Audit reviewing contraceptive methods

Published Date: 19th July 2016

Publication Authors: Rimmer K, Pilkington L, Quayle P

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Background

Regular review of contraceptive methods in HIV positive women is important to help prevent on-toward drug interaction and un-intended pregnancies. The British HIV Association (BHIVA) recommends all HIV positive women not on therapy be offered all forms of available contraception and those on therapy to avoid certain hormonal combinations. The aim of the audit was to determine whether the contraceptive needs of HIV positive women attending a sexual health clinic were met in accordance with guidelines.

Methods

All HIV positive women were selected from an electronic patient record (EPR) system. Twelve patients were found. A Microsoft spreadsheet was constructed and the following areas were recorded: length of diagnosis, CD4, Viral Load, HIV regimen, contraceptive method and partner/ child status.

Results

Of the patients reviewed, 10 (83%) were White British, 1 of mixed background (8.5%) and 1 Black African (8.5%). Patients' age ranged between 25 and 50 years, suggesting many will be of child-bearing age. The length of diagnosis ranged from 1996-2014. The majority of women 8 (66.6%) had a CD4 count of >500 and the remaining 4 (33.3%) possessed a CD4 count of <500, the lowest recorded being 102. The viral loads were undetectable in 7 (58%) of the cases, 3 (25%) had low level virus (long-term non-progressors) and 2 (17%) failed to suppress post switching. 9 (75%) women were on HIV therapy and the remaining 3 (25%) were deemed long-term non-progressors not requiring treatment. Of the patients on therapy the regimens included Eviplera, Truvada/ Darunavir/Ritonavir, Striblid, Truvada/Atazanavir /Ritonavir and Darunavir/Maraviroc. 8 (66.6%). Only one (8.5%) patient had a documented form of contraception, the IUD coil in her notes. A quarter of the patients had children who ranged in age from 12 months to 25 years. They all tested negative for HIV. Half of their partners were tested for HIV. 4 (66%) tested positive.

Conclusion

The cohort demonstrated stable well controlled HIV infection on and off therapy however, their contraceptive needs may have been overlooked. There is need for a robust system to ensure all patients where necessary are established on a reliable form of contraception, especially those between age 25-35 years as they all have regular partners.

Friday, D; Baisley, C; Rimmer, K; Pilkington, L; Quayle, P; Muhammad, H. (2015).  An audit reviewing contraceptive methods in a small group of HIV-positive women at a sexual health clinic . HIV Medicine. 16 (Suppl S2), 59

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