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. 2024 Dec 27;21(1):199.
doi: 10.1186/s12978-024-01942-7.

Contraceptive use, prevalence and incidence of pregnancy and associated factors among women participating in a vaccine preparedness cohort study in Masaka, Uganda, a retrospective secondary analysis

Sylvia Kusemererwa  1 , Sheila Kansiime  2   3 , Sarah Nakamanya  2 , Elizabeth Mbabazi  2 , Julie Fox  4 , Sheena McCormack  5 , Pontiano Kaleebu  2   3 , Eugene Ruzagira  2   3
Affiliations

Contraceptive use, prevalence and incidence of pregnancy and associated factors among women participating in a vaccine preparedness cohort study in Masaka, Uganda, a retrospective secondary analysis

Sylvia Kusemererwa et al. Reprod Health. .

Abstract

Background: HIV prevention trials usually require that women of childbearing potential use an effective method of contraception. This is because the effect of most investigational products on unborn babies is unknown. We assessed contraceptive use, prevalence and incidence of pregnancy and associated factors among women in a HIV vaccine preparedness study in Masaka, Uganda.

Methods: HIV sero-negative women (18-45 years) at high risk of HIV infection identified through HIV counselling and testing (HCT) were recruited between July 2018 and October 2022. Study procedures included collection of baseline socio-demographics and contraceptive use data, quarterly HCT, counselling on and provision of contraceptive methods onsite/through referral, and 6-monthly urine pregnancy tests. Multivariable Logistic and Poisson regression analyses were conducted to determine factors associated with contraceptive use, prevalence, and incidence of pregnancy.

Results: 652 (73%) of 891 women reported contraceptive use at baseline. Contraceptive use was higher in women who were in a relationship/married/cohabiting [adjusted odds ratio (aOR) = 1.60; 95% confidence interval (CI) 1.07-2.40] or divorced/separated/widowed [aOR = 1.86; 95% CI 1.24-2.79] versus those that were single, and among women reporting transactional sex [aOR = 2.10; 95% CI 1.16-3.80] versus those who did not. Baseline pregnancy prevalence was 4% (95% CI 3-6%) and lower in women who reported using long-acting contraceptive methods (aOR = 0.17; 95% CI 0.07-0.39) versus women who did not use these methods. A total of 65 pregnancies over 301.3 person-years of observation (PYO), an incidence rate of 21.6/100 (95% CI 16.9-27.5) PYO, higher among younger women (≤ 24 versus 25 + years, adjusted incidence rate ratio = 1.97; 95% CI 1.15-3.40).

Conclusion: We observed a high pregnancy incidence in this cohort. Innovative strategies that promote sustained and consistent use of highly effective contraceptive methods especially for young women will be critical to the success of HIV prevention trials in this and similar populations.

Keywords: Contraception; HIV; High risk; Pregnancy; Uganda.

Plain language summary

HIV prevention trials require that women use contraception because the effect of most investigational products on unborn babies in not known. We assessed contraceptive use, incidence of pregnancy and factors associated with contraceptive use among women in a HIV vaccine preparedness study in Masaka, Uganda. HIV sero-negative women (18–45 years) at high risk of HIV infection identified through HIV counselling and testing (HCT) were recruited into the study between July 2018 and October 2022. Study procedures included collection of baseline socio-demographic and contraceptive use data, quarterly HCT, counselling on and provision of contraceptive methods onsite/through referral, and 6-monthly urine pregnancy tests. Regression analyses were conducted to determine factors associated with contraceptive use, prevalence, and incidence of pregnancy. Of 891 enrolled women, 73% reported contraceptive use at baseline. Contraceptive use was almost twice as high in women who were in a relationship/married/cohabiting or divorced/separated/widowed compared to those that were single. Women reporting transactional sex were twice as likely to use contraceptives than women who did not. 4% of the women were pregnant at the time of recruitment. Women using long-acting contraceptives had fewer pregnancies compared to non-users. Incidence of pregnancy was high, especially among younger women (≤ 24 years). Innovative strategies that promote sustained use of highly effective contraceptive methods especially for younger women will be critical to the success of HIV prevention trials.

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Conflict of interest statement

Declarations. Ethics approval and consent to participants: The study was approved by the UVRI Research Ethics Committee (GC/127/18/03/637), the Uganda National Council for Science and Technology (HS2392) and LSHTM Ethics Committee (26494). All participants provided written informed consent before undergoing study procedures. All pregnant women were referred for antenatal care services. Additionally, pregnant women who tested HIV positive were referred for prevention-of-mother-to-child services. Competing interests: The authors declare no competing interests.

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