Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services.

Autor: Yam EA; Population Council, Washington, DC, United States of America., Kahabuka C; CSK Research Solutions Ltd., Dar es Salaam, Tanzania., Mbita G; Sauti Program, Jhpiego, Dar es Salaam, Tanzania., Winani K; Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania., Apicella L; Population Council, Dar es Salaam, Tanzania., Casalini C; Sauti Program, Jhpiego, Dar es Salaam, Tanzania., Mbuguni Z; Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Jul 21; Vol. 15 (7), pp. e0235739. Date of Electronic Publication: 2020 Jul 21 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0235739
Abstrakt: Background: With the advent of effective treatment, women living with HIV can plan for pregnancy while minimizing risk of transmission to infants and seronegative partners. Family planning (FP) services tend to focus solely on addressing contraceptive need, but HIV-positive women-including female sex workers-often plan to have children someday. Various "safer conception" strategies are now available to support women living with HIV achieve fertility intentions, and integrated HIV/FP services may be a promising platform to offer these services.
Methods: At integrated community-based HIV/FP service delivery sites operated by Jhpiego's Sauti project in Dar es Salaam, we conducted exit interviews with 300 HIV-positive female sex workers. Descriptive analyses were conducted to describe their desire for children, use of condoms and other modern contraceptive methods, self-reported viral suppression, and knowledge of and interest in safer conception strategies. We conducted bivariate and multivariate logistic regression analysis to examine correlates of fertility desire among respondents.
Results: Median age of participants was 32. Nearly one-third wished to have a child within two years. Seventy-two percent had heard of having the HIV-positive partner taking ART to reduce sexual transmission during pregnancy attempts. Thirty-one percent felt the amount of FP content covered in the consultation was "too little." Factors significantly associated with desire for children were having a nonpaying partner (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI]1.13-4.20) and having fewer children (AOR 0.65, 95% CI 0.48-0.87). Viral suppression was not associated with fertility desire.
Conclusions: Sex workers living with HIV attending integrated HIV/FP services have need for both contraception as well as safer conception counseling. This integrated service delivery modality is a promising platform for providing safer conception services. FP counseling for HIV-positive women should be broadened to broach the topic of safer pregnancy, as well as explicit counseling on strategies to minimize risk of sexual transmission to partners.
Competing Interests: The funder [the President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Agency for International Development (USAID)] had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authors EY and LA are employees of the Population Council, which was the recipient of the funder’s support. The Population Council issued a subaward to the Tanzanian commercial research firm, CSK Research Solutions, to implement data collection activities (i.e., survey administration, data management, fieldwork management). Author CK is the owner of CSK Research Solutions. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The specific roles of these authors are articulated in the ‘author contributions’ section.
Databáze: MEDLINE
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