Interactions of hormonal contraceptives and antiretrovirals: Beliefs among ART-initiated women at Family AIDS Care and Education Services (FACES) Clinic in Nairobi, Kenya

Background: While new research has shown that the use of hormonal contraceptives (HC) does not accelerate HIV progression, the issues concerning HIV-positive women using antiretroviral therapy (ART) and HC continue. Currently, within the body of knowledge, little information is available describing HIV+ women's own preferences, perceptions and experiences of hormonal contraception use while on ART. Family planning for HIV-positive women remains an important HIV prevention strategy, reducing unplanned pregnancies, prevention of mother to child transmission as well as adverse health complications, however, more research is needed about FP for women who are on ART. Methods: Between October-November 2010, a qualitative, exploratory study including 20 in-depth interviews, and 3 focus groups (20 participants) was conducted with HIV positive ART-initiated women in Nairobi, Kenya. Purposive sampling was used to recruit representative HC methods based on Kenya DHS data. Data was analyzed with Atlas.ti software. This study investigates the concerns, decision-making factors, and beliefs of women on ART and using HC. Results: Participants reported concerns about interactions of ART and HC, including side effects, pill burden, and drug interactions. These beliefs also led to reported discontinuation of HC methods when initiating on ART. 16% of focus group participants reported switching methods from contraceptive to barrier methods after seroconversion. Conclusion: Interventions are needed that address the beliefs, needs, and decision-making factors of HIV+ women using family planning methods. Understanding the concerns of women on ART and using HC can inform targeted interventions, integration of family planning into HIV care, and relevant policy decisions.