Skip to content

Advertisement

  • Research note
  • Open Access

Prevalence of dual contraceptive use and associated factors among HIV positive women at University of Gondar Hospital, Northwest Ethiopia

  • 1Email author,
  • 2 and
  • 3
BMC Research Notes201912:36

https://doi.org/10.1186/s13104-019-4053-2

  • Received: 21 November 2018
  • Accepted: 8 January 2019
  • Published:

Abstract

Objective

Dual contraceptive is the use of male condom besides any modern contraceptive. It reduces parent to child transmission of HIV and other sexually transmitted infections between partners. The aim of this study was to investigate the prevalence and associated factors of dual contraceptive use among HIV positive women at University of Gondar Hospital, North West Ethiopia.

Result

The prevalence of dual contraceptive use was found to be 13.2% (95% CI 10.5, 16.0). Partner involvement in post-test counseling [AOR = 3.11 (95% CI = 1.74, 5.57)], open partner discussion on using dual contraceptive [AOR = 7.84, 95% CI (4.26, 14.42)], provision of counseling about dual contraception [AOR = 6.56, 95% CI (3.54, 12.18)], age 18–24 years [AOR = 4.79, 95% CI (1.72, 13.32)], age 25–34 years [AOR = 1.97, 95% CI (1.01, 3.85)] and being a housewife [AOR = 4.38, 95% CI (1.89, 10.16)] were significant factors associated with dual contraceptive use. The prevalence of dual contraceptive use was low. This shows, there is a need to in promote partner involvement in HIV testing and counseling by offering counseling session in a couple-basis. It is also necessary for programmers to routinely focus on provision of dual contraception for HIV-infected women and Integration of family planning into HIV care follow-up clinic need to be strengthened.

Keywords

  • Dual contraceptive
  • HIV/AIDS
  • Women
  • Ethiopia

Introduction

In 2017, about 37 million people were living with HIV/AIDS in the world. More than two-third of them were living in sub-Saharan Africa and close to three-fourth of all AIDS related deaths were occurred in this region [1, 2]. Nearly 92% of pregnant women living with HIV were also from sub-Saharan Africa [3]. According to the 2011 Ethiopian demographic Health Survey (EDHS), the prevalence of HIV infection in women was 1.9% [4]. Dual contraceptive can reduce the transmission of resistant strains of HIV between partners [5]. Prevention of unintended pregnancy is the second approach in prevention of mother to child transmission of HIV (PMTCT) [6]. In doing so, contraceptive use is necessary and suggested by WHO and ministry of Health [7]. However, although HIV-positive women can use most of the available contraceptive methods, including hormonal, intrauterine devices and sterilization method [8], these methods are falling short in preventing transmission of HIV and STIs between partners. The effectiveness of estrogen based hormonal contraceptive is also affected by an interaction with some Antiretroviral (ARV) drugs such as Non Nucleotide reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) [9]. As a result, an HIV-infected woman requires barrier methods such as, condom on top of the methods they used for the prevention of unintended pregnancies. Dual protection by using condom and any modern contraceptive method has paramount benefit for HIV positive women. Therefore, the study can provide evidence for the planners, officers and care providers in order to design appropriate interventions.

Main text

Methods

Study deign and participants

An institution based cross-sectional study was conducted at the University of Gondar Hospital, Northwest Ethiopia. The Hospital is located in Gondar town, 737 km from Addis Ababa. The hospital is serving for more than five million people in the catchment area. It has more than 600 inpatient admissions. There were a total of 6232 HIV patients at ART follow up clinic during data collection. The number of HIV positive women attending HIV care was 3219. HIV positive married women attending chronic HIV care follow up at the ART clinic during data collection were participated in the study. Pregnant HIV positive women were excluded from the study.

Sampling and sample size calculation

The sample size was determined using single population proportion formula by considering the following assumptions. Prevalence (P) was taken as 50%, since there was no study in Ethiopia. The 95% confidence interval, 4% level of precision and 5% non-response rate was considered to get a sample size of 630. Simple random sampling technique was used to select the study participants from July to August 2014.

