Ambade Preshit Nemdas, Hajjar Julia, Adjei Nicholas Kofi, Yaya Sanni
Department of Health Management, Economics and Policy, School of Public Health, Augusta University, Augusta, Georgia, United States of America.
Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada.
PLOS Glob Public Health. 2024 Aug 6;4(8):e0002637. doi: 10.1371/journal.pgph.0002637. eCollection 2024.
The combination of low uptake of modern contraceptives, high rates of unintended pregnancies, and the pervasive HIV epidemic in Sub-Saharan Africa (SSA) poses a threat to maternal, newborn, and child health in the region. This study examined the prevalence, need, and demand satisfied by modern contraceptive methods for women who tested positive for HIV (both unmarried and married) in 10 countries in SSA. We used the Family Planning Estimation Tool (FPET) to generate national-level trends and projections from 1983 through 2030. Individual-level data from 30 DHS surveys conducted between 2004 and 2018 in 10 sub-Saharan Africa (SSA) countries were used to produce projections for 1) all women and 2) unmarried and married women who tested positive for HIV. Throughout the period, Ethiopian and Guinean women who tested positive for HIV had a higher %mCPR (utilization of modern family planning methods) vis-à-vis all women. Among women who tested positive for HIV, the highest percentage of family planning demand satisfied by modern methods was observed in Zimbabwe (85.27, CI: 76.32-91.69), Lesotho (82.75, CI: 71.80-89.86), Rwanda (80.17, CI: 70.01-87.62), Malawi (73.11, CI: 61.50-82.63), and Zambia (72.63, CI: 64.49-80.09). The highest unmet need for modern contraceptives was found in Senegal (25.38, CI:18.36-33.72), followed by Cameroon (23.59, CI:19.30-28.59) and Sierra Leone (23.16, CI:16.64-32.05). Zimbabwe had the lowest unmet need (10.61, CI:6.36-16.13) and achieved the highest change in %mCPR (49.28, SE:6.80). Among married women who tested positive for HIV, their unmet need for modern contraception will remain higher in 2030. Continuing existing policies until 2030 would result in significant coverage gain among married vis-à-vis unmarried women who tested positive for HIV. Our projections emphasize the importance of country-specific strengthening initiatives, programs, and services targeting unmarried women.
现代避孕方法使用率低、意外怀孕率高以及撒哈拉以南非洲地区普遍存在的艾滋病毒疫情，对该地区的孕产妇、新生儿和儿童健康构成了威胁。本研究调查了撒哈拉以南非洲10个国家中艾滋病毒检测呈阳性的女性（包括未婚和已婚）对现代避孕方法的使用情况、需求及需求满足情况。我们使用计划生育估计工具（FPET）生成了1983年至2030年的国家级趋势和预测。利用2004年至2018年期间在撒哈拉以南非洲10个国家进行的30次人口与健康调查（DHS）的个体层面数据，对以下两类人群进行预测：1）所有女性；2）艾滋病毒检测呈阳性的未婚和已婚女性。在整个时期，埃塞俄比亚和几内亚艾滋病毒检测呈阳性的女性相对于所有女性而言，现代避孕方法使用率（mCPR）更高。在艾滋病毒检测呈阳性的女性中，现代方法满足计划生育需求比例最高的是津巴布韦（85.27，置信区间：76.32 - 91.69）、莱索托（82.75，置信区间：71.80 - 89.86）、卢旺达（80.17，置信区间：70.01 - 87.62）、马拉维（73.11，置信区间：61.50 - 82.63）和赞比亚（72.63，置信区间：64.49 - 80.09）。现代避孕方法未满足需求最高的是塞内加尔（25.38，置信区间：18.36 - 33.72），其次是喀麦隆（23.59，置信区间：19.30 - 28.59）和塞拉利昂（23.16，置信区间：16.64 - 32.05）。津巴布韦的未满足需求最低（10.61，置信区间：6.36 - 16.13），且现代避孕方法使用率变化最大（49.28，标准误差：6.80）。在艾滋病毒检测呈阳性的已婚女性中，到2030年她们对现代避孕方法的未满足需求仍将更高。持续现有政策至2030年将使艾滋病毒检测呈阳性的已婚女性相对于未婚女性在覆盖率上有显著提升。我们的预测强调了针对未婚女性开展特定国家强化举措、项目和服务的重要性。
