Low Rates of Contraception Use in Women With Human Immunodeficiency Virus. (8th March 2022)

• Record Type: Journal Article
• Authors: Bhatta, Manasa; Bian, Aihua; Norwood, Jamison; Shepherd, Bryan E; Ransby, Imani; Nelson, Jeffrey; Turner, Megan; Sterling, Timothy R; Castilho, Jessica L
• Is Part Of: Open forum infectious diseases. Volume 9:Number 5(2022)
• Publication Date: 2022-03-08
• Subjects: contraception -- family planning -- HIV -- pregnancy -- women; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac113
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Women with human immunodeficiency virus (WWH) have low rates of hormonal or long-acting contraceptive use. Few studies have described contraception use among WWH over time. Methods: We examined contraception (including all forms of hormonal contraception, intrauterine devices, and bilateral tubal ligations) use among cisgender women aged 18–45 years in care at Vanderbilt's human immunodeficiency virus (HIV) clinic in Nashville, Tennessee, from 1998 through 2018. Weighted annual prevalence estimates of contraception use were described. Cox proportional hazards models examined factors associated with incident contraception use and pregnancy. Results: Of the 737 women included, median age at clinic entry was 31 years; average follow-up was 4.1 years. At clinic entry, 47 (6%) women were on contraception and 164 (22%) were pregnant. The median annual percentage of time on any contraception use among nonpregnant women was 31.7% and remained stable throughout the study period. Younger age was associated with increased risk of pregnancy and contraceptive use. Psychiatric comorbidity decreased likelihood of contraception (adjusted hazard ratio [aHR], 0.52 [95% CI {confidence interval}, .29–.93]) and increased likelihood of pregnancy (aHR, 1.77 [95% CI, .97–3.25]). While not associated with contraceptive use, more recent year of clinic entry was associated with higher pregnancy risk. Race, substance use, CD4 cell count, HIV RNA, smoking, and antiretroviral therapy were not associated with contraception use nor pregnancy. Conclusions: Most WWH did not use contraception at baseline nor during follow-up. Likelihood of pregnancy increased with recent clinic entry while contraception use remained stable over time. Continued efforts to ensure access to effective contraception options are needed in HIV clinics. Abstract : We examined contraception use (all hormonal contraception, tubal ligations, and intrauterine device) from 1998 through 2018 at an HIV clinic in Tennessee. Contraception use prevalence and incidence remained low and stable over time; recent year of entry predicted higher likelihood of pregnancy.