Determinants of Unmet Need for Contraception use among Hiv-Positive Women in Kwale County, Kenya
Mumbo, Edward M
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Prevention of unplanned pregnancies is one of the four approaches in the prevention of MTCT of HIV. Even with the constant availability of modern contraceptives in the health facilities, 352 known HIV-positive women attending Comprehensive Care Clinics (CCC) services in Kwale County conceived in 2018, risking an increased rate of vertical transmission of HIV. The main objective of the study was to understand the use of contraception by HIV-Positive clients of childbearing age and find out the possible factors for their unmet need for contraception in Kwale County. The study aimed to determine the contraceptive prevalence among HIV-positive, to establish the socio-demographic, socioeconomic, health facility, and sociocultural factors that are associated with the unmet need for contraception use among HIV-positive women of childbearing age in Kwale County. The study targeted all HIV-positive women of childbearing age attending comprehensive care clinic services in Kwale County and officers in charge of CCCs. The study had 347 clients that were sampled using a systematic random sampling technique, while thirty-three (33) in charge of CCCs were purposefully selected as KIIs. An analytical cross-sectional research design was used. Trained research assistants were used to collect data in the selected CCCs using semi-structured questionnaires. Further information was obtained by reviewing the clients’ notes in the health facilities. To take care of any inconsistent entries, pre-analysis data cleaning was done and wrongly captured data, missing information, outliers, and repetition were checked. Microsoft Excel was used for data cleaning. STATA 16 was used for the data analysis. The descriptive analysis involved frequency distribution tables, and calculations for mean, middle, and prevalence estimates. Inferential statistics were both bivariate and multivariate. Fisher's exact test was used to test for the relationship between independent variables and unmet FP needs. The statistically significant variables (p-value < 0.05) during bivariate analysis were then subjected to a multivariate logistic regression model to identify the independent variables associated with the unmet need for family planning. The outcome variable was coded “0” for “FP need met” and “1” for “unmet FP need”. Odds Ratios (OR) were computed. Qualitative data from the KIIs were synthesized and emerging themes were grouped according to their similarities and differences. The study revealed a 78.9% Contraceptive prevalence rate (95% CI 74.3; 82.9), while the unmet need for contraception use among HIV-positive women in the County was 21% with 18% and 3% with unmet need for limiting and spacing respectively. In the multivariate analysis, sociodemographic, health facility, and socio-cultural factors were found to be independently associated with the unmet need for family planning among women of reproductive age living with HIV in Kwale County. Among the demographic characteristics that independently influenced FP use are age, marital status, and the clients’parity. Demographic factors: Age 45-49 years OR=9.95, 95% CI[1.4-63.2, P= 0.014] was found to be 10 times more likely to have unmet FP need as compared to age 25 to 34 years OR 0.569,95% CI [0.165-1.964, P=0.372]. Being widowed increased the probability of unmet FP needs, OR 6.5, 95% CI [2.003-21.415, P=0.002]. Being a grand multipara was associated with a reduced unmet need for contraception, X2=, 7.9921 p=0.018. Sociocultural attributes:- Intimate partner disclosure of HIV state , OR 0.262, 95% CI [ 0.01-6.686, P= 0.006], awareness of FP methods OR 0.02, 95% CI [0.052-0.773, P= 0.02] and independence to use Fp were associated with reduction in unmet need for contraceptive use. Health facility characteristics that have influenced the unmet demand for contraception among HIV-Positive women were lack of integration of FP services in CCCs, no stocking of FP commodities in the CCCs, Lack of FP services reporting and documentation tools, and inadequate space in the CCCs. The study concludes that HIV-Positive women of reproductive age in Kwale County had an unmet need for contraception use. The study recommends that the department of health services should invest in clients and community education on the importance of FP use, raise more awareness of FP services among HIV-positive women, promote male involvement and partners disclosure, Promote programs to empower women in FP decision-making, & facilitate the integration of FP in all the CCCs.