Reproductive health among women living with HIV attending Melbourne Sexual Health Centre for HIV care from February 2019 to February 2020
Joanne Peel
A B * , Joshua Brousse de Gersigny C , Richard Teague A , Jayne Howard A , Catriona Bradshaw A D , Marcus Chen A D and Melanie Bissessor A
A
B
C
D
Abstract
Women living with HIV are a minority population with unique care needs. Rates of unintended pregnancy are higher among women living with HIV versus HIV negative women. However, uptake of contraception among women living with HIV including long-acting-reversible contraceptives (LARCs) remains low. This quality improvement project aimed to identify gaps in reproductive healthcare for women living with HIV attending Melbourne Sexual Health Centre (MSHC).
We performed a retrospective review of women living with HIV attending MSHC for HIV care February 2019–February 2020. Women aged over 45 years were excluded. Primary outcomes included proportion using contraception, methods used and whether a sexual or reproductive health history had been taken in the past year.
A total of 100 women were included, predominantly born overseas (Asia, 38%; sub-Saharan Africa, 34%). Of these, 5% were pregnant, 16% were trying to conceive and 1% were undergoing elective oocyte preservation. Of the remaining 74 women, 48.6% were using any form of contraception, including 17.6% women using less-effective methods (withdrawal and condoms), 6.8% using the combined oral contraceptive pill, 18.9% using LARCs and 5.4% using permanent methods. Sexual activity status was documented for 61% women, 1% declined to answer and not documented for 38% women.
Rate of contraceptive use in this study was lower than previously reported among women living with HIV in Australia; however, our findings suggest contraceptive methods may be changing in light of undetectable equals untransmittable and increased fertility desires. Discussions regarding sexual activity and reproductive health were limited. Mechanisms to increase clinician–patient discourse regarding these important issues should be explored.
Keywords: anti-retroviral therapy, contraception, HIV, long-acting-reversible-contraception, pregnancy, sexual and reproductive health, women, women-centred HIV care.
References
1 UN AIDS resources. 20.2 million girls and women living with HIV. 2022. Available at https://www.unaids.org/en/resources/infographics/girls-and-women-living-with-HIV
2 UNSW. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2021. Sydney: Kirby Institute, UNSW Sydney; 2021. Available at https://data.kirby.unsw.edu.au/hiv [accessed March 2022]
3 Giles ML, MacPhail A, Bell C, Bradshaw CS, Furner V, Gunathilake M, et al. A national study of the clinical management of HIV-positive women in Australia: what are the successes and where are the gaps? Sex Health 2019; 16(3): 282-288.
| Crossref | Google Scholar | PubMed |
5 Mekie M, Addisu D, Taklual W, Melkie A. The level of unmet need for family planning and its predictors among HIV-positive women in Ethiopia: a systematic review and meta-analysis. Biomed Res Int 2021; 2021: 3139272.
| Crossref | Google Scholar |
6 Sheth AN, Angert CD, Haddad LB, Mehta CC, Cohn SE. Contraception methods used among women with HIV starting antiretroviral therapy in a large United States clinical trial, 2009-2011. Contraception 2021; 103(4): 225-231.
| Crossref | Google Scholar | PubMed |
7 Yaya I, Nambiema A, Dieng S, Djalogue L, Agboyibor MK, N’Dri MK, et al. Factors associated with unmet need for limiting childbirth among women living with HIV in Togo: an averaging approach. PLoS ONE 2020; 15(5): e0233136.
| Crossref | Google Scholar | PubMed |
8 Waters L, Lord E, Mackie N, Melvin L, Ashby J, Babu C, Black B, Boyle D, Dhairyawan R, Gilleece Y, Hardman S, Jay S, Kumar V, O’Connor C, Radcliffe K, Wright A, Tariq S, Watson S, White K. BHIVA/BASHH/FSRH guidelines for the sexual and reproductive health of people living with HIV. 2017. Available at https://www.bhiva.org/file/zryuNVwnXcxMC/SRH-guidelines-for-consultation-2017.pdf
9 Kaida A, Patterson S, Carter A, Loutfy M, Ding E, Sereda P, et al. Contraceptive choice and use of dual protection among women living with HIV in Canada: priorities for integrated care. Perspect Sex Reprod Health 2017; 49(4): 223-236.
