May 2014

Clinicians' perceptions and provision of hormonal contraceptives for HIV-positive and at-risk women in Southern Africa: An original research article

Blanchard K, Chipato T, Ramjee G, Nhemachena T, Harper CC, 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. 2014 May 4. pii: S0010-7824(14)00195-4. doi: 10.1016/j.contraception.2014.04.010. [Epub ahead of print].

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.