Study Objective

To investigate whether contraceptive service uptake (including current contraceptive use), unmet need for contraception, unintended pregnancy, preferences for service provision, and providers among female adolescents living with HIV (ALHIV) vary with HIV-acquisition route, that is, perinatal HIV acquisition vs horizontal HIV acquisition.

Design

Mixed methods including exit and in-depth interviews

Setting

Multicenter, public sector primary health care facilities, Cape Town, South Africa

Participants

Sexually experienced female ALHIV aged 14-19 years (n = 303) including both peri/postnatally infected ALHIV (pALHIV) and horizontally infected ALHIV (hALHIV) and health care providers involved in HIV care and treatment services (n = 19)

Main Outcome Measures

Current contraceptive use, unintended pregnancy, and preferences for service provision and providers

Results

The association between HIV-acquisition route and current use of any contraceptive method (aOR = 1.23; 95% CI, 0.52-2.92) and unintended pregnancy (aOR = 1.02; 95% CI, 0.39-2.67) was not significant. In contrast, pALHIV had significantly decreased odds of receiving dual-method contraception (aOR = 0.02; 95% CI, 0.00-0.38) and significantly increased odds of preferences for younger providers (aOR = 4.45; 95% CI, 2.84-6.97), female providers (aOR = 5.11; 95% CI, 1.25-20.91), and standalone youth clinics (aOR = 7.01; 95% CI, 2.39-20.55) compared with female hALHIV. Qualitative findings indicate that provider positive attitudes, as opposed to judgmental attitudes, encourage pALHIV acceptance of care from any provider regardless of, for example, the provider's age.

Conclusions

Current contraceptive use and unintended pregnancies were similar between pALHIV and hALHIV, but the 2 distinct groups of ALHIV were heterogeneous in terms of dual-method contraception and preferences for type of clinic model and providers. Promoting positive provider attitudes could improve ALHIV's contraceptive uptake.

中文翻译：

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感染艾滋病毒的围产期和横向感染女性青少年的避孕服务采用和分娩偏好：南非混合方法研究的结果”

学习目标

调查避孕服务的接受（包括当前的避孕药具使用）、未满足的避孕需求、意外怀孕、对服务提供的偏好以及感染艾滋病毒的女性青少年 (ALHIV) 的提供者是否随 HIV 感染途径（即围产期 HIV 感染）而变化与水平 HIV 感染相比。

设计

混合方法，包括退出和深度访谈

环境

多中心、公共部门初级卫生保健设施，南非开普敦

参加者

有性经历的 14-19 岁女性 ALHIV（n  = 303），包括围产期/产后感染的 ALHIV（pALHIV）和水平感染的 ALHIV（hALHIV）以及参与 HIV 护理和治疗服务的医疗保健提供者（n  = 19）

主要观察指标

目前的避孕药具使用、意外怀孕以及对服务提供和提供者的偏好

结果

HIV 感染途径与当前使用任何避孕方法（aOR = 1.23；95% CI，0.52-2.92）和意外怀孕（aOR = 1.02；95% CI，0.39-2.67）之间的关联不显着。相比之下，pALHIV 显着降低了接受双重避孕方法的几率（aOR = 0.02；95% CI，0.00-0.38），并且显着增加了更年轻提供者的偏好几率（aOR = 4.45；95% CI，2.84-6.97），女性提供者（aOR = 5.11；95% CI，1.25-20.91）和独立青年诊所（aOR = 7.01；95% CI，2.39-20.55）与女性 hALHIV 相比。定性研究结果表明，提供者积极的态度，而不是判断性态度，鼓励 pALHIV 接受任何提供者的护理，无论提供者的年龄如何。

结论

目前避孕药的使用和意外怀孕在 pALHIV 和 hALHIV 之间是相似的，但是 2 个不同的 ALHIV 组在双重方法避孕和对临床模式和提供者类型的偏好方面是异质的。促进提供者的积极态度可以提高 ALHIV 的避孕药具使用率。