Use of long-acting reversible contraception in a cluster-random sample of female sex workers in Kenya.

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OBJECTIVE:
To assess correlates of long-acting reversible contraceptive (LARC) use, and explore patterns of LARC use among female sex workers (FSWs) in Kenya.
METHODS:
Baseline cross-sectional data were collected between September 2016 and May 2017 in a cluster-randomized controlled trial in Mombasa. Eligibility criteria included current sex work, age 16-34 years, not pregnant, and not planning pregnancy. Peer educators recruited FSWs from randomly selected sex-work venues. Multiple logistic regression identified correlates of LARC use. Prevalence estimates were weighted to adjust for variation in FSW numbers recruited across venues.
RESULTS:
Among 879 participants, the prevalence of contraceptive use was 22.6% for implants and 1.6% for intra-uterine devices (IUDs). LARC use was independently associated with previous pregnancy (adjusted odds ratio for one pregnancy, 11.4; 95% confidence interval, 4.25-30.8), positive attitude to and better knowledge of family planning, younger age, and lower education. High rates of adverse effects were reported for all methods.
CONCLUSION:
The findings suggest that implant use has increased among FSWs in Kenya. Unintended pregnancy risks remain high and IUD use is negligible. Although LARC rates are encouraging, further intervention is required to improve both uptake (particularly of IUDs) and greater access to family planning services.

KEYWORDS:
Cluster-randomized design; Complex sampling; Contraceptive implant; Intra-uterine device; Kenya; Long-acting reversible contraception; Sex work

Authors & affiliation: 
Ampt FH1,2, Lim MSC1,2,3, Agius PA1,2,4, Chersich MF5,6, Manguro G7, Gichuki CM7, Stoové M1, Temