2009 Dec;14(6):420-5. doi: 10.3109/13625180903340584.
Long-acting reversible contraceptives (LARCs) and sterilisation are the most cost-effective methods of contraception but are rarely used in sub-Saharan Africa partly due to limited access.
HIV-positive pregnant women attending two urban clinics in Rwanda were followed prospectively in a perinatal HIV transmission cohort study. Women attending one clinic were referred to public family planning (FP) services for all contraceptive methods (Site A) and women attending the other clinic (Site B) were offered implants and intrauterine devices (IUDs) on-site.
Fifty three percent of the pregnant women reported an intention to use a LARC or to be sterilised after delivery. The uptake of implants was significantly higher at Site B (38%) than at Site A (6%). The IUD uptake was extremely low at both sites (2%). Twenty-eight of the 39 women at Site B who had intended to start using a LARC actually did so as compared to only one of 23 at Site A.
When access to LARC was provided, a substantial number of HIV-positive women started using hormonal implants, but not IUDs, in the postpartum period. HIV and FP services should consider improving access to implants to reduce the number of unintended pregnancies.
长效可逆避孕法（LARC）和绝育是最具成本效益的避孕方法，但在撒哈拉以南非洲地区很少使用，部分原因是获取途径有限。
在卢旺达两家城市诊所就诊的HIV阳性孕妇在一项围产期HIV传播队列研究中接受前瞻性随访。在一家诊所就诊的妇女被转介到公共计划生育（FP）服务部门获取所有避孕方法（A地点），而在另一家诊所（B地点）就诊的妇女在现场获得植入剂和宫内节育器（IUD）。
53%的孕妇表示打算在产后使用LARC或进行绝育。B地点植入剂的使用率（38%）显著高于A地点（6%）。两个地点的IUD使用率都极低（2%）。B地点39名打算开始使用LARC的妇女中有28名实际使用了，而A地点23名妇女中只有1名使用。
当提供获取LARC的途径时，相当数量的HIV阳性妇女在产后开始使用激素植入剂，但未使用IUD。HIV和FP服务部门应考虑改善植入剂的获取途径，以减少意外怀孕的数量。
