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Provision of long‐acting reversible contraception in HIV ‐prevalent countries: results from nationally representative surveys in southern Africa
Author(s) -
Morse J,
Chipato T,
Blanchard K,
Nhemachena T,
Ramjee G,
McCulloch C,
Blum M,
Saleeby E,
Harper CC
Publication year - 2013
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12290
Subject(s) - medicine , logistic regression , intrauterine device , family medicine , long acting reversible contraception , family planning , population , developing country , human immunodeficiency virus (hiv) , environmental health , research methodology , economic growth , economics
Objective To analyse the current provision of long‐acting reversible contraception ( LARC ) and clinician training needs in HIV ‐prevalent settings. Design Nationally representative survey of clinicians. Setting HIV ‐prevalent settings in S outh A frica and Z imbabwe. Population Clinicians in S outh A frica and Z imbabwe. Methods Nationally representative surveys of clinicians were conducted in South Africa and Zimbabwe ( n = 1444) to assess current clinical practice in the provision of LARC in HIV ‐prevalent settings. Multivariable logistic regression was used to analyse contraceptive provision and clinician training needs. Main outcome measure Multivariable logistic regression of contraceptive provision and clinician training needs. Results Provision of the most effective reversible contraceptives is limited: only 14% of clinicians provide copper intrauterine devices ( IUD s), 4% levonorgestrel‐releasing IUD s and 16% contraceptive implants. Clinicians’ perceptions of patient eligibility for IUD use were overly restrictive, especially related to HIV risks. Less than 5% reported that IUD s were appropriate for women at high risk of HIV or for HIV ‐positive women, contrary to evidence‐based guidelines. Only 15% viewed implants as appropriate for women at risk of HIV . Most clinicians (82%), however, felt that IUD s were underused by patients, and over half desired additional training on LARC methods. Logistic regression analysis showed that LARC provision was largely restricted to physicians, hospital settings and urban areas. Results also showed that clinicians in rural areas and clinics, including nurses, were especially interested in training. Conclusions Clinician competency in LARC provision is important in southern Africa, given the low use of methods and high rates of unintended pregnancy among HIV ‐positive and at‐risk women. Despite low provision, clinician interest is high, suggesting the need for increased evidence‐based training in LARC to reduce unintended pregnancy and associated morbidities.