Predictors of Safer Conception Practices Among HIV-Infected Women in Northern Nigeria

Document Type: Original Article

Authors

1 Department of Community Medicine, Bayero University, Kano, Nigeria

2 Centre for Infectious Diseases Research, Bayero University, Kano, Nigeria

3 Department of Obstetrics and Gynecology, Bayero University, Kano, Nigeria

4 Department of Medicine, Bayero University, Kano, Nigeria

5 Department of Health Policy & Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA

Abstract

Background
Persons living with HIV often face discrimination in safe sex and reproductive choices, especially in lowresource settings. This study assessed fertility desires and intentions, risk perception and correlates of ever use of at least one safer conception method among HIV-infected women attending a tertiary health facility in Kano, Nigeria.

 
Methods
Structured questionnaires were administered to a cross section of 328 of 427 eligible HIV-infected women. Fertility desires and intentions, risk perception and safer conception practice were analyzed. Logistic regression was employed to assess for predictors.

 
Results
Of the 328 respondents, 150 respondents (45.7%) wanted more children. The proportions of respondents aware of their transmission risk during pregnancy, delivery, and breastfeeding were 69.5%, 75.3%, and 78.9%, respectively. Further, 68.9% of respondents were aware of the prospects of bearing HIV-negative children without infecting their partners. About 64.8% of women were aware of at least one safer conception method. Safer conception methods everused by the participants include: antiretroviral therapy (ART) (36.7%), timed unprotected intercourse with (10.9%), and without pre-exposure prophylaxis (PrEP) (17.2%), intravaginal insemination (7.3%) and intrauterine insemination (4.7%). Safer conception practice was predicted by marital status (married versus single, adjusted odds ratio [AOR] = 1.50, 95% CI = 1.10-3.55), parity (2-4 versus 0, AOR = 12.1, 95% CI = 3.7-39.8), occupation (civil servants versus traders, AOR = 0.37, 95% CI = 0.16-0.86), husband’s serostatus (seroconcordant versus serodiscordant) (AOR = 1.51, 95% CI = 1.13-4.64), couple contraceptive use (users versus non-users) (AOR = 1.62, 95% CI = 1.16-5.83) and transmission risk perception (high risk versus low/no risk) (AOR = 2.14, 95% CI = 1.18-3.90).

 
Conclusion
We found high levels of fertility desires and intentions and moderate risk perception among a cohort of HIV-infected women in urban Kano, Nigeria. The use of safer conception practices was not common. Our findings underscore the need for healthcare provider capacity building to enhance safer conception counseling and service delivery.