Data collection techniques and procedures

Face to face interviewer administered questionnaire containing socio demographic and clinical characteristics and information on contraceptive use was used for data collection. Participants chart was also reviewed to record their date of HIV diagnosis, WHO clinical stage and current CD4 count. Once the participant interviewed, chart was labeled using a code to avoid repetition. The questionnaire was prepared in English and translated to Amharic and then back to English to maintain its consistency. Four trained nurses having a bachelor degree and one supervisor were involved in the data collection.

Data analysis

The filled questionnaires were checked for completeness, cleaned manually, pre-coded and entered to EPI Info version 3.5.3 statistical software before exported to SPSS version 20 for analysis. Descriptive and summary statistics were used to explain the study population with respect to the associated factors. Binary logistic regression was used primarily to check factors associated with the outcome variable and variables having p value of less than 0.2 were fitted into the multivariable logistic regression model. Backward stepwise multiple logistic regression model was fitted to identify the determinants of dual contraceptive utilization practice. Crude odds ratio with 95% CI was computed. Adjusted odds ratios with 95% CI were calculated. Statistical significance was inferred at a P value of < 0.05.

Results

A total of 619 women were participated in the study with a response rate of 98.25%. The majority (92.9%) were urban residents. The mean age of the respondents was 32.26 [SD 6.3] years. One Hundred seventy (27.6%) of women were house wives. Five hundred ninety-three (95.8%) of women received post test counseling service. Only 38.1% percent of HIV positive women had discussion with their health care provider about dual contraceptive. Majority (65%) of the study participants had a CD4 count between 201 and 350 cells/mm3 (Table 1).
Table 1

Scio-demographic and clinical characteristics of HIV positive women at University of Gondar referral Hospital, North west Ethiopia, 2014 (n = 619)

Variables

Category

Frequency

Dual contraceptive use

Percent

Residence

Urban

575

76

13.2

Rural

44

6

13.6

Age in years

18–24

56

12

21.43

25–34

341

52

15.25

≥ 35

222

18

8.1

Religion

Orthodox

546

77

14.1

Muslim

58

4

6.9

Othersa

15

1

6.6

Ethnicity

Amhara

560

76

13.6

Kemant

25

2

8

Tigre

26

4

15.4

Othersb

8

0

0.0

Educational status

Can’t read and write

139

25

18

Read and write only

22

2

9.1

Primary school

190

165

86.84

Secondary school

195

171

87.7

TVET/College/University

73

6

8.22

Occupation

House wife

171

40

23.4

Merchant

153

20

13.1

Daily laborer

118

12

10.2

Government employee

177

10

5.65

Partner’s occupation

Merchant

151

18

11.9

Daily laborer

150

26

17.3

Farmer

96

10

10.42

Government employee

196

27

13.8

Othersc

25

1

4.0

Duration of HIV follow up (months)

< 6

33

4

12.1

6–24

109

11

10.1

> 24

477

67

14.05

Received post test counseling

Yes

477

70

14.7

No

142

12

8.45

Counseled by HCP about dual contraceptive use

Yes

236

65

27.54

No

383

17

4.44

HIV status disclosed to partner

Yes

452

72

15.9

No

167

10

6.0

Partner involved in posttest counseling

Yes

245

56

22.86

No

374

26

6.95

Partners HIV status

Reactive

356

66

18.54

Non reactive

19

1

5.3

Unknown

244

15

6.15

WHO Clinical stage

I

153

27

17.65

II

112

12

10.71

III

282

36

12.77

IV

72

7

9.72

Recent CD4 count (cells/mm3)

