Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia

Abstract

Objective: To describe predictors of contraceptive method discontinuation and switching behaviours among HIV-positive couples receiving couples' voluntary HIV counselling and testing services in Lusaka, Zambia.

Design: Couples were randomized in a factorial design to two-family planning educational intervention videos, received comprehensive family planning services and were assessed every 3 months for contraceptive initiation, discontinuation and switching.

Methods: We modelled factors associated with contraceptive method upgrading and downgrading via multivariate Andersen-Gill models.

Results: Most women continued the initial method selected after randomization. The highest rates of discontinuation/switching were observed for injectable contraceptive and intrauterine device users. Time to discontinuing the more effective contraceptive methods or downgrading to oral contraceptives or condoms was associated with the women's younger age, desire for more children within the next year, heavy menstrual bleeding, bleeding between periods and cystitis/dysuria. Health concerns among women about contraceptive implants and male partners not wanting more children were associated with upgrading from oral contraceptives or condoms. HIV status of the woman or the couple was not predictive of switching or stopping.

Conclusion: We found complicated patterns of contraceptive use. The predictors of contraception switching indicate that interventions targeted to younger couples that address common contraception-related misconceptions could improve effective family planning utilization. We recommend these findings be used to increase the uptake and continuation of contraception, especially long-acting reversible contraceptive (LARC) methods, and that fertility goal based, LARC-focused family planning be offered as an integral part of HIV prevention services.

Trial registration: ClinicalTrials.gov NCT00067522.

Conflict of interest statement

Conflicts of interest: The authors have no conflicts of interest, including relevant financial interests, activities, relationships, and affiliations.

Figures

Figure 1

Descriptive flow diagram of contraceptive method use, discontinuation, switching, and pregnancies occurring during follow-up OCP: oral contraceptive pill; INJ: injectable contraception; IUD: intrauterine device; IMP: implant. Condoms were provided to all couples and are not considered in this flow diagram. N = 12 clients selected tubal ligation (no pregnancies observed after tubal ligation)