Keywords

Main Subjects


  1. Streatfield PK, Khan WA, Bhuiya A, et al. HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites. Glob Health Action. 2014;7:25370. doi:10.3402/gha.v7.25370
  2. Cornia GA, Patel M, Zagonari F. The Impact of HIV/AIDS on the Health System and Child Health. AIDS, Public Policy and Child Well-being, Innocenti Publications 2007. https://www.unicef-irc.org/publications/476-aids-public-policy-and-child-well-being.html.  Accessed April 12, 2018
  3. Shao Y, Williamson C. The HIV-1 epidemic: low- to middle-income countries. Cold Spring Harb Perspect Med. 2012;2(3):a007187. doi:10.1101/cshperspect.a007187
  4. Boutyeb A. The impact of HIV/AIDS on human development in African countries. BMC Public Health. 2009;9(suppl 1):S3. doi: 10.1186/1471-2458-9-S1-S3
  5. UNAIDS Joint United Nations Programme on HIV/AIDS.UNAIDS Data 2017. http://www.unaids.org/sites/default/files/media_asset/20170720_Data_book_2017_en.pdf.  Accessed February 16, 2018.
  6. Rutenberg N, Kaufman CE, Macintyre K, et al. Pregnant or positive: adolescent childbearing and HIV risk in KwaZulu Natal, South Africa. Reprod Health Matters. 2003;11:122-133.
  7. MacCarthy S, Laher F, Nduna M, Farlane L, Kaida A. Responding to her question: a review of the influence of pregnancy on HIV disease progression in the context of expanded access to HAART in sub-Saharan Africa. AIDS Behav. 2009;13 (Suppl 1):66–71.
  8. Hancuch K, Baeten J, Ngure K, Celum C, Mugo N, Tindimwebwa E, et al; Partners Demonstration Project Team. Safer conception among HIV-1 serodiscordant couples in East Africa: understanding knowledge, attitudes and experiences. AIDS Care. 2018;17:1-9. doi:10.1080/09540121.2018.1437251.
  9. Alaba OO, Olubusoye OE, Olaomi JO. Spatial patterns and determinants of fertility levels among women of childbearing age in Nigeria. South African Family Practice 2017;59(4):143-147. doi:10.1080/20786190.2017.1292693
  10. Barreiro P, Castilla JA, Labarga P, Soriano V. Is natural conception a valid option for HIV-serodiscordant couples? Hum Reprod. 2007;22(9):2353-2358.
  11. Berhan Y, Berhan A. Meta-analyses of fertility desires of people living with HIV. BMC Public Health. 2013;13:409. doi:10.1186/1471-2458-13-409.
  12. Tai JH, Udoji MA, Barkanic G, Byrne DW, Rebeiro PF, Byram BR, Kheshti A, Carter JD, Graves CR, Raffanti SP, Sterling TR. Pregnancy and HIV disease progression during the era of highly active antiretroviral therapy. J Infect Dis. 2007;196 (7):1044-52.
  13. Westreich D, Maskew M, Evans D, Firnhaber C, Majuba P, Sanne I. Incident Pregnancy and Time to Death or AIDS among HIV-Positive Women Receiving Antiretroviral Therapy.PLoS One. 2013;8(3):e58117. doi:10.1371/journal.pone.0058117.
  14. Ashaba  S, Kaida A, Coleman JN, Burns BF, Dunkley E, O'Neil K. Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda. PLoS One. 2017;12(5): e0176256.
  15. Hancuch K, Baeten J, Ngure K, Celum C, Mugo N, Tindimwebwa E, Heffron R, Partners Demonstration Project Team. Safer conception among HIV-1 serodiscordant couples in East Africa: understanding knowledge, attitudes, and experiences. AIDS Care. 2018:1-9. doi:10.1080/09540121.2018.1437251.
  16. UNAIDS. AIDS by the numbers: Ending the AIDS epidemic by 2030 as part of the sustainable development goals, July 2016. http//www.unaids.gov Last accessed 23/4/2018
  17. Chadwick RJ, Mantell JE, Moodley J, Harries J, Zwigenthal V, Cooper D. Safer conception interventions for HIV-affected couples: implications for resource-constrained settings. Top Antivir Med. 2011;19(4):148-55.
  18. Ciaranello AL, Matthews LT. Safer Conception Strategies for HIV-Serodiscordant Couples: How Safe Is Safe Enough? J Infect Dis. 2015;212 (10):1525-1528. doi:10.1093/infdis/jiv275
  19. National Population Commission (NPC) [Nigeria] and ICF International. Nigeria Demographic and Health Survey 2013. Published 2014.
  20. National Population Census. Legal notice on publication of the details of the breakdown of the national and state provisional totals 2006 census. Federal Republic of Nigeria Official Gazette. 2007;94:178-198.
  21. Federal Ministry of Health, Nigeria (FMOH). National Guidelines for HIV and AIDS Treatment and Care in Adolescents and Adults. Abuja, Nigeria: FMOH; 2010.
  22. Federal Ministry of Health, Nigeria (FMOH)/National AIDS/STI Control Program (NASCAP). National HIV Seroprevalence Survey Technical report. Nigeria: Federal Ministry of Health; 2010:34-37.
  23. Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies: A Practical Manual. Geneva: World Health Organization; 1991:29-32.