< 200

84

5

5.95

201–350

207

31

15

> 350

328

46

14

aCatholic, Wakefata, b Oromo, Gurage, c Jobless, private employee

Five hundred twenty-five (84.8%) women had ever given birth. One hundred thirteen (18.3%) and 36 (5.8%) had history of abortion and still birth respectively. Six hundred four (97.6%) of the respondents were informed about modern contraceptive methods. Depo-Provera, Oral contraceptive pills and male condom were the most recognized family planning methods by the women (92.9%, 91.1% and 84.3%) respectively. Two hundred forty-one (38.9%) heard about dual contraceptive methods. About (38.1% and 33.9%) of the study participants had discussion with health care worker and with their partner about the use of dual contraceptives respectively. Male condom was the most commonly used contraceptive by 33.12% of their partners (Table 2).
Table 2

Information on modern contraceptive methods among HIV positive women at University of Gondar referral Hospital, North west Ethiopia, 2014 (n = 619)

Variables

Frequency

Percentage

Informed regarding modern contraceptive methods

OCP

564

91.1

IUCD

443

71.6

Depo provera

575

92.9

Norplant

446

72.1

Female condom

122

19.7

Female sterilization

94

15.2

Male condom

522

84.3

Male sterilization

84

13.6

Emergency pills

128

20.7

Ever heard about modern contraceptive

606

97.9

Ever heard about dual contraceptive

241

38.9

Counseled about dual contraceptive by HCP

236

38.1

Discussed about dual contraceptive with partner/husband

210

33.9

Two hundred sixty-two (42.3%) respondents were current users of modern contraceptive methods. Male condoms were the most commonly used method. In this study the prevalence of dual contraceptive was 13.2% [95% CI (10.5, 16.0)]. Among those who were using the dual contraceptives, majority of them used condom with injectable 57 (69.5%). About 66% of them were using condom consistently. Fear of side effects, partner disapproval to use condom and lack of women’s self-interest to use condom were major reasons not to use dual contraceptive. However, they were not statistically significant Multivariable logistic regression indicated that, partner involvement in post test counseling, open discussion between partners on dual contraceptive, counseling by health care providers (HCP) about its benefit, Age, and being a housewife were significant factors associated with dual contraceptive use. Partner involvement in post test counseling had three times more odds of dual contraceptive utilization than those who did not have any partner involvement [AOR = 3.11 (95% CI = 1.74, 5.57)]. Those who had Open partner discussion about dual contraceptive use were almost 8 times more odds of dual contraceptive use than who never discussed [AOR = 7.84, 95% CI (4.26, 14.42)]. Women counseled by health care provider to use dual contraceptive were 7 times more odds to use [AOR = 6.56, 95% CI (3.54, 12.18)]. Age 18–24 years were close to five times more odds of using dual contraceptive [AOR = 4.79, 95% CI (1.72, 13.32)] and those age 25–34 years had two times more odds of dual contraceptive use than age 35 and above [AOR = 1.97, 95% CI (1.01, 3.85)]. Housewives were 4.4 times more odds of using dual contraceptive than government employees [AOR = 4.38, 95% CI (1.89, 10.16)] (Table 3).
Table 3

Logistic regression analysis of variables on dual contraceptive practice among HIV positive women at University of Gondar referral Hospital, North west Ethiopia, 2014 (n = 619)

Variables

Categories

Dual contraceptive use (n = 619)

COR (95% CI)

AOR (95% CI)

P value

Yes

No

Age in years

18–24

12

44

3.1 (1.39, 6.88)

4.79 (1.72, 13.32)

0.003

25–34

52

29

2.04 (1.16, 3.59)

1.97 (1.01, 3.85)

0.048

≥ 35

18

204

1

1

 

Occupation

Housewife

40

131

5.1 (2.46, 10.56)

4.38 (1.89, 10.16)

0.001

Merchant

20

133

2.51 (1.14, 5.55)

1.99 (0.82, 4.88)

 

Daily laborer

12

106

1.89 (0.79, 4.53

1.43 (0.54, 3.87)

 

Government employee

10

167

1

1

 

