Missed Opportunities for Family Planning Counselling among HIV-Positive Women Receiving HIV Care in Uganda

Abstract

Abstract; Introduction; ; 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 FP counseling and current use of modern contraception to inform programming.; ; Methods; ; Data were drawn from a quantitative national cross-sectional survey of 5,198 HIV-positive women receiving HIV care at 245 HIV clinics in Uganda; conducted between August and November 2016. Family planning counseling was defined as receipt of FP information by an HIV-positive woman during ANC, at the time of delivery or at the PNC visit. Analyses on receipt of FP counseling were done on 2,760 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 counseling and current use of modern contraception, controlling for potential confounders. Analyses were performed using STATA statistical software, version 14.1.; ; Results; ; Overall, 2,104 (76.2%) HIV-positive women reported that they received FP counseling at any of the three critical time-points. Of the 24% ( n =656) who did not, 37.9% missed FP counseling at ANC; 41% missed FP counseling during delivery; while 54% missed FP counseling at the post-natal care visit. HIV-positive women who received any FP counseling 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).; ; Conclusion; ; Nearly one-quarter of HIV-positive women did not receive any form of FP counseling 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 counseling into HIV care at all critical time-points.