Brahmbhatt Heena, Makumbi Fredrick, Lutalo Tom, Sekasanvu Joseph, Serwadda David, Wawer Maria J, Gray Ronald H
Assistant Professor, Department of Population, Reproductive and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lecturer, Makerere University, School of Public Health, Kampala, Uganda and Associate Professor, Population, Reproductive and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Fam Plann Reprod Health Care. 2014 Jul;40(3):208-16. doi: 10.1136/jfprhc-2013-100593. Epub 2013 Aug 16.
To assess trends and determinants of family planning use and impact of HIV serostatus among couples.
Couples' data were retrospectively linked from cohort surveys in Rakai, Uganda between 1999 and 2011, and were classified by HIV status as concordant (M+F+/M-F-) or serodiscordant (M-F+/M+F-). HIV care (HIVC) was grouped into three periods, pre-antiretroviral therapy (pre-HIVC) (<2004), HIVC roll-out (2005-2007) and HIVC scale-up (≥ 2008). Trends in couple contraceptive use were assessed by chi-square test (χ(2)) for trend, and multinomial logistic regression was used to estimate adjusted odds ratios (ORs) of predictors of contraceptive use.
A total of 6139 couples contributed 13,709 observations. Hormonal contraception (HC) use increased over time from 22.9% to 33.9%, p<0.001), with significant increases among M-F- (23.2% to 34.8%, p<0.0001) and M+F+ (20.8% to 32.2%, p=0.0005), but not serodiscordant couples. Condom use significantly increased among M+F+ (30.3% to 48.0%, p<0.001) and serodiscordant couples (24.2% to 48.7%, p<0.001), but not among M-F- couples. Dual use of HC and condoms increased over time, irrespective of HIV status. Factors associated with increases in contraceptive use were: higher education, co-resident children, male non-marital relationship and scaled-up HIVC phase. Enrollment into HIVC was associated with increased HC and condom use among HIV+ concordant [adjusted OR (adjOR)=3.03; 95% confidence interval (CI) 1.69-5.44 and adjOR=4.46, 95% CI 2.53-7.86, respectively], and serodiscordant couples (adjOR=2.21; 95% CI 1.25-3.92 and adjOR=4.75; 95% CI 2.89-7.82, respectively).
Use of modern contraception and dual method use increased over time, particularly after enrollment into HIVC. Integration of HIV and reproductive health services is critical for prevention of unwanted pregnancies and HIV infection.
评估计划生育的使用趋势和决定因素以及夫妻中艾滋病毒血清学状态的影响。
回顾性地将1999年至2011年乌干达拉凯队列调查中的夫妻数据进行关联，并根据艾滋病毒状态分为一致（男阳性/女阳性/男阴性/女阴性）或血清学不一致（男阴性/女阳性/男阳性/女阴性）。艾滋病毒护理（HIVC）分为三个时期，抗逆转录病毒治疗前（HIVC前）（<2004年）、HIVC推广期（2005 - 2007年）和HIVC扩大期（≥2008年）。通过卡方趋势检验（χ(2)）评估夫妻避孕使用趋势，并使用多项逻辑回归估计避孕使用预测因素的调整比值比（OR）。
共有6139对夫妻提供了13709次观察数据。激素避孕（HC）的使用随时间增加，从22.9%增至33.9%，p<0.001），在男阴性/女阴性（23.2%至34.8%，p<0.0001）和男阳性/女阳性（20.8%至32.2%，p = 0.0005）夫妻中显著增加，但在血清学不一致的夫妻中未增加。男阳性/女阳性（30.3%至48.0%，p<0.001）和血清学不一致的夫妻（24.2%至48.7%，p<0.001）中避孕套使用显著增加，但在男阴性/女阴性夫妻中未增加。HC和避孕套的双重使用随时间增加，与艾滋病毒状态无关。与避孕使用增加相关的因素有：高等教育、同住子女、男性非婚姻关系和HIVC扩大期。加入HIVC与艾滋病毒阳性一致夫妻[调整后OR（adjOR）=3.03；95%置信区间（CI）1.69 - 5.44和adjOR = 4.46，95% CI 2.53 - 7.86，分别]以及血清学不一致夫妻（adjOR = 2.21；95% CI 1.25 - 3.92和adjOR = 4.75；95% CI 2.89 - 7.82，分别）中HC和避孕套使用增加有关。
现代避孕方法的使用和双重方法的使用随时间增加，尤其是在加入HIVC之后。整合艾滋病毒和生殖健康服务对于预防意外怀孕和艾滋病毒感染至关重要。