Counseled by HCP about dual contraceptive

Yes

65

171

8.18 (4.66, 14.38)

6.56 (3.54, 12.18)

< 0.001

No

17

366

1

1

 

HIV status disclosed to partner

Yes

72

380

2.98 (1.50, 5.91)

1.12 (0.48, 2.58)

 

No

10

157

1

1

 

Partner involved in post test counseling

Yes

56

189

3.97 (2.41, 6.52)

3.11 (1.74, 5.57)

< 0.001

No

26

348

1

1

 

Ever heard about dual contraceptive

Yes

82

524

7.84 (4.46, 13.78)

1.19 (0.10, 14.33)

 

No

0

13

1

1

 

Discussed with partner about dual contraceptive

Yes

60

150

7.04 (4.17–11.88)

7.84 (4.26, 14.42)

< 0.001

No

22

387

1

1

 

Ever gave birth

Yes

74

451

1.76 (0.82, 3.79)

1.51 (0.58, 3.96)

 

No

8

86

1

1

 

Most recent CD4 count (cells/mm3)

< 200

5

79

1

  

200–350

31

176

2.76 (1.04, 7.42)

1.57 (0.51, 4.80)

 

≥ 350

46

282

2.58 (0.99, 6.71)

1.19 (0.40, 3.52

 

Discussion

The use of dual contraceptive is very important for effectiveness of PMTCT program. However, this study revealed that the prevalence of dual contraceptive utilization was low. Similar result was also reported in Kenya (13.5%) [10], Uganda (17%) [11], Uganda (17%) [12], Zambia (17%) [13]. This may be due you to the variation in time of enrolment in HIV care and the time that the study was conducted (16). As compared to the study in Ireland (22%) [14], Nigeria (25.1%) [15], Zambia (25%) [16], India (23%) [16], South Africa (22%) [17], Southwest Ethiopia (19.8%) [18], Thailand (29.6%) [19], Tanzania (33%) [20], Kenya [21] and Fitche hospital, Ethiopia (32%) [22] our finding is lower. This finding was also much lower than the finding of the study done in Nigeria and United States of America where (50% and 59.7%) of HIV positive women were using dual contraceptive methods respectively [23, 24]. This may be due to the fact that women in the study area may lack negotiation skill as a result of socio-cultural influence that hinders open partner discussion about contraceptive. It may also be due to lack of knowledge about dual contraceptive when compared with women in Ireland, India, South Africa and Nigeria.

Concerning the factors affecting dual contraceptive methods utilization, partner involvement in HIV testing and counseling was found to be significant factor to use dual contraceptive methods by HIV positive women. Those who were tested and counseled together with their partner were 3.1 times more odds to use dual contraceptive [AOR = 3.11 (95% CI = 1.74, 5.57)]. This finding is supported by a survey conducted in Addis Ababa [25] and India [26]. This suggests that testing and counseling partners together encourages them to have open discussion while choosing the appropriate contraceptive methods they use. An open partner discussion on choosing contraceptive was significantly associated with dual contraceptive use. Those who ever had open discussion were almost 8 times more odds of dual contraceptive use than who never discussed [AOR = 7.84, 95% CI (4.26, 14.42)]. This was again supported by a study conducted in Addis Ababa [25], Tanzania [20], Bahir Dar [27], south west Ethiopia [28] and Tigray region [29]. This suggests that, creating an open discussion between partners about contraceptive choice and its benefit is advantageous. Counseling by health care provider was significant factor to use dual contraceptive among HIV positive women. Those counseled by health care provider to use dual contraceptive were six and half times more odds of using dual contraceptive [AOR = 6.56, 95% CI (3.54, 12.18)]. This agrees with a study conducted in Lusaka, Zambia [13] and India [26], Tanzania [20], Kenya [21] and Bahir Dar [27]. This strongly indicates that counseling of HIV positive women can improve the utilization of dual contraceptive use in preventing unintended pregnancy and sexually transmitted infections. It also suggests that health care providers need to focus on counseling on dual contraceptives and its benefit to HIV positive women attending care at ART clinic. This study also showed that age of the respondents was one of the important factors. Those women age 18–24 years [AOR = 4.79, 95% CI (1.72, 13.32)], age 25–34 years [AOR = 1.97, 95% CI (1.01, 3.85)] were having more odds of dual contraceptive use than those above 35 years old. This was supported by the finding of the study in Northern Uganda [30]. This finding was also supported by the finding in a systematic review done by Marge Berer [31]. It may be due to the fact that those young women may not be interested to have child at this age and may have better understanding on the benefit of using dual contraceptive. However, the finding of this study was not consistent with the finding of the study conducted in southwest Ethiopia [28]. This variation may be due to the fact that the difference in the study design and sample size; mixed method was used in the study conducted in southwest Ethiopia with small sample size. Being a house wife was significantly associated with dual contraceptive use. Those housewife in their occupation were about 4.5 times more odds of using dual contraceptive compared to government employees [AOR = 4.38, 95% CI (1.89, 10.16)]. The reason for this may be due to economical concern. Housewives do not have their own monthly income and they are dependent on their partner. Due to this, they may believe that they can’t afford expenses if they become pregnant and give birth. This assumption is supported by the finding of a study conducted northern Uganda [30] and Southwestern Uganda [32].

