FERTILITY INTENTIONS AND LONG-ACTING REVERSIBLE CONTRACEPTIVE USE AMONG HIV-NEGATIVE SINGLE MOTHERS IN ZAMBIA
BACKGROUND: Integrating family planning interventions with HIV studies in developing countries has been shown to prevent mother-to-child HIV transmission and simultaneously reduce HIV and unintended pregnancy in high-risk populations. As part of a prospective cohort study on HIV incidence and risk factors in Zambian women having unprotected sex, we also offered family planning counseling and immediate access to long-acting reversible contraceptives. Although long-acting reversible contraceptives are the most effective form of contraception, many Zambian women are limited to oral or injectable methods due to lack of knowledge or method availability. This project offers single mothers enrolled in a cohort study information about and access to long-acting reversible contraceptives at enrollment and at each follow-up visit. OBJECTIVE: This study evaluates how fertility intentions affect long-acting reversible contraceptive utilization in HIV-negative single mothers in Zambia. Our primary outcome was long-acting reversible contraceptive use throughout study participation. We also estimated rates of long-acting reversible contraceptive uptake and discontinuation. We specifically studied single mothers because they are at high risk for unintended pregnancy, which can have significant negative ramifications on their financial, social and psychological circumstances. STUDY DESIGN: From 2012–2017, Zambia Emory HIV Research Project recruited 521 HIV-negative single mothers between the ages of 18–45 years from government clinics in Lusaka and Ndola, Zambia's two largest cities. Participants were followed every three months for up to five years. At each visit, we discussed fertility goals and contraceptive options and offered a long-acting reversible method to any woman who was not pregnant or already using a long-acting reversible or permanent contraceptive method. Data was collected on demographic factors, sexual behavior and reproductive history. Multivariable logistic regression was used to model baseline fertility ...