Factors affecting dual contraception preference among seropositive women in discordant relationships in nyatike sub-county, Kenya

Abstract

HIV-discordant couples are faced with dual problem of preventing unwanted pregnancy and HIV transmission to uninfected partner. Dual contraception involving consistent use of condoms to prevent STIs/HIV infection and another more effective modern contraceptive for pregnancy prevention has been recommended to offer dual protection for discordant couples. However a large proportion of new HIV infections and unwanted pregnancies in sub-Saharan Africa still occur in stable HIV-discordant partnerships. This is an indication that there is generally low dual contraception acceptance and use among discordant couples in subSaharan Africa and Nyatike Sub-county in Migori County, Kenya is no exception. Despite this, little is known about how demographic and socio-economic factors affect dual contraception preference among discordant couples. The objectives of this study were to find out the prevalence of dual contraception; determine the most common form of dual contraception used to offer dual protection; establish the association between demographic factors and dual contraception preference; and establish the association between socioeconomic factors and dual contraception preference among seropositive women in discordant marital relationships in Nyatike sub-County in Migori County, Kenya. A cross-sectional survey design was employed. Fourteen health facilities were purposively sampled within Nyatike Sub-county. A total of 174 seropositive women in discordant marital relationships were randomly sampled from the fourteen health facilities and subjected to questionnaire interviews while another 28 took part in FGDs. Fourteen seronegative men were randomly sampled while fourteen healthcare providers (key informants) purposively sampled to take part in the study. Interviewer administered questionnaire was used to collect quantitative data while in-depth interviews and focused group discussions (FGDs) were used to collect qualitative data. Quantitative data was analyzed descriptively by way of frequencies and percentages. Cross-tabulation, Chi-square test and binary logistic regression modeling was also performed to test the relationship between independent and dependent variables. Thematic analysis was used to analyze qualitative data. Tables were used as techniques of presenting research results. The study revealed low dual contraception prevalence (29.3%) despite high level of dual contraception preference (63.2%) among the study participants. Condom plus injections was the most used form of dual contraception to offer dual protection at 24.1%, followed by condom plus implants at 19.1%. Parity (p=.001), level of education (p=.003) and monthly income (p=.026) were statistically significantly associated with dual contraception preference while age (p=.051) was not. Independent variables that significantly contributed to predicting dual contraception preference were age (p=.003), parity (p < 0.05) and level of education (p=.029). However level of monthly income (p=0.222) was not statistically significant in predicting dual contraception preference. The study recommends formulation of HIV integrated family planning programs that intensify efforts in improving knowledge of dual contraception use among seropositive women and its critical health benefits, coupled with encouraging constructive male partner communication and engagement in order to increase dual contraception uptake.