Conclusion

Only small proportion of HIV positive women were using dual contraceptive. Partner involvement in post test counseling, open partner discussion about dual contraceptive, providing counseling by HCP about dual contraceptive, age and occupation of the women were positively associated with dual contraceptive use. Simultaneous HIV testing and counseling of women with their partner, open partner discussion s on family planning choice and provision of counseling by health care providers shall be encouraged.

Limitations

Major limitations in this study are absence of variables that might have been associated with dual contraceptive use, such as: social support and variables related to mental health. Absence of partner involvement in the study was also another limitation. A cross-sectional study design lacks temporal association. In addition, since the questionnaire covers private issues there might be information bias.

Abbreviations

AIDS: 

Acquired Immune deficiency Syndrome

ART: 

antiretroviral therapy

ARV: 

antiretroviral

EDHS: 

Ethiopian Demographic Health Survey

HCP: 

Health Care Provider

HCW: 

health care worker

PMTCT: 

Prevention of Mother to Child Transmission

STIs: 

Sexually Transmitted Infections

TVET: 

Technical and Vocational Education and Training

WHO: 

World Health Organization

Declarations

Authors’ contributions

MM wrote the proposal, participated in data collection, analyzed the data, drafted the paper and prepared the manuscript. GA and GS approved the proposal with some revisions, participated in data analysis and revised subsequent drafts of the paper. All authors read and approved the final manuscript.

Acknowledgements

We acknowledge all staffs of University of Gondar, College of Medicine and Health Sciences. In addition; University of Gondar administrative office, data collectors, and all the study participants were highly acknowledged.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Consent for publication

Not applicable.

Ethics approval and consent to participate

Ethical clearance was obtained from University of Gondar Institutional review board following the Ethiopian National research Ethics review guideline of the federal ministry of science and technology. Permission letter was obtained from University of Gondar referral hospital chief executive officer. Participants were fully informed about the purpose of the study before the beginning of the interview and verbal informed consent was obtained.

