{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:25:48Z","timestamp":1788870348653,"version":"build-2803163510"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T00:00:00Z","timestamp":1710115200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"President\u2019s Emergency Plan for AIDS Relief","award":["DAIDS\/NIAID\/NIH"],"award-info":[{"award-number":["DAIDS\/NIAID\/NIH"]}]},{"name":"JHU-Uganda CTU Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration","award":["UM1 AI069530-11"],"award-info":[{"award-number":["UM1 AI069530-11"]}]},{"name":"The Johns Hopkins University-Blantyre Clinical Trials Unit","award":["UM1AI069518-12"],"award-info":[{"award-number":["UM1AI069518-12"]}]},{"name":"The University of North Carolina Global HIV Prevention and Treatment Clinical Trials Unit","award":["5UM1AI069423-12"],"award-info":[{"award-number":["5UM1AI069423-12"]}]},{"name":"University of Zimbabwe College of Health Sciences Clinical Trials Research Centre","award":["5UM1AI069436-12"],"award-info":[{"award-number":["5UM1AI069436-12"]}]},{"name":"PHRU KARABELO Clinical Trials Unit for NIAID Networks","award":["5UM1AI069453"],"award-info":[{"award-number":["5UM1AI069453"]}]},{"name":"Clinical Trials Unit for AIDS\/Tuberculosis Prevention and Treatment","award":["5 UM1AI069469-11"],"award-info":[{"award-number":["5 UM1AI069469-11"]}]},{"name":"CAPRISA Clinical Trials Unit for AIDS\/Tuberculosis Prevention and Treatment","award":["5UM1 AI069469"],"award-info":[{"award-number":["5UM1 AI069469"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>About 90% of unintended pregnancies are attributed to non-use of effective contraception\u2013tubal ligation, or reversible effective contraception (REC) including injectables, oral pills, intra-uterine contraceptive device (IUCD), and implant. We assessed the prevalence of unintended pregnancy and factors associated with using RECs, and Long-Acting-Reversible-Contraceptives (LARCs)\u2013implants and IUCDs, among women living with HIV (WLHIV) receiving antiretroviral therapy (ART).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted cross-sectional analyses of the US-PEPFAR PROMOTE study WLHIV on ART at enrollment. Separate outcome (REC and LARC) modified-Poisson regression models were used to estimate prevalence risk ratio (PRR) and corresponding 95% confidence interval (CI).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 1,987 enrolled WLHIV, 990 (49.8%) reported their last\/current pregnancy was unintended; 1,027\/1,254 (81.9%) non-pregnant women with a potential to become pregnant reported current use of effective contraception including 215\/1,254 (17.1%) LARC users. Compared to Zimbabwe, REC rates were similar in South Africa, aPRR = 0.97 (95% CI: 0.90\u20131.04), p = 0.355, lower in Malawi, aPRR = 0.84 (95% CI: 0.78\u20130.91), p&lt;0.001, and Uganda, 0.82 (95% CI: 0.73\u20130.91), p&lt;0.001. Additionally, REC use was independently associated with education attained, primary versus higher education, aPRR = 1.10 (95% CI: 1.02\u20131.18), p = 0.013; marriage\/stable union, aPRR = 1.10 (95% CI: 1.01\u20131.21), p = 0.039; no desire for another child, PRR = 1.10 (95% CI: 1.02\u20131.16), p = 0.016; infrequent sex (none in the last 3 months), aPRR = 1.24 (95% CI: 1.15\u20131.33), p&lt;0001; and <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.editorialmanager.com\/pone\/SubManuscriptData.aspx?SessionThreadIdField=5dc1494b-7a95-40bf-8c49-e186898da057\" xlink:type=\"simple\">controlled<\/jats:ext-link> HIV load (\u2264 1000 copies\/ml), PRR = 1.10 (95% CI: 1.02\u20131.19), p = 0.014. LARC use was independently associated with country (Zimbabwe ref: South Africa, PRR = 0.39 (95% CI: 0.26\u20130.57), p&lt;0.001; Uganda, PRR = 0.65 (95% CI: 0.42\u20131.01), p = 0.054; and Malawi, aPRR = 0.87 (95% CI: 0.64\u20131.19), p = 0.386; <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.editorialmanager.com\/pone\/SubManuscriptData.aspx?SessionThreadIdField=5dc1494b-7a95-40bf-8c49-e186898da057\" xlink:type=\"simple\">HIV load (\u2264 1000 copies\/ml copies\/ml),<\/jats:ext-link> <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.editorialmanager.com\/pone\/SubManuscriptData.aspx?SessionThreadIdField=5dc1494b-7a95-40bf-8c49-e186898da057\" xlink:type=\"simple\">aPRR=<\/jats:ext-link>1.73 (95% CI: 1.26\u20132.37), p&lt;0.001; and formal\/self-employment, aPRR = <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.editorialmanager.com\/pone\/SubManuscriptData.aspx?SessionThreadIdField=5dc1494b-7a95-40bf-8c49-e186898da057\" xlink:type=\"simple\">1.37 (95% CI: 1.02-1.91),<\/jats:ext-link> p = 0.027.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Unintended pregnancy was common while use of effective contraception methods particularly LARCs was low among these African WLHIV. HIV viral load, education, sexual-activity, fertility desires, and economic independence are pertinent individual-level factors integral to the multi-level barriers to utilization of effective contraception among African WLHIV. National programs should prioritize strategies for effective integration of HIV and reproductive health care in the respective African countries.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0290285","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T17:38:36Z","timestamp":1710178716000},"page":"e0290285","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Unintended pregnancy and contraception use among African women living with HIV: Baseline analysis of the multi-country US PEPFAR PROMOTE cohort"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4408-8839","authenticated-orcid":true,"given":"Jim","family":"Aizire","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nonhlanhla","family":"Yende-Zuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherika","family":"Hanley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4786-1396","authenticated-orcid":true,"given":"Teacler","family":"Nematadzira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandisa M.","family":"Nyati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sufia","family":"Dadabhai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lameck","family":"Chinula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Nakaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Glenn","family":"Fowler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taha","family":"Taha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the US-PEPFAR PROMOTE Cohort Study team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,3,11]]},"reference":[{"key":"pone.0290285.ref001","doi-asserted-by":"crossref","DOI":"10.18356\/9789210055475","author":"UNAIDS","year":"2020","journal-title":"UNAIDS 2020 Global AIDS Report"},{"key":"pone.0290285.ref002","author":"UNFPA","year":"2019","journal-title":"State of world population 2019"},{"key":"pone.0290285.ref003","author":"UNAIDS","year":"2019","journal-title":"\u201cThe gap report"},{"key":"pone.0290285.ref004","doi-asserted-by":"crossref","DOI":"10.1186\/s12978-021-01286-6","article-title":"Reproductive justice in the time of COVID-19: a systematic review of the indirect impacts of COVID-19 on sexual and reproductive health","volume":"18","author":"T. 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