Barriers and Facilitators to Uptake of Long-Acting Reversible Contraceptives by Women on Antiretroviral Treatment at New Start Centre in Harare City

Abstract

Voluntary use of contraception by women living with HIV for prevention pregnancy is critical for upholding their reproductive rights and remains an important strategy for reducing vertical HIV transmission. However, uptake of long acting reversible contraceptives (LARCs) in developing countries remains low when longitudinally compared with developed countries. The purpose of the study was to determine the barriers and facilitators to the uptake of long acting reversible contraceptives by women of childbearing age on antiretroviral treatment at New Start Centre in Harare City between January – December 2020. A total of 190 women had used LARCs (cases) compared 96 who had used short acting reversible contraceptives (controls). Participants were selected through systematic random sampling. An intervieweradministered questionnaire was used to collect data. Factors were analysed using logistic regression in Epi Infor 7.2. Employment status [OR = 1.7, 95% CI (1.1-2.7)] and Catholic religion [OR = 1.5; 95% CI (0.9-2.7)] were the socio-demographic factors independently associated with usage of LARCs. In addition, Multigravida (≥3 pregnancies) [OR = 2.5; 95% CI (1.5-4.1)] and multiparity (≥ 3 children) [OR = 2.4, 95% CI (1.5-4)] were significantly associated with the use of long acting reversible contraceptives. Health system-related factors associated with long acting reversible contraceptives uptake included accessibility [OR = 3.4; 95% CI (1.8-6.6)] and availability of the LARCs service [OR = 2.4; 95% CI (1.4-3.9)]. Similarly, having received prior counselling on long acting reversible contraceptives [OR = 5.2; 95% CI (2.4-11.4)] and counselling from clinicians rather than peer counsellors or friends [OR = 3.5; 95% CI (2.0-5.9)] had higher odds of using LARCs. On multivariate logistic regression, only receiving prior counselling on LARCs remained statistically significantly associated with LARC usage [AOR = 3.5; 95% CI (1.0-3.9)]. Uptake of LARCs is a function of individual socio-demographic and reproductive health related factors and to an extent, health system structural factors. Due to the diverse nature of the clients on antiretroviral treatment, it is important to further investigate the uptake of long acting reversible contraceptives in different populations.