CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

their HIV-positive status prior to pregnancy were more likely to have unplanned pregnancy (67.9% vs. 62.7% p<0.05) and unmet need for contraception (71.4% vs 64.8% p<0.01) compared to those who knew their status. In multivariate analysis, factors associated with unplanned pregnancy were: being younger than 20 years (aOR=3.23; 95% CI: 1.83-5.67), being unmarried (aOR=2.99; CI: 2.42-3.68), primary or less education (aOR=2.40; CI: 1.03-5.61), unaware of partners HIV status (aOR=1.40; CI: 1.16-1.69) and nondisclosure of HIV status to partner (aOR=1.39; CI: 1.07-1.18). Factors associated with unmet need for contraception were: self-reported HIV-positive serostatus (aOR 2.37; CI: 1.33-4.41), being younger than 20 years (aOR=3.55; CI: 2.27-5.55), being single (aOR=2.15; CI: 1.73-2.67), unaware of partner’s HIV status (aOR=1.33; CI: 1.11- 1.60), and nondisclosure of HIV status to partner (aOR=1.53; CI: 1.22-1.93). Conclusion: Interventions to reduce unplanned pregnancy and unmet need for contraception could include education of young women and programmes that increase sexual and reproductive health education and facilitate disclosure in young women and their partners. 1008 UPTAKE OF POSTPARTUM CONTRACEPTION IN BOTSWANA, A HIGH BURDEN HIV SETTING Kathleen M. Powis 1 , Shan Sun 2 , Keolebogile N. Mmasa 3 , Gosego Masasa 3 , Samuel W. Kgole 3 , Justine Legbedze 2 , Joseph Makhema 3 , Lesego Mokganya 4 , Elaine J. Abrams 5 , Lynn M. Yee 6 , Lisa B. Haddad 7 , Rebecca Luckett 3 , Jennifer Jao 6 1 Harvard University, Boston, MA, USA, 2 Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA, 3 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 4 Botswana Ministry of Health, Gaborone, Botswana, 5 ICAP at Columbia University, New York, NY, USA, 6 Northwestern University, Chicago, IL, USA, 7 Emory University, Atlanta, GA, USA Background: In high burden HIV settings, well-functioning sexual and reproductive health programming prevents unplanned pregnancies and HIV transmission. In Botswana, where HIV incidence approaches 1% per 100 person- years and prevalence among adults age 15-49 is > 20%, we sought to quantify pregnancy intention and uptake of contraception among postpartumwomen living with HIV (WLHIV) and HIV-uninfected (HIV-U) women. Methods: The Tshilo Dikotla study is prospectively enrolling pregnant WLHIV and HIV-U women ≥ 18 years old in Gaborone, Botswana, and following mother-infant pairs through 3 years postpartum. WLHIV are on dolutegravir (DTG)- or efavirenz (EFV)-based combination antiretroviral treatment (cART) regimens in pregnancy. Data on future pregnancy intention and contraception use are collected via questionnaire at 6 months postpartum. We compared the proportion of women without plans for pregnancy (ever or within 2 years), proportions of women reporting use of contraception, and adopted contraception methods by HIV status. In women reporting >1 type of contraception, the most efficacious method was used for analysis. Results: Among 233 women attending the 6-month postpartum visit, 142 (61%) were WLHIV. WLHIV were older (28.5 vs 24.3 years; p<0.001) and had higher gravidity (3 vs 1; p<0.001) compared to HIV-U women. More WLHIV expressed a desire to prevent future pregnancies or defer pregnancy for ≥2 years compared to HIV-U women (87% vs 66%; p<0.001). Among women not planning pregnancy in ≤2 years, only 89 (49%) reported using contraception, with similar uptake by WLHIV and HIV-U women (50% vs 47% respectively; p=0.71). Of the 61 WLHIV using contraception, 57%were on DTG- and 43% on EFV-based cART, with none using hormonal implants. Only 14% of HIV-U women were using implants. (Table 1) Depot medroxyprogesterone acetate was the most commonly used method overall. Uptake of condom use was low as a primary or secondary method, yet a higher proportion of WLHIV reported condom use (39% vs 32%). Only 7 women were using more than one method. Conclusion: Uptake of contraception at 6-months postpartumwas universally poor among women desiring pregnancy prevention, regardless of HIV status. In addition, dual condom use with more efficacious methods was particularly low, a concerning finding in a high burden HIV setting. Understanding individual and programmatic impediments to contraception uptake is needed to better match contraception use to pregnancy desires in Botswana and prevent HIV transmission.

1009 IMPACT OF INTEGRATION OF FAMILY PLANNING INTO HIV TREATMENT PROGRAMS IN CAMEROON Andrew Abutu 1 , Tih M. Pius 2 , Evelyn Kim 1 , Jessica L. Stephens 3 , Lily Foglabenchi 2 , Holl Jennifer 4 , Abigail R. Greenleaf 5 , Eveline M. Khan 2 , Thomas Welty 2 , Edith Welty 2 , Florence Tumasang 2 , Jembia Mosoko 2 , Omotayo Bolu 1 1 CDC, Atlanta, GA, USA, 2 Cameroon Baptist Convention Health Services, Bamenda, Cameroon, 3 Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA, 4 Emory University, Atlanta, GA, USA, 5 Johns Hopkins University, Baltimore, MD, USA Background: Uptake of family planning (FP) methods in Sub-Saharan Africa (SSA) is low among women living with HIV (WLHIV). Studies have shown increased use of modern contraceptive methods as a positive effect of integrating FP services into HIV treatment programs. This study evaluated changes in unmet need and modern contraceptive use after integration of FP services at HIV clinics. Methods: A serial, cross-sectional study of sexually active WLHIV at two HIV Treatment Clinics in Southwest Cameroon at baseline, six-month and 12-month follow up visits was conducted. Data were collected through interviews and chart abstractions to evaluate the unmet need for FP and contraceptive prevalence rate (CPR).Demographic characteristics, FP practices, and selected clinical outcomes were described using frequencies and percentages. These were compared using Chi-square (χ2) tests, Fisher’s exact tests, and independent samples t-tests. We compared baseline data with the 12-month follow-up data. Logistic regression was used to estimate the impact of the intervention adjusted to other covariates. Results: A total of 852 eligible women were surveyed across two sites; 51.6% were married. Modern CPR increased from 33.7% to 43.8% (p=0.003) and unmet FP need decreased from 13.9% to 9.6% (p=0.02). However, unmarried participants showed no significant increase in modern CPR from 36.2% to 41.9% (p=0.235). Long-acting reversible contraceptive (LARC) use significantly increased from 15.4% to 38.4% (p<0.001) while use of short-acting methods decreased from 86.0% to 63.3% (<0.001). For specific LARC methods, use of implants increased from 8.8% to 36.2% (p<0.001), while intrauterine contraceptive device use significantly decreased (6.6% to 2.0%, p=0.034). For short-acting methods, condom use decreased (83.1% to 38.3%, p<0.001), while injectable use increased (2.9% to 6.3%, p<0.001). Adjusting for demographic and clinical characteristics, women with unmet FP need were significantly likely to be Catholics [odds ratio (aOR) =1.30, 95% confidence interval (CI): 1.02-1.65] compared to non-Catholics, and to be on HIV treatment for more than 5-years (aOR=1.06, 95% CI: 1.01-1.10) compared to one year HIV treatment. Conclusion: Integration of FP services into HIV treatment programs in Cameroon resulted in a significant decrease in the unmet need for FP and a significant increase in CPR. Successes of this program, as well as lessons learned during the service integration process, will lay the groundwork for future related programming.

Poster Abstracts

CROI 2019 395