Funding

This research received no specific Grant from any funding agency in the public, commercial or not-for-profit sectors. But the financial backing of this research was provided by University of Gondar as a grant to its staff. The funder has no role in the publication process.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Internal Medicine, School of Medicine, University of Gondar, Gondar, Ethiopia
(2)
Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
(3)
Department of Gynecology and Obstetrics, School of Medicine, University of Gondar, Gondar, Ethiopia

References

  1. UNAIDS. Global HIV statistics. In: Fact sheet 2018. 2017.Google Scholar
  2. Amuche NJ, Emmanuel EI, Innocen NE. HIV/AIDS in sub-Saharan Africa: current status, challenges and prospects. Asian Pac J Trop Dis. 2017;7(4):239–56.View ArticleGoogle Scholar
  3. UNAIDS. Regional HIV/AIDS fact sheet: sub-Saharan Africa. UNAIDS. p. 1–3.Google Scholar
  4. CSA. Ethiopian Demographic and Health Survey (EDHS) 2011. Addis Ababa, Ethiopia; 2012.Google Scholar
  5. Raifman J, Chetty T, Tanser F, Mutevedzi T, Matthews PHK, Pillay D. Preventing unintended pregnancy and HIV transmission: effects of the HIV treatment cascade on contraceptive use and choice in rural KwaZulu-Natal. J Acquir Immune Defic Syndr. 2014;67(4):218–27.View ArticleGoogle Scholar
  6. FHAPCO. Guidelines for prevention of mother-to-child transmission of HIV. Addis Ababa, Ethiopia; 2007.Google Scholar
  7. Health FDRoEMo. Competency based National Comprehensive PMTCT/MNCH training participants manual. Addis Ababa; 2017.Google Scholar
  8. King-Spooner S. HIV prevention and the positive population. Int J STD AIDS. 1999;10(3):141–50.View ArticleGoogle Scholar
  9. Agboghoroma CO. Contraception in the context of HIV/AIDS. Afr J Reprod Health. 2011;15(3):15–23.PubMedGoogle Scholar
  10. Mutiso SM, Kinuthia J, Qureshi Z. Contraceptive use among HIV infected women attending Comprehensive Care Centre. East Afr Med J. 2008;85(4):171–7.View ArticleGoogle Scholar
  11. Nattabi B, Li J, Thompson SC, Orach CG, Earnest J. Family planning among people living with HIV in post-conflict Northern Uganda: a mixed methods study. Confl Health. 2011;5:18.View ArticleGoogle Scholar
  12. Magala I, Onega L, Rose N, Patrick S. Factors influencing contraceptive uptake among sexually active HIV positive clients in TASO Masaka, Uganda. J Public Health Policy Plan. 2017;1(2):46–9.Google Scholar
  13. Chibwesha CJ, Li MS, Matoba CK, Mbewe RK, Chi BH, Stringer JSA, Stringer EM. Modern contraceptive and dual method use among HIV-infected women in Lusaka, Zambia. Infect Dis Obstetr Gynecol. 2011;2011:8.Google Scholar
  14. Murphy D, Lynch M, Desmond N, Mulcahy FM. Contraceptive practices in HIV seropositive females in Ireland. Int J STD AIDS. 1993;4(2):107–9.View ArticleGoogle Scholar
  15. Ezugwu EC, Nkwo PO, Agu PU, Ugwu EO, Asogwa AO. Contraceptive use among HIV-positive women in Enugu, southeast Nigeria. Int J Gynaecol Obstetr. 2014;126(1):14–7.View ArticleGoogle Scholar
  16. Hancock NL, Chibwesha CJ, Bosomprah S, Newman J, Mubiana-Mbewe M, Sitali ES, Bolton-Moore C, Mbwili-Muleya C, Chi BH. Contraceptive use among HIV-infected women and men receiving antiretroviral therapy in Lusaka, Zambia: a cross-sectional survey. BMC Public Health. 2016;16:392.View ArticleGoogle Scholar
  17. Morroni C, Myer L, Mlobeli R, Gutin S, Grimsrud A. Dual protection among South African women and men: perspectives from HIV care, family planning and sexually transmitted infection services. Cape Town: University of Cape Town; 2007.Google Scholar