| Crossref | Google Scholar | PubMed |
10 Rhodes CM, Cu-Uvin S, Rana AI. Pregnancy desire, partner serodiscordance, and partner HIV disclosure among reproductive age HIV-infected women in an urban clinic. Infect Dis Obstet Gynecol 2016; 2016: 8048457.
| Crossref | Google Scholar |
11 Skerritt L, Kaida A, O’Brien N, Burchell AN, Bartlett G, Savoie E, et al. Patterns of changing pregnancy intentions among women living with HIV in Canada. BMC Womens Health 2021; 21(1): 350.
| Crossref | Google Scholar |
12 Dude AM, Miller ES, Garcia PM, Yee LM. Unintended pregnancy and viral suppression in pregnant women living with HIV. Am J Obstet Gynecol MFM 2021; 3(2): 100300.
| Crossref | Google Scholar | PubMed |
13 Ruiz-Alguero M, Izquierdo R, Suarez-Garcia I, Moreno C, Alejos B, Rava M, et al. Unplanned pregnancies and social and partner support during pregnancy in Spanish women living with HIV. HIV Med 2023; 24(6): 727-737.
| Google Scholar | PubMed |
14 Sutton MY, Zhou W, Frazier EL. Unplanned pregnancies and contraceptive use among HIV-positive women in care. PLoS ONE 2018; 13(5): e0197216.
| Crossref | Google Scholar | PubMed |
15 McCoy SI, Buzdugan R, Ralph LJ, Mushavi A, Mahomva A, Hakobyan A, et al. Unmet need for family planning, contraceptive failure, and unintended pregnancy among HIV-infected and HIV-uninfected women in Zimbabwe. PLoS ONE 2014; 9(8): e105320.
| Crossref | Google Scholar |
16 Salters K, Loutfy M, de Pokomandy A, Money D, Pick N, Wang L, et al. Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada. PLoS ONE 2017; 12(7): e0180524.
| Crossref | Google Scholar | PubMed |
17 Elgalib A, Hegazi A, Samarawickrama A, Roedling S, Tariq S, Draeger E, et al. Pregnancy in HIV-infected teenagers in London. HIV Med 2011; 12(2): 118-123.
| Crossref | Google Scholar |
18 Iyun V, Brittain K, Phillips TK, le Roux S, McIntyre JA, Zerbe A, et al. Prevalence and determinants of unplanned pregnancy in HIV-positive and HIV-negative pregnant women in Cape Town, South Africa: a cross-sectional study. BMJ Open 2018; 8(4): e019979.
| Crossref | Google Scholar |
19 Anderson JC, Grace KT, Miller E. Reproductive coercion among women living with HIV: an unexplored risk factor for negative sexual and mental health outcomes. AIDS 2017; 31(16): 2261-2265.
| Crossref | Google Scholar |
20 Mayondi GK, Wirth K, Morroni C, Moyo S, Ajibola G, Diseko M, et al. Unintended pregnancy, contraceptive use, and childbearing desires among HIV-infected and HIV-uninfected women in Botswana: across-sectional study. BMC Public Health 2015; 16: 44.
| Crossref | Google Scholar | PubMed |
21 Haddad LB, Monsour M, Tepper NK, Whiteman MK, Kourtis AP, Jamieson DJ. Trends in contraceptive use according to HIV status among privately insured women in the United States. Am J Obstet Gynecol 2017; 217(6): 676.e1-676.e11.
| Crossref | Google Scholar | PubMed |
22 Kikula AI, Moshiro C, Makoko N, Park E, Pembe AB. Low use of long-acting reversible contraceptives in Tanzania: evidence from the Tanzania Demographic and Health Survey. Int J Environ Res Public Health 2022; 19(7): 4206.
| Crossref | Google Scholar |
23 Haberlen SA, Narasimhan M, Beres LK, Kennedy CE. Integration of family planning services into HIV care and treatment services: a systematic review. Stud Fam Plann 2017; 48(2): 153-177.
| Crossref | Google Scholar | PubMed |
24 Sharma M, Walmsley SL. Contraceptive options for HIV-positive women: making evidence-based, patient-centred decisions. HIV Med 2015; 16(6): 329-336.
