Does family planning and HIV services integration increase contraceptive prevalence? A comparative analysis of modern contraceptive prevalence among HIV-positive and HIV-negative women of reproductive age in Tanzania-analysis of the 2016/17 Tanzania HIV impact survey

AbstractBackground Prevention of unplanned pregnancies through modern contraceptives among HIV-positive women is one of the essential strategies for reducing mother-to-child transmission of HIV. Family planning and HIV services integration is a national strategy designed to scale-up modern contraceptives among HIV-positive women. This study evaluates the success of the service integration strategy by comparing modern contraceptive prevalence among HIV-positive accessing HIV treatment (ARV) through integrated services with those not accessing the services in Tanzania. Methods We used data from the Tanzania HIV impact survey (THIS) of 2016/17. THIS provided HIV counselling and testing with a return of results in over 30,000 adults over 15 years of age. Women tested positive self reported their enrollment into ARV with further confirmation through laboratory analysis for any detectible ARV in their blood. All non-pregnant women reported their contraceptive use. Univariate and multivariate logistic regression was used to assess the effect of accessing integrated services controlling for potential confounders. Results A total of 14,986 women were included in the analysis; HIV-positive women were 1,066 and HIV-negative women 13,830. Prevalence of modern contraceptive was 35% in HIV-positive women and 30% in HIV-negative women. Prevalence was higher among women enrolled into integrated service (40%) compared to those who were HIV-positive but unaware of their HIV status (27%) (p-value = 0.0014). The most common contraceptive methods in HIV-positive women were injectables (32%) and male condoms (31%), while in HIV-negative women, injectables (39%) and implants (30%, n = 1032) were the most preferred methods. Among HIV-positive women, enrolment into integrated services (currently on ART) demonstrated an increase in the odds of modern contraceptives by 85% (AOD = 1.85, 95%CI: 1.27–2.71) Conclusion Our study therefore calls for the evaluation on the implementation of the integration programme to identify factors that constrain or facilitate programme effectiveness.