Preventing Unintended Pregnancy and HIV Transmission: The Effect of the HIV Treatment Cascade on Contraceptive Use and Choice in Rural Kwazulu-Natal

Julia Raifman, Harvard University
Terusha Chetty, Africa Centre for Health and Population Studies
Frank Tanser, Africa Centre for Health and Population Studies
Tinofa Mutevedzi, Africa Centre for Health and Population Studies
Philippa Matthews, Africa Centre for Health and Population Studies
Kobus Herbst, Africa Centre for Health and Population Studies
Deenan Pillay, Africa Centre for Health and Population Studies

We estimate the effect of movement along the HIV treatment cascade on contraceptive use and choice among HIV-infected women in rural South Africa. We linked population-based surveillance and HIV treatment program data in KwaZulu-Natal. In bivariate probit regression, we estimated the effects of moving through the cascade on contraceptive choice among HIV-infected, sexually active women aged 15-49 years (N=3169), controlling for a wide range of potential confounders. Contraceptive use increased across the cascade. Holding other factors equal, (i) awareness of HIV status, (ii) ART initiation, and (iii) being on ART for 4-7 years increased the likelihood of using condoms/condoms plus another method by the following, compared to women who were unaware of their HIV status: (i) 4.6 (p=0.030)/3.5 (p=0.001); (ii) 10.3 (p=0.003)/5.2 (p=0.007); and (iii) 21.6 (p<0.001)/11.2 (p<0.001) percentage points. We conclude that movement along the HIV treatment cascade significantly increased the likelihood of contraception, particularly condoms.