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Clinicians' perceptions about hormonal contraceptives for HIV-positive and at-risk women

Citation: 
CITATION: Kelly Blancharda, Tsungai Chipatob, Gita Ramjeec, Tzadzaa Nhemachenab, Cynthia C. Harperd, the Provider Study Writing Committee. Clinicians' perceptions and provision of hormonal contraceptives for HIV-positive and at-risk women in Southern Africa: an original research article. Contraception. DOI: 10.1016/j.contraception.2014.04.010
Abstract / Summary: 
ABSTRACT   Objectives: To assess clinician provision of hormonal contraception for HIV-positive and at-risk women in Southern Africa.   Study Design: We conducted a nationally representative survey of clinicians (n= 1444) in HIV-prevalent settings in South Africa and Zimbabwe to evaluate evidence-based contraceptive care and clinician views of hormonal contraceptives for HIV-positive and at-risk women. Multivariable logistic regression was used to analyze differences in contraceptive provision by professional training and practice setting.   Results: Most providers offered oral contraceptives (85%), but only a small minority considered them appropriate for women at risk of HIV (27%) or HIV-positive women (25%). A higher proportion of clinicians considered injections appropriate for women at risk of HIV (42%) or HIV-positive women (46%). Very few considered emergency contraceptives appropriate (13%). Multivariable results showed that family planning training and clinic as compared to hospital practices were associated with evidence-based attitudes about contraception for HIV-positive or at-risk women and greater provision. There were no differences, however, between physicians and nurses or by HIV training.   Conclusions: These findings emphasize the need to improve clinicians' awareness of evidence-based guidelines for hormonal contraception for women at high risk of HIV and HIV-positive women. Evidence-based information that oral contraception and injections are appropriate is essential. Contraceptive education should be integrated into HIV training to reach at-risk populations.  
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Selected extracts: 
'Unmet need for contraception in developing countries remains high, especially among HIV-positive women who experience high rates of unintended pregnancy. HIV-positive women may face special barriers to access to contraception, including misconceptions among clinicians about appropriate methods for them... Little is known about how clinicians, including physicians and nurses, address contraceptive needs of women at risk of or infected with HIV in high-prevalence countries. Misinformation can put women's health at risk.'
 
'According to the World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use, the full range of contraceptive methods are appropriate for women at risk of or infected with HIV. These nationally generalizable data highlight the important need for clinician education on hormonal contraceptives. All women, including HIV-positive women, need access to the full range of safe, effective contraceptive options to promote their health and rights to decide when and whether to have children.'
 
'Provider family planning and HIV training should emphasize the full range of safe and effective methods, including hormonal methods like the pill and the contraceptive injection.'
 
Formal literature type: 
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Author(s): 
Kelly Blancharda, Tsungai Chipatob, Gita Ramjeec, Tzadzaa Nhemachenab, Cynthia C. Harperd, the Provider Study Writing Committee. 
Year published: 
2014
Month published: 
May