Vol.:(0123456789)
1 3
AIDS and Behavior (2018) 22:S131–S138
https://doi.org/10.1007/s10461-018-2177-3
Contraceptive Preference Among Women at Risk of HIV Acquisition
in a Preparatory Screening Study for a Phase III Microbicide Trial
in South Western Uganda
Sylvia Kusemererwa
1
· Andrew Abaasa
1
· Martin Onyango
1
· Annalene M. Nel
2
· Michelle Isaacs
2
· Gershim Asiki
3
Published online: 31 May 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract
Contraceptive preferences of women at risk for HIV acquisition are not well documented. We report on contraceptive choices
among women residing in small townships in southwestern Uganda. This was part of preparatory efforts for recruitment into
the Ring Study, a phase 3 microbicide trial, between July 2013 and October 2014. Clinicians provided contraceptives per a
woman’s choice. HIV testing and screening for other sexually transmitted infections were done at first contact and at screen-
ing for the trial. Contraceptive choice was summarized by demographics and regression analysis to show factors associated
with use of the injectable method. Of 6725 women contacted, 489 were prescreened. Of these 489 women, most (306, 63%)
were already using contraception. Injectables were most preferred (58.7%), followed by implants (23.9%). Women living
with a regular sexual partner preferred the injectable method (61.0%, P = 0.06), compared with other methods. Women at risk
for HIV infection are willing to initiate use of modern contraceptives, which may reduce study dropout during intervention
trials due to unintended pregnancy. Registration no: NCT01539226.
Keywords Contraceptives · Contraceptive preference · Women at high-risk · Uganda
Introduction
Annually, women in sub-Saharan Africa experience more
than 14 million unintended pregnancies due to improper use
of short-acting contraceptives [1]. Approximately 775,000
women in Uganda have unintended pregnancies every year
due to low uptake of contraception [2]. Although there has
been an increase in the use of modern contraceptives, there
is still an unmet need for contraception in many develop-
ing countries. In Uganda, unmet need for contraception,
both traditional and modern, remains high at 28% despite
a decline from 34% in 2011 [3]. Women at high risk for
acquiring HIV face a high burden of sexually transmitted
infections (STI) and unintended pregnancies, with little
access to sexual and reproductive health services [4]. An
increase in access to and use of effective modern contra-
ceptives is needed among this key population in order to
improve their reproductive health [5].
HIV intervention studies target women at high risk for
HIV for enrollment in clinical trials. The use of modern
contraceptives has become a key inclusion criterion for
enrollment [6, 7]. Modern contraceptives are recommended
because the effect of trial-investigational products on
embryos or fetuses is unknown [8]. Furthermore, the recent
UNAIDS guidelines issued a call for comprehensive and
sustainable HIV prevention programs emphasizing reliable
and affordable access to health-related services, including
contraceptives [9]. In order to adequately plan for contra-
ception needs during trial participation, there is an urgent
need to assess contraceptive preference among women at
risk for HIV, especially in high-risk settings [10]. Promotion
and provision of contraception prior to trial onset may also
create a pool of women at high risk who can be enrolled in
trials. Consistent contraception use may limit trial dropout
due to unintended pregnancies [8]. A few studies among
* Sylvia Kusemererwa
Sylvia.Kusemererwa@mrcuganda.org; kushylvia@gmail.com
1
MRC/UVRI and LSHTM Uganda Research Unit, Entebbe,
Uganda
2
International Partnership for Microbicides (IPM), Silver
Spring, MA, USA
3
African Population and Health Research Centre (APHRC),
Health and Systems for Health Unit Department, Nairobi,
Kenya
@Phil_Robichaud
@deepthiw
@JoseServera