  18. Mariam W, Erashi M, Tesso F, Tema Beyene T. Dual-contraceptive method utilization and associated factors among HIV positive women attending art clinic in Gebretsadik Shawo Hospital, SNNPR, South West Ethiopia. J Women’s Health Care. 2015;4:2167.Google Scholar
  19. Munsakul W, Lolekha R, Kowadisaiburana B, Roongpisuthipong A, Jirajariyavej S, Asavapiriyanont S, Hancharoenkit U, Baipluthong B, Pattanasin S, Martin M. Dual contraceptive method use and pregnancy intention among people living with HIV receiving HIV care at six hospitals in Thailand. Reprod Health. 2016;13:8.View ArticleGoogle Scholar
  20. Damian DJ, George JM, Martin E, Temba B, Msuya SE. Prevalence and factors influencing modern contraceptive use among HIV-positive women in Kilimanjaro region, northern Tanzania. Contracept Reprod Med. 2018;3:7.View ArticleGoogle Scholar
  21. Mulongo AM, Lihana RW, Githuku J, Gura Z, Karanja S. Factors associated with uptake of dual contraception among HIV-infected women in Bungoma County, Kenya: a cross-sectional study. Pan Afr Med J. 2017;10:11604.Google Scholar
  22. Demissie DB, Girma T, Abdissa G. Dual contraceptive utilization and associated factors among people living with HIV attending ART clinic in Fitche Hospital, Ethiopia. J Health Med Nurs. 2015;2015:20.Google Scholar
  23. Ogbe A, Mutihir J. Pattern of contraception among HIV positive women in Jos University Teaching Hospital. Nigerian J Med. 2012;21(1):11–5.Google Scholar
  24. Sutton MY, Zhou W, Frazier EL. Unplanned pregnancies and contraceptive use among HIV-positive women in care. PLoS ONE. 2018;13(5):e0197216.View ArticleGoogle Scholar
  25. Asfaw HM, Gashe FE. Contraceptive use and method preference among HIV positive women in Addis Ababa, Ethiopia: a cross sectional survey. BMC Public Health. 2014;14:556.View ArticleGoogle Scholar
  26. Chakrapani V, Kershaw T, Shunmugam M, Newman PA, Cornman DH, Dubrow R. Prevalence of and barriers to dual-contraceptive methods use among married men and women living with HIV in India. Infect Dis Obstet Gynecol. 2011;3:7.Google Scholar
  27. Kebede HG, Nahusenay H, Birhane Y, Tesfaye DJ. Assessment of contraceptive use and associated factors among HIV positive women in Bahir-Dar Town, Northwest Ethiopia. Open Access Library Journal. 2015;2(10):19.Google Scholar
  28. Erashi MWM, Tesso FY, Beyene TT. Dual-contraceptive method utilization and associated factors among HIV positive women attending art clinic in Gebretsadik Shawo Hospital, SNNPR, South West Ethiopia. Women’s Health Care. 2015;4:267.Google Scholar
  29. Melaku YA, Zeleke EG. Contraceptive utilization and associated factors among HIV positive women on chronic follow up care in Tigray Region, Northern Ethiopia: a cross sectional study. PLoS ONE. 2014;9(4):e94682.View ArticleGoogle Scholar
  30. Bongomin F, Chelangat M, Eriatu A, Chan Onen B, Cheputyo P, Godmercy SA, Ekuk E, Idony F, Henry Obol J. Prevalence and factors associated with contraceptive use among HIV-infected women of reproductive age attending infectious disease clinic at Gulu Regional Referral Hospital, Northern Uganda. BioMed Res Int. 2018;2018:8.View ArticleGoogle Scholar
  31. Berer M. Dual protection: more needed than practised or understood. Reprod Health Matters. 2006;14(28):162–70.View ArticleGoogle Scholar
  32. Muyindike W, Fatch R, Steinfield R, Matthews LT, Musinguzi N, Emenyonu NI, Martin JN, Hahn JA. Contraceptive use and associated factors among women enrolling into HIV care in Southwestern Uganda. Infect Dis Obstetr Gynecol. 2012;2012:9.Google Scholar

Copyright

© The Author(s) 2019

Advertisement