| Crossref | Google Scholar | PubMed |
25 Carter AJ, Bourgeois S, O’Brien N, Abelsohn K, Tharao W, Greene S, et al. Women-specific HIV/AIDS services: identifying and defining the components of holistic service delivery for women living with HIV/AIDS. J Int AIDS Soc 2013; 16(1): 17433.
| Crossref | Google Scholar | PubMed |
26 Loutfy M, Tharao W, Kazemi M, Logie CH, Underhill A, O’Brien N, et al. Development of the Canadian women-centred HIV care model using the knowledge-to-action framework. J Int Assoc Provid AIDS Care 2021; 20: 232595822199561.
| Crossref | Google Scholar |
27 O’Brien N, Greene S, Carter A, Lewis J, Nicholson V, Kwaramba G, et al. Envisioning women-centered HIV care: perspectives from women living with HIV in Canada. Womens Health Issues 2017; 27(6): 721-730.
| Crossref | Google Scholar | PubMed |
28 Australasian Society for Sexual Health Medicine. Women with HIV. 2019. Available at https://arv.ashm.org.au/women-with-hiv/
29 European AIDS Clinical Society (EACS). Guidelines version 11.1. October 2022. Available at https://www.eacsociety.org/media/guidelines-11.1_final_09-10.pdf
30 Family Planning Alliance Australia. How effective is my contraceptive method? Hamilton Valley: FPAA; 2020. Available at https://www1.racgp.org.au/getmedia/b48531ad-4874-40d6-8e53-14969c163162/AJGP-04-2022-Clinical-Pearson-LARC-New-Evidence-Fig-1.pdf.aspx [accessed 25 October 2023]
31 Safari W, Urassa M, Mtenga B, Changalucha J, Beard J, Church K, et al. Contraceptive use and discontinuation among women in rural North-West Tanzania. Contracept Reprod Med 2019; 4: 18.
| Crossref | Google Scholar | PubMed |
32 Tweya H, Feldacker C, Gugsa S, Phiri S. Contraceptive use and pregnancy rates among women receiving antiretroviral therapy in Malawi: a retrospective cohort study. Reprod Health 2018; 15(1): 25.
| Crossref | Google Scholar | PubMed |
33 Atukunda EC, Mugyenyi GR, Atuhumuza EB, Kaida A, Boatin A, Agaba AG, et al. Factors associated with pregnancy intentions amongst postpartum women living with HIV in rural Southwestern Uganda. AIDS Behav 2019; 23(6): 1552-1560.
| Crossref | Google Scholar | PubMed |
34 Chen Y, Begnel E, Muthigani W, Achwoka D, McGrath CJ, Singa B, et al. Higher contraceptive uptake in HIV treatment centers offering integrated family planning services: a national survey in Kenya. Contraception 2020; 102(1): 39-45.
| Crossref | Google Scholar | PubMed |
35 Centre for Effective Practice. Women centred HIV care. 2020. Available at https://cep.health/clinical-products/hiv/ [accessed 30 October 2023]
36 Teodoro N, Fu A, Ohly NT, Shalev N, Matseoane-Peterssen D, Westhoff CL. Long-acting reversible contraception knowledge, attitudes and use among HIV-infected and -uninfected women and their providers. Contraception 2019; 100(4): 269-274.
| Crossref | Google Scholar | PubMed |
37 Clinical Info HIV.gov. HIV clinical guidelines: adult and adolescent ARV, special populations, women with HIV. September 2022. Available at https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/women-hiv?view=full
38 Zash R, Holmes L, Diseko M, Jacobson DL, Brummel S, Mayondi G, et al. Neural-tube defects and antiretroviral treatment regimens in Botswana. N Engl J Med 2019; 381(9): 827-840.
| Crossref | Google Scholar | PubMed |
39 World Health Organization. WHO recommends dolutegravir as preferred HIV treatment option in all populations. 2019. Available at https://www.who.int/news/item/22-07-2019-who-recommends-dolutegravir-as-preferred-hiv-treatment-option-in-all-populations
40 Dharan NJ, Radovich T, Che S, Petoumenos K, Juneja P, Law M, et al. HIV treatment regimens and adherence to national guidelines in Australia: an analysis of dispensing data from the Australian pharmaceutical benefits scheme. BMC Public Health 2019; 19(1): 13.
| Crossref | Google Scholar | PubMed |
