Factors associated with contraceptive use among women living with HIV in Canada: a controlled, cross-sectional study

Reproductive Health

Jason Brophy¹  Angela Kaida²  Emilie A. B. Russell³  Chadni C. Khondoker⁴  Neora Pick⁵  Melanie C. M. Murray⁵  Anna Marquez⁶  Amber R. Campbell⁷  Evelyn J. Maan⁸  Chelsea Elwood⁹  Arianne Y. Albert^1,10  Jerilynn C. Prior^1,11  Hélène C. F. Côté^1,12 

[1] Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada;Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada;Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada;Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada;Oak Tree Clinic, BC Women’s Hospital, Vancouver, BC, Canada;Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada;Oak Tree Clinic, BC Women’s Hospital, Vancouver, BC, Canada;Women’s Health Research Institute, BC Women’s Hospital, E600B-4500 Oak Street, V6H 3N1, Vancouver, BC, Canada;Oak Tree Clinic, BC Women’s Hospital, Vancouver, BC, Canada;Oak Tree Clinic, BC Women’s Hospital, Vancouver, BC, Canada;Department of Experimental Medicine, UBC, Vancouver, BC, Canada;Women’s Health Research Institute, BC Women’s Hospital, E600B-4500 Oak Street, V6H 3N1, Vancouver, BC, Canada;Oak Tree Clinic, BC Women’s Hospital, Vancouver, BC, Canada;Women’s Health Research Institute, BC Women’s Hospital, E600B-4500 Oak Street, V6H 3N1, Vancouver, BC, Canada;Oak Tree Clinic, BC Women’s Hospital, Vancouver, BC, Canada;Women’s Health Research Institute, BC Women’s Hospital, E600B-4500 Oak Street, V6H 3N1, Vancouver, BC, Canada;Department of Obstetrics and Gynecology, UBC, Vancouver, BC, Canada;Women’s Health Research Institute, BC Women’s Hospital, E600B-4500 Oak Street, V6H 3N1, Vancouver, BC, Canada;Women’s Health Research Institute, BC Women’s Hospital, E600B-4500 Oak Street, V6H 3N1, Vancouver, BC, Canada;Centre for Menstrual Cycle and Ovulation Research, Endocrinology, Department of Medicine, UBC, Vancouver, BC, Canada;Women’s Health Research Institute, BC Women’s Hospital, E600B-4500 Oak Street, V6H 3N1, Vancouver, BC, Canada;Department of Pathology & Laboratory Medicine, UBC, Vancouver, BC, Canada;

关键词: HIV;    Contraception;    Women;    Canada;   

DOI  :  10.1186/s12978-021-01312-7

来源: Springer

【 摘 要 】

BackgroundMultiple contraindications to combined hormonal contraceptives (CHC) use exist. The impact of these factors on contraceptive choice, particularly among women living with HIV (WLWH), is not well understood. We measured and compared the prevalence of contraceptive use and contraindications among WLWH and women not living with HIV (controls).MethodsWe examined cross-sectional survey and medical chart data from 83 WLWH and 62 controls, aged 16–49 and sexually active, from 2013–2017. We compared the age-adjusted prevalence and types of contraceptives used in the last month and the proportion of women with CHC contraindications, including drug interactions, medical comorbidities, and smoking at ≥ 35 years old. All WLWH received care at an interdisciplinary, women-centred HIV clinic.ResultsCompared to controls, WLWH were older (median [IQR)] 39 [34–43] vs 31 [23–41] years; p = 0.003), had less post-secondary education (37% vs 73%; p < 0.001), and more often had household income < $15,000/year (49% vs 30%; p = 0.006). WLWH trended to higher contraceptive prevalence than controls (80% vs 63%; p = 0.06 adjusted for age). Overall hormonal contraceptive use was similar. However, despite controlling for age, WLWH used CHC less (4% vs 18%; p = 0.006) than controls, and had more frequently undergone tubal ligation (12% vs 2%; p = 0.03). WLWH also experienced more CHC contraindications (54% vs 13%; p = 0.0001), including smoking at ≥ 35 years old (30% vs 6%; p = 0.0003) or a CHC-related drug interaction (all antiretroviral related) (25% vs 0%; p = 0.0001).ConclusionsWLWH attending our interdisciplinary clinic used hormonal contraception at similar rates as controls, though with different types. Differences may reflect different distributions of CHC contraindications. CHC contraindications present barriers to accessing the full range of contraceptive choices for WLWH. Guidelines and education for care providers and WLWH regarding contraceptive choices and drug interactions are needed, especially when care is provided without the benefit of an interdisciplinary women-centered healthcare team.

【 授权许可】

CC BY