Contraceptives among patients on anti-retroviral therapy

By Angella Maris Nantezza


Conceiving yet you are using a long term contraceptive has been a bothering setback for both clients and family planning service providers and it has brought a lot of skepticism towards the effectiveness of family planning. Whereas failure of some methods may be expected to occur in very rare cases, when the numbers become common it is very problematic.

It is even worse if the failure occurs among clients on highly active anti-retroviral therapy (HAART). Whereas studies have indicated that patients on HAART are most likely to use any contraceptive method to avoid unintended pregnancies, failure may reverse this gain in this key population.

The use of Long Acting Reversible Contraceptives (LARC) by people on HAART has been a policy matter for a while because of the advantages the methods confer especially when adherence to treatment is strategic for survival of the client. According to Andia (2008) uptake of contraceptives among patients on HAART, is at 85% much higher than the general population 35%.

The observed cases of HAART clients who conceive while on LARC are commonly on Jadelle and Implanon. Getting pregnant while on LARC has devastated the ladies on HAART and somehow it has affected their treatment.

Sometimes it escalates their ailments and some have lost hope. These failures cast doom on the provision of family planning services especially the use of modern contraceptives at a time where the known traditional barriers still exist.

This has pushed people to abandon their use thus undoing the great gains that have been achieved over time in changing mindsets to the use of family planning. We risk a rise in fertility and the economic uncertainties that comes with unplanned families.

In our health facilities tour across the country to assess the status of family planning services provision, at least 12 cases of failure were reported especially by patients on Implanon and Jadelle. The observed cases were at Kyenjojo hospital, Kyarusozi HC IV in Kyenjojo, Kihiihi HC IV in Kanungu, Kassanda HC III, Kiganda HC III in Mubende, MAZIBA HC III, Bubare HC III, Kaharo HC III, Mparo HC IV in Kabale, Bwera hospital and Kyarumba HC IV in Kasese.

For example a health worker at Kihiihi HC IV received a client (name withheld) who had received 5 year contraceptive which is Jadelle on 30 May 2014. The client conceived in March 2017 and got a miscarriage in June 2017 and a removal of the Jadelle implant and Post Abortion Care (PAC) was conducted at the facility.

Another midwife at Kasanda HC III received seven HAART clients who conceived yet using Implanon just after a period of one year after insertion and they all successfully carried their pregnancies to term.

Whereas such cases of failure have been reported at various family planning units, the causes have not been fully researched on to find out the remedies and course of improvement. Worse still, the adverse cases have not been fully documented and a database created for effective follow up.

Manufacturers should be notified on these failures to allow a meaningful audit into the manufacturing and storage conditions of these contraceptives. The local teams working in the family planning clinics must do due diligence to ensure that the contraceptives are kept well and applied using the set guidelines to avoid user dependent causes of failure like deterioration of the contraceptives.

The writer is a Public Health, Health Communication and Promotion specialist doing consultancy with the Ministry of Health. lourdelangel@gmail.com.