Community-based family planning resources and modern contraceptive use among young women living with HIV in semi-rural northern Uganda: a mixed-method study.

Abstract

Background: Adolescent girls and young women living with HIV (AGYWLHIV) face heightened risks of unintended pregnancy and often encounter barriers to accessing appropriate family planning (FP) services, particularly in Uganda. Village Health Teams (VHTs) are expected to promote the uptake of modern contraceptives (MCs), yet limited evidence exists regarding their effectiveness among AGYWLHIV in semi-rural areas. This study aimed to determine the prevalence, associated factors, and predictors of MC use among AGYWLHIV accessing HIV care in semi-rural northern Uganda, with a focus on the role of VHTs and other individual, sociocultural, and structural influences. Methods: A convergent mixed-methods study was conducted in Lira district and city northern Uganda among a stratified sample of AGYWLHIV aged 15–24 accessing antiretroviral therapy (ART) at public health facilities. Quantitative data were collected using interviewer-administered questionnaires while qualitative data were gathered through individual in-depth interviews with a purposively selected subsample reporting non-use of MCs. Participants were asked about their awareness and use of FP services, current MC use, and reasons for non-use. Statistical analysis involved descriptive statistics and multivariable modified Poisson regression at a 5% significance level. Manual thematic analysis was used for qualitative data and integration was performed at interpretation to provide a comprehensive understanding. Results: We recruited 423 AGYWLHIV aged 21.6 ±2.5. The study found 62.4% (95% CI 57.8 – 67.0) MC use prevalence. The MC use was significantly associated with the woman being a catholic by religion (p= 0.001, APR 1.262 (95% CI 1.096-1.452), having no fertility desires (p= 0.034, APR 0.728, 95% CI 0.5430.976), being single (P<0.001, APR 0.751, 95% CI 0.651-0.866), alcohol use (p= 0.001, APR 1.288 (95% CI 1.117-1.485), being pregnant (p= 0.004, APR 0.306, 95% CI 0.137-0.684) and having an HIV negative male partner (p= 0.009, APR 1.225, 95% CI 1.052-1.425). Qualitative findings highlighted barriers including male partner disapproval, stigma, misinformation, pregnancy or postpartum status and sociocultural norms. Conclusion: While MC use prevalence among AGYWLHIV in semi-rural northern Uganda exceeds national, East African and SSA averages, uptake is influenced by multifaceted socio-cultural, individual and systemic factors. The lack of significant associations between the women’s awareness of the various community-based FP resources or providers and their use of MCs but religious affiliation, marital status, alcohol use, fertility desires and male partner’s HIV status implies that socio-cultural, individual and systemic barriers to MC use should be addressed alongside awareness creation to improve the MC use in the AGYWLHIV population.