Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.
Busitema University Faculty of Health Sciences, Mbale, Uganda.
BMC Womens Health. 2020 May 5;20(1):91. doi: 10.1186/s12905-020-00942-6.
HIV-positive women who are still in the reproductive years need adequate sexual and reproductive health information to make informed reproductive health choices. However, many HIV-positive women who interface with the health system continue to miss out on this information. We sought to: a) determine the proportion of HIV-positive women enrolled in HIV care who missed family planning (FP) counselling; and b) assess if any association existed between receipt of FP counselling and current use of modern contraception to inform programming.
Data were drawn from a quantitative national cross-sectional survey of 5198 HIV-positive women receiving HIV care at 245 HIV clinics in Uganda; conducted between August and November 2016. Family planning counselling was defined as provision of FP information (i.e. available FP methods and choices) to an HIV-positive woman by a health provider during ANC, at the time of delivery or at the PNC visit. Analyses on receipt of FP counselling were done on 2760 HIV-positive women aged 15-49 years who were not currently pregnant and did not intend to have children in the future. We used a modified Poisson regression model to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counselling and current use of modern contraception, controlling for potential confounders. Analyses were performed using STATA statistical software, version 14.1.
Overall, 2104 (76.2%) HIV-positive women reported that they received FP counselling at any of the three critical time-points. Of the 24% (n = 656) who did not, 37.9% missed FP counselling at ANC; 41% missed FP counselling during delivery; while 54% missed FP counselling at the post-natal care visit. HIV-positive women who received any FP counselling were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.21; 95% Confidence Interval [CI]: 1.10, 1.33).
Nearly one-quarter of HIV-positive women did not receive any form of FP counselling when they interfaced with the healthcare system. This presents a missed opportunity for prevention of unintended pregnancies, and suggests a need for the integration of FP counselling into HIV care at all critical time-points.
仍处于生育年龄的 HIV 阳性妇女需要获得充分的性健康和生殖健康信息，以便做出知情的生殖健康选择。然而，许多与卫生系统接触的 HIV 阳性妇女仍然无法获得这些信息。我们试图：a）确定在接受 HIV 护理的 HIV 阳性妇女中，错过计划生育（FP）咨询的比例；b）评估接受 FP 咨询与当前使用现代避孕方法之间是否存在任何关联，以便为规划提供信息。
数据来自于 2016 年 8 月至 11 月期间在乌干达 245 个 HIV 诊所接受 HIV 护理的 5198 名 HIV 阳性妇女的一项全国性横断面定量调查；计划生育咨询的定义是由卫生保健提供者在 ANC 期间、分娩时或 PNC 就诊时向 HIV 阳性妇女提供 FP 信息（即可用的 FP 方法和选择）。对 2760 名年龄在 15-49 岁之间、目前未怀孕且未来不打算生育的 HIV 阳性妇女进行了 FP 咨询接受情况分析。我们使用修正泊松回归模型来确定接受任何 FP 咨询与当前使用现代避孕方法之间的患病率比（PR），作为关联的衡量标准，并控制了潜在的混杂因素。使用 STATA 统计软件，版本 14.1 进行分析。
总体而言，2104 名（76.2%）HIV 阳性妇女报告在三个关键时间点中的任何一个时间点都接受了 FP 咨询。在未接受 FP 咨询的 24%（n=656）妇女中，37.9%在 ANC 时错过 FP 咨询；41%在分娩时错过 FP 咨询；而 54%在产后护理就诊时错过 FP 咨询。接受任何 FP 咨询的 HIV 阳性妇女报告当前使用现代避孕方法的可能性明显高于未接受 FP 咨询的妇女（调整后的患病率比[adj. PR] = 1.21；95%置信区间[CI]：1.10，1.33）。
近四分之一的 HIV 阳性妇女在与医疗保健系统接触时没有接受任何形式的 FP 咨询。这为预防意外怀孕提供了一个错失的机会，并表明需要在所有关键时间点将 FP 咨询纳入 HIV 护理。
