A couples-based intervention and postpartum contraceptive uptake in Zambézia Province, Mozambique

Abstract

Postpartum contraceptive uptake reduces short interpregnancy intervals, unintended pregnancies, and their negative sequalae: poor maternal and fetal outcomes. Healthy timing and spacing of pregnancy in people with HIV also allows for time to achieve viral suppression to reduce maternal-to-child HIV transmission. There is scant understanding about how couples-based interventions impact postpartum contraceptive uptake for pregnant people with HIV in sub-Saharan Africa. This project supplements the Homens para Saúde Mais (HoPS+) [Men for Health Plus] trial, a cluster randomized controlled trial to improve maternal HIV treatment uptake via couples-based HIV care and enhanced male partner support in Zambézia Province, Mozambique. It included 887 female participants who delivered before November 30, 2020. Couples in the HoPS+ intervention group (n = 416) received joint – as opposed to individual – HIV-management, six counseling and skills sessions, and nine sessions with a peer support couple. I used thematic analysis to qualitatively explore perceptions of, attitudes towards, and experiences with contraceptive use among 38 female and 26 male HoPS+ participants (Aim 1). I incorporated their attitudes and perspectives about postpartum contraceptive uptake into a model that can guide future interventions to increase uptake in the region. I then used marginalized multilevel models to assess impact of randomization to the HoPS+ intervention arm on modern postpartum contraceptive uptake after from live birth (Aim 2). After multiply imputing missing data and clustering on clinic site, I found evidence the randomization into the HoPS+ intervention arm was associated with a slightly increased, but not meaningful, odds of modern postpartum contraceptive use (Odds Ratio [OR]: 1.34, 95% Confidence Interval [CI]: 0.57, 3.12). Finally, I assessed how attendance at each HoPS+ intervention session, among female and male participants separately, impacted modern postpartum contraceptive uptake in the intervention arm using inverse probability weighting (Aim 3). I found that with each additional counseling and skills session male partners attended, female participants were more likely to use modern contraceptives in the postpartum period (OR: 1.26, 95% CI: 1.09, 1.46). This project expanded the impact of the HoPS+ trial and reinforced the importance of partner inclusion in pregnancy care for people with HIV in the region.