Study area and setting
This study was conducted at Felege Hiwot referral Hospital ART clinic which is located in Bahir Dar City, capital city of Amhara regional State, from June 01th -30th, 2018. Bahir Dar City is located 564 km northwest from Addis Ababa, the capital city of Ethiopia. The Hospital has started providing ART services for free since 2005.the Hospital provides different inpatient and outpatient services to the population of the region including ART and family planning services for clients referred from all district and zonal health care facilities in the Regional State.
Study design and population
An institution-based, cross-sectional study design was used to investigate contraceptive use and its associated factors among HIV positive women attending ART clinic at Felege Hiwot referral Hospital. The source population for this study was all reproductive age (15-49 years old) living with HIV/AIDS who were attending the ART clinic. A total 11,120 people living with HIV were enrolled in ART of the hospital during the study period. Out of these, 50.76% were reproductive age women. All of them were on HAART at the time of the study. Randomly selected sexually active HIV positive women between 15 and 49 years old, available at the time of data collection, who were sexually active in the last six months and who had at least one visit were included in this study. Sexually active HIV positive reproductive age women with surgical removal of uterus, permanent contraception, who were unable to communicate, who were pregnant, who had a known infertility, received service for less than one month and who were below the age of 18 without family or guardian were excluded from the study.
Sample size and sampling procedure
A total sample of 308 was calculated using single population formula; [n=Z2α/2× P (1-P) /d2] ; with the following assumptions. Prevalence of contraceptive use P=76% from previous study conducted in Addis Ababa, Ethiopia, (d) margin of error d=5%, Zα⁄2=1.96 at 95% confidence interval and non-response rate of 10%. We recruited study participants by using simple random sampling method i.e., lottery method. The research team carried out the following activities in the sampling procedure. First, we retrieved the list of female clients from ART service record. Then, we enumerated and listed the numbers of sexually active HIV positive women aged 15-49 years old based on eligibility criteria. A code number was given to each eligible participant and was written on a piece of paper. All pieces of papers were placed into a box. Finally, each pieces of paper were picked randomly until the required sample size was achieved.
The main outcome variable was self-reported contraceptive use of any method. Independent variables included in this study were age of woman, educational level, and number of living children, drinking habit, and partner HIV status, HIV status disclosure to partner, having stable sexual partner, previous contraceptive use, condom use, and having sexual activity in the last six months.
Contraceptive use: Current use of any method by women to delay or avoid pregnancy for the last six months prior to the study commencement.
Consistent condom use: The use of female or male condoms in all vaginal sexual relationships with casual and/or steady partners.
Sexual activity: A woman who had sexual intercourse at list once in the last six months.
Drinking habit: Drinking of alcohol more than 12 drinks per week.
Data collection instrument
The questionnaire had assessed Socio-demographic characteristics, reproductive history, sexual history, contraceptive use and HIV related factors. The questionnaire was developed by organizing variables from previously done researches [5, 23, 24]. First, the developed questionnaire was structured, modified and prepared in English language. Then, language experts translated it to local language (Amharic) and back to English language. The content validity of the questionnaire was assessed by seven experts from the Bahir Dar University Nursing, Public Health, and Midwifery Departments who had more than four years of research experience each. The internal consistencies of all indexes were assessed, and were found to be satisfactory. The team then pre-tested the questionnaire at Addis Alem Hospital, located in Abay Mado, out of the study area with 30 mothers (10% of the sample size). Based on the pre-test results, the questionnaire wording was modified for clarity. Medical records of participants were also reviewed to get clinical information on anti-retroviral treatment and CD4 cell count.
Data collection and data quality assurance
Trained data collectors have collected the data using the pre-tested interviewer administered questionnaire at working hours. Four diploma nurses as data collectors and two Bachelor of Science nurses as supervisors were recruited. Additionally, we gave training for data collectors and supervisors on the overall content of questionnaire, ethical issues, and data collection process for two consecutive days. Assigned supervisors have closely managed the data collection process on daily basis.
Data processing and analysis
The collected data were checked manually for completeness and consistency. Then, coded and entered into EPI Info version 3.5.3 and transferred to SPSS version 20 for analysis. Descriptive statistics were used to summarize sociodemographic characteristics of participants and to show prevalence of contraceptive use. Binary logistic regression analysis was carried out at two levels to identify factors associated with contraceptive use. First, bivariate logistic regression was performed to each independent variable with the outcome variable. Then, variables with p-value < 0.05 in bivariate analysis were included in multivariate analysis. Strength of association was measured using odds ratio and 95% confidence intervals. Finally, statistical significance was declared at p-value <0.05.