Effective Contraceptive Use Following Unplanned Pregnancy Among Ugandan Women Living with HIV

BACKGROUND: Prevention of unplanned pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals, and forms the second prong of the Global Plan to eliminate perinatal transmission of HIV. Family planning services need to identify women at risk of unplanned pregnancy to be effective. This study examines the relationship between unplanned pregnancy and subsequent use of effective contraception among WLWH in Uganda. METHODS: This is a retrospective analysis of data from the Uganda Aids Rural Treatment Outcomes study, which was a longitudinal cohort of individuals initiating antiretroviral therapy. Women with incident pregnancies between 2011 and 2013 who reported on intent of the pregnancy were included in this analysis. The exposure of interest was referent pregnancy intent, using questions derived from the CDC PRAMS instrument. The primary outcome was self-report of effective contraceptive use 9–15 months post-partum (hormonal methods, intrauterine device, sterilization, or consistent condom use). RESULTS: Among 455 women who enrolled with a baseline median age of 29 years, CD4 count 403 cells/mm(3), and living with HIV for 3.8 years, there were 110 incident pregnancies with reported intent. Of these pregnancies, 50 (45%) were reported as unplanned, and 60 (55%) as planned. Postpartum, 51% of women with unplanned and 44% with planned pregnancy reported effective contraception (P = 0.52). In models adjusted for pregnancy intent, only partner pregnancy desire was significantly associated with contraceptive use, with aRR 0.37 (95% CI 0.18–0.76, P = 0.01) for effective contraceptive use when the participant reported that her primary partner “definitely or probably” wants her to have a child compared with “never discussed or don’t know”. CONCLUSION: Almost half of incident pregnancies among WLHW in this cohort were unplanned. Unplanned pregnancy was not associated with effective contraceptive use post-partum. These results demonstrate continued unmet need for family planning services in this population. Creative strategies to support the planning of families among women living with HIV are needed. Engaging men is likely to be a critical approach. DISCLOSURES: J. E. Haberer, Merck: Consultant, Consulting fee; Natera: Shareholder, Stock ownership