Psychosocial, clinical, and behavioral factors related to dual method contraceptive use in HIV positive women 公开
Delaney, Augustina Mara (2016)
Abstract
Background: HIV-infected women need protection from unintended pregnancy and STI/HIV transmission. The most effective way to achieve this is through dual method contraceptive use (dual methods). Dual methods is the use of a barrier method with concurrent use of contraception effective at preventing pregnancy. Rates of dual methods are low among HIV-infected women, but the dearth of research makes it difficult to determine why uptake is low. Therefore the purpose of this investigation was to identify factors impacting uptake, consistent use, and sustained use of dual methods using an ecological health model.
Methods: Data was from the Women's Interagency HIV Study, a national, longitudinal, epidemiological cohort study. Participants were HIV positive females, age 18 to 45, not currently trying to conceive, and no history of hysterectomy. Bivariate analysis and logistic regression modeling were used to examine factors related to the three behaviors of interest: dual method use, consistent dual method use, and sustained dual method use.
Results: Rates of dual method use were low (36.7%), but among those who used them, rates of consistent use (77.1%) and sustained use (71.4%) were high. Higher parity, being at a southern study site, and older age increased the odds of dual method use. Higher CD4 percent and having more than two male sexual partners significantly decreased the odds of consistent dual methods. Lastly, having a partner significantly increased the odds of sustained dual methods.
Conclusion: Overall, an ecological model is a useful framework for understanding dual method use. Findings suggest that multilevel factors influence uptake of dual method use while interpersonal factors such as partner status and number of sexual partners and intrapersonal factors including CD4 percent are more relevant to consistent and sustained use of dual methods. Regional differences in dual methods suggest policy, community, and organizational level factors impact uptake. Efforts to increase uptake should focus on higher-level factors and not just individuals. Future interventions could also target communication with sexual partners and HIV knowledge to promote consistent and sustained dual methods.
Table of Contents
Chapter One: Introductory Chapter…..1
Statement of Problem…..1
Conceptual Framework……4
Background…..5
References…..12
Chapter Two: Integrative Review of Dual Method Contraceptive Use in HIV Positive Women…..22
Background…..22
Methods…..24
Results…..26
Discussion…..38
Conclusion…..42
References…..55
Chapter Three: Psychosocial, Clinical, and Behavioral Factors Impacting Dual Method Contraceptive Use…..64
Introduction…..64
Methods…..67
Results…..75
Discussion…..78
Conclusion…..82
References…..88
Chapter Four: Psychosocial, Clinical, and Behavioral Factors Impacting Sustained and Consistent Dual Method Contraceptive Use…..98
Introduction……98
Methods…..100
Results…..110
Discussion…..113
Conclusion…..117
References…..126
Chapter Five: Summary and Synthesis…..135
Introduction…..135
Integrative Review…..136
Aim One…..137
Aim Two…..138
Aim Three…..138
Synthesis…..139
Implications for Research……141
Implications for Practice…..141
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