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High Uptake of Postpartum Hormonal Contraception Among HIV-1-Seropositive Women in Kenya

Balkus, Jennifer MPH*; Bosire, Rose MBChB, MPH; John-stewart, Grace MD, MPH, PhD*†; Mbori-ngacha, Dorothy MBChB, MMed, MPH; Schiff, Melissa A. MD, MPH*; Wamalwa, Dalton MBChB, MMed, MPH; Gichuhi, Christine MBChB, MMed; Obimbo, Elizabeth MBChB, MMed, MPH; Wariua, Grace MBChB; Farquhar, Carey MD, MPH*†

Sexually Transmitted Diseases: January 2007 - Volume 34 - Issue 1 - p 25-29
doi: 10.1097/01.olq.0000218880.88179.36

Objectives: The objectives of this study were to determine patterns of contraceptive utilization among sexually active HIV-1-seropositive women postpartum and to identify correlates of hormonal contraception uptake.

Goal: The goal of this study was to improve delivery of family planning services to HIV-1-infected women in resource-limited settings.

Study Design: HIV-1-infected pregnant women were followed prospectively in a perinatal HIV-1 transmission study. Participants were referred to local clinics for contraceptive counseling and management.

Results: Among 319 HIV-1-infected women, median time to sexual activity postpartum was 2 months and 231 (72%) women used hormonal contraception for at least 2 months during follow-up, initiating use at approximately 3 months postpartum (range, 1–11 months). Overall, 101 (44%) used DMPA, 71 (31%) oral contraception, and 59 (25%) switched methods during follow-up. Partner notification, infant mortality, and condom use were similar between those using and not using contraception.

Conclusions: Using existing the healthcare infrastructure, it is possible to achieve high levels of postpartum hormonal contraceptive utilization among HIV-1-seropositive women.

Among 319 HIV-1-infected women followed postpartum in Nairobi, 77% resumed sexual activity within 3 months after delivery and more than 70% accepted hormonal contraception when referred to existing public sector clinics for family planning.

From the Departments of *Epidemiology, and †Medicine, University of Washington, Seattle, Washington; and the ‡Departments of Paediatrics and ∥Pharmacology, University of Nairobi, Nairobi, Kenya

This research was funded by U.S. National Institutes of Health (NIH) grant R01 HD23412. J. Balkus and M. Schiff were supported in part by Project T76 MC 00,011 from the Maternal and Child Health Bureau, U.S. Department of Health and Human Services. C. Farquhar receives support from NIH grant K23 HD41879. R. Bosire, D. Wamalwa, and E. Obimbo were scholars in the AIDS International Training and Research Program supported by the NIH Fogarty International Center grant D43 TW00007. G. John-Stewart is an Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Scientist and D. Mbori-Ngacha had an EGPAF Leadership Award.

Written informed consent was obtained from all study participants. This study received ethical approval from the Institutional Review Boards of the University of Washington and the University of Nairobi and was conducted according to the guidelines set forth by the United States Department of Health and Human Services.

Correspondence: Jennifer Balkus, MPH, 325 Ninth Avenue, University of Washington Box 359909, Seattle, WA 98104. E-mail:

Received for publication December 5, 2005, and accepted March 13, 2006.

© Copyright 2007 American Sexually Transmitted Diseases Association