Predictors of contraceptive utilization among HIV positive women in Kumasi Metropolis Ghana

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Introduction: Preventing unintended pregnancy among HIV-positive women through effective contraception constitutes a critical and cost-effective approach to primary prevention of mother-to-child transmission of HIV and is a global public health priority for addressing the desperate state of maternal and child health in HIV hyper-endemic settings. This strategy is however undervalued and less used throughout sub Saharan Africa. This study was conducted in order to identify the predictors of contraceptive users among HIV positive women in the Kumasi metropolis. Methodology: A multistage sampling technique was employed in this study. The first stage involved a simple random sampling of the ART centres and the second stage involved a systematic random sampling of respondents for the study. This is a cross-sectional study and it employed both qualitative and quantitative methods and involved 414 randomly selected HIV positive women receiving treatment at the Suntreso Government Hospital, a public hospital and SDA hospital, affiliated to the Christian Health Association of Ghana (CHAG) ART centres in the Kumasi Metropolis. A multistage samplying technique was used in this study. Quantitative data was gathered with the use of semi-structured questionnaires while qualitative data made use of Focus group discussion guides. Quantitative data was analyzed at the univariate and multivariate levels using STATA software version 11 used whereas the qualitative data was analyzed thematically. Results: This study revealed a high awareness of the knowledge of contraceptives among HIV positive women. This however did not translate to its usage as only 32% were using contraceptives. The level of unmet need of contraception was 37.8%. Condom (both male and female) was the most cited contraceptive heard, followed by the pill and 47.8% of the women used condoms with their partners. Use of family planning services differed significantly among HIV positive clients from public and private health facilities (43.9% versus 15%; p<0.001). The known predictors of contraceptive usage among public facilities were marital status and religion. Being married or cohabitating was associated with increased odds of using a contraceptive (OR=6.0; p<0.001 and OR=15.5; p<0.01 respectively). Among private facilities, the known predictors of contraceptive usage were religion, length of relationship and partner’s HIV status. The known predictors of condom use were religion, education and marital status of HIV positive woman. Having a partner with a positive sero-status increased the likelihood of using contraceptives among HIV positive women (OR=8.4; p<0.05). Conclusion: The increased awareness and appreciation of the importance of contraceptives did not translate to usage. Use of contraceptives among HIV positive women was low. An improvement in educational intentions to improve utilization should be incorporated into the general healthcare and support program at ART centers. Contraceptive utilization among HIV positive women is barred by interplay of socio-demographic, socio-cultural and relationship issues. The study recommends an effective intervention, targeted at resolving these barriers to improve contraceptive usage among HIV positive women.
A thesis submitted to the Department of Population, Family & Reproductive Health, College of Health Sciences, School of Public Health, in partial fulfillment of the requirements for the degree of Master of Public Health in Population, Family and Reproductive Health.