Factors associated with contraceptive use among women living with HIV in Canada: a controlled, cross-sectional study
Chadni C. Khondoker , Angela Kaida, Anna Marquez
Amber R Campbell, Hélène C F Côté, Arianne Albert, Neora Pick, Evelyn J Maan, Emilie A. B. Russell , Jerilynn C Prior, Chelsea Elwood, Jason Brophy, Melanie C M Murray, Melanie C M Murray \r\n , for the CIHR team grant on Cellular Aging, H. I. V. Comorbidities in Women, Children (CARMA), (CIHR HIV Clinical Trials Network study 277) , CIHR team grant on Cellular Aging, H. I. V. Comorbidities in Women, Children (CARMA), (CIHR HIV Clinical Trials Network study 277)
Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada; Department of Pathology & Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Wesb...ROR
Multiple 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).
Methods
We 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.
Results
Compared 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).
Conclusions
WLWH 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.
contraceptive use women HIV, hormonal contraceptives HIV interaction, combined hormonal contraceptives contraindications, WLWH contraceptive choice, antiretroviral therapy contraception, HIV positive family planning, contraceptive prevalence cross-sectional, drug interaction contraceptives antiretrovirals, reproductive health HIV Canada, contraindication awareness contraception
PMID 34986848 34986848 DOI 10.1186/s12978-021-01312-7 10.1186/s12978-021-01312-7
Cite this article
Khondoker, C. C., Kaida, A., Marquez, A., Campbell, A. R., Côté, H. C. F., Albert, A. Y., Pick, N., Maan, E. J., Russell, E. A. B., Prior, J. C., Elwood, C., Brophy, J., Murray, M. C. M., CIHR team grant on Cellular Aging, H. I. V. Comorbidities in Women, Children (CARMA), & (CIHR HIV Clinical Trials Network study 277) (2022). Factors associated with contraceptive use among women living with HIV in Canada: a controlled, cross-sectional study. Reproductive health, 19(1), 3. https://doi.org/10.1186/s12978-021-01312-7
Khondoker CC, Kaida A, Marquez A, Campbell AR, Côté HCF, Albert AY, et al. Factors associated with contraceptive use among women living with HIV in Canada: a controlled, cross-sectional study. Reprod Health. 2022;19(1):3. doi:10.1186/s12978-021-01312-7
Khondoker, C. C., et al. "Factors associated with contraceptive use among women living with HIV in Canada: a controlled, cross-sectional study." Reproductive health, vol. 19, no. 1, 2022, pp. 3.
Keywords
Contraceptive Agents
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