  24. Scherer ML, Douglas NC, Churnet BH, et al. Survey of HIV care providers on management of HIV serodiscordant couples – assessment of attitudes, knowledge, and practices. AIDS Care. 2014;26(11):1435-1439.
  25. Miller WB. Childbearing motivations, desires, and intentions: a theoretical framework. Genetic, Social and General Psychology Monograph. 1994;120(2):223-258.
  26. IBM Corp. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY, USA: IBM Corporation; 2013.
  27. Ashimi AO, Amole TG, Abubakar MY, Ugwa EA. Fertility desire and utilization of family planning methods among HIV-positive women attending a tertiary hospital in a suburban setting in Northern Nigeria. Trop J Obstet Gynaecol. 2017;34:54-60.
  28. Melaku YA, Zeleke EG, Kinsman J, Abraha AK. Fertility desire among HIV-positive women in Tigray region, Ethiopia: implications for the provision of reproductive health and prevention of mother-to-child HIV transmission services. BMC Womens Health. 2014;14:137 doi:10.1186/s12905-014-0137-2
  29. Gutin SA, Namusoke F, Shade SB, Mirembe F. Fertility Desires and Intentions among HIV-Positive Women during the Post-natal Period in Uganda. Afr J Reprod Health. 2014;18(3):67-77.
  30. Steiner RJ, Black V, Rees H, Schwartz SR. Low receipt and uptake of safer conception messages in routine HIV care: findings from a prospective cohort of women living with HIV in South Africa. J Acquir Immune Defic Syndr. 2016;72:105-113. doi:10.1097/QAI.0000000000000945
  31. Schwartz SR, Bassett J, Holmes CB, et al. Client uptake of safer conception strategies: implementation outcomes from the Sakh’umndeni Safer Conception Clinic in South Africa. J Int AIDS Soc. 2017;20(Suppl 1):21291. doi:10.7448/IAS.20.2.21291
  32. Bankole A, Biddlecom AE, Dzekedzeke K. Women’s and men’s fertility preferences and contraceptive behaviors by HIV status in 10 sub-Saharan African countries. AIDS Educ Prev.  2011;23(4):313-328.  doi:10.1521/aeap.2011.23.4.313
  33. Rahangdale L, Stewart A, Stewart RD, et al. Pregnancy intentions among women living with HIV in the United States. J Acquir Immune Defic Syndr. 2014;65(3):306.
  34. Cliffe S, Townsend CL, Cortina-Borja M, Newell M. Fertility intentions of HIV-infected women in the United Kingdom. AIDS Care. 2011;23(9):1093-1101.
  35. Wagner GJ, Woldetsadik MA, Beyeza-Kashesya J, et al. Multi-level correlates of safer conception methods awareness and attitudes among Ugandan HIV clients with fertility intentions.  Afr J Reprod Health. 2016;20(1):40.
  36. Finocchario-Kessler S, Wanyenze R, Mindry D, et al. "I may not say we really have a method, it is gambling work": knowledge and acceptability of safer conception methods among providers and HIV clients in Uganda. Health Care Women Int. 2014;35(7-9):896-917. doi:10.1080/07399332.2014.924520
  37. Andersen M, Roxby A, Marx G, et al. Reproductive desires and family planning and safer conception knowledge among women in HIV-serodiscordant relationships in Kenya: a qualitative study. Contraception. 2015;92(4):359-414.
  38. National Bureau of Statistics (NBS) and United Nations Children’s Fund (UNICEF). Multiple Indicator Cluster Survey 2016-17, Survey Findings Report. Abuja, Nigeria: National Bureau of Statistics and United Nations Children’s Fund; 2017.
  39. Center for Reproductive Rights Federation of Women Lawyers – Kenya. At risk: rights violations of HIV-positive women in Kenyan health facilities. http://reproductiverights.org/sites/default/files/documents/At_Risk.pdf.  Accessed May 19,  2018. Published 2008.
  40. Messersmith LJ, Semrau K, Anh TL, et al. Women living with HIV in Vietnam: desire for children, use of sexual and reproductive health services, and advice from providers.  Reprod Health Matters. 2012;20(39S):27-38.
  41. Larsson C, Stanfors M. Women’s Education, empowerment, and contraceptive use in sub-Saharan Africa: findings from recent demographic and health surveys. Afr Pop Stud. 2014;28(2 suppl.):1022-1034.
  42. Matthews LT, Burns BF, Bajunirwe F, et al. Beyond HIV-serodiscordance: Partnership communication dynamics that affect engagement in safer conception care. PLoS One. 2017;12(9):e0183131.
  43. West N, Schwartz S, Phofa R, et al. "I don't know if this is right … but this is what I'm offering": healthcare provider knowledge, practice, and attitudes towards safer conception for HIV-affected couples in the context of Southern African guidelines. AIDS Care. 2016;28(3):390-396. doi:10.1080/09540121.2015.1093596
  44. Lassi ZS, Imam AM, Dean SV, Bhutta ZA. Preconception care: preventing and treating infections. Reprod Health. 2014;11(Suppl 3):S4. doi:10.1186/1742-4755-11-S3-S4