Predictors of contraceptive uptake by adolescent girls and young women attending the HIV clinic at Mayuge health center III

Abstract

Introduction: In spite of the availability of a variety of contraceptives, their use among HIV infected women of reproductive age (15-49years) has remained low. The situation does not get any better among HIV infected Adolescent Girls and Young Women (AGYW) aged 15-24years leading to unintended pregnancies, unsafe abortions increased MTCT rates and increased maternal mortality. The factors associated with contraceptive use in HIV positive AGYW are unknown. The objective of this study was to determine the factors associated with contraceptive use by HIV infected AGYW attending the HIV clinic at Mayuge Health Centre (HC) III, Eastern Uganda. Methods: This was a cross-sectional mixed methods study conducted at Mayuge HCIII in Eastern Uganda. Quantitative data were collected using researcher administered questionnaires. Qualitative data were collected by conducting two key informant interviews and three focused group discussions. Quantitative data were analyzed using STATA v15. Chi square was used for bivariate analysis and logistic regression was used for multivariate analysis. Qualitative data was analyzed using thematic analysis and presented using representative quotations. Results: Overall, 336 HIV positive AGYW participated in the study. Majority (71.1%) were aged 20-24years. Contraceptive use was at 86% and the commonest contraceptive method was DepoProvera (38%) followed by condoms (31%). In the multivariate analysis, being Muslim or Anglican (AOR=5.6,1.8, 17.2), being sexually active (AOR=4.0, 1.3,12.4), discussing contraception with partner (AOR=10.1,3.6,28.1) and receiving health education on contraceptive use (AOR=4.8, 2.0,11.3) were significantly associated with contraceptive use. Ability of the health facility to provide contraception services throughout the week and at all units of the health facility, ability of all clinicians to provide contraception services, provision of continuous health education, fast tracking of HIV infected AGYW with contraceptive needs and constant supply of contraceptive commodities were some of the enablers of contraception use among HIV infected AGYW. Conclusion: Contraceptive use among HIV infected AGYW was high at Mayuge HCIII. Being Muslim or Anglican, being sexually active, discussing with partner and receiving health education were significantly associated with contraceptive use. The Ministry of Health and health facilities should promote partner services, intensify health education, positively engage with religious xi leaders and focus on provision of adolescent girl and young women friendly services in order to scale up contraceptive use in HIV infected AGYW across all health facilities.