Dual contraceptive use and associated factors among women aged 15-49 years on antiretroviral therapy in Kayonza District, Rwanda: a cross-sectional study

Abstract

Introduction: globally, 600,000 women died of complications due to pregnancies among more than 2 million women on antiretroviral treatment who get pregnant every year due to low utilization of dual contraception and unsafe sex. The failure rate of preventing of mother-to-child transmission of HIV/AIDS (PMTCT) in Rwanda was 2% in 2019. In Rwanda, there was no research done and published on this topic. To fill the gap, the study aimed to assess the use of dual contraceptives and associated factors among women aged 15-49 years on antiretroviral (ART) in Kayonza District, Rwanda.

Methods: a cross-sectional design was conducted in October 2021. The sample was 345 participants selected by cluster simple random sampling from a targeted population of 1426 women. The interviews were conducted, and structured questionnaires were filled out before entering and analyzing data into Statistical Package Social Sciences (SPSS). Descriptive statistics analysis was used to determine frequencies and percentages, while multivariate seconded the bivariate regression analysis determine the factors associated to dual contraception by odds ratio with 95% CI.

Results: the mean age of interviewees was 35.59 years and the majority of them were married women (60.9%). The dual contraception rate was 40%. The multivariate analysis of factors associated with dual contraception revealed that single women were most likely (AOR=38.123, 95% CI: 6.575-221.040, p<0.001) to use combinations of condoms and other methods. The odds of utilizing dual contraceptive methods were 7.347 times (AOR=7.347, 95% CI: 0.936-57.671, p=0.049) higher among women whose partners were casual laborers. Women who did not desire to have a baby were most likely (AOR=3.990, 95% CI: 1.796-8.865, p=0.001) to utilize dual contraception. The odds of utilizing dual methods were 5.634 times (AOR=5.634, 95% CI: 2.277-13.939, p<0.001) higher among women whose sexual partners did not desire a baby compared to those whose partners did. The odds of using dual methods were 1.354 times (AOR=1.354, 95% CI: 0.705-2.602) higher among women who disclosed their HIV status to their sexual partners compared to those who did not. The odds of using dual contraception were 5.526 times (AOR=5.526, 95% CI: 2.186-13.968, p<0.001) higher among women who were in HIV program for more than five years compared to those who were in the program for one year or less.

Conclusion: the rate of dual contraception in this area is still low according to World Health Organization (WHO) recommendation and strategies to increase it are of paramount importance to be put in place by the Ministry of Health through Rwanda Biomedical Center, health facilities and partners in terms of training, health education, availability of dual methods at the level of the health system and men involvement in family planning.

Keywords: Dual contraception; antiretroviral therapy; women in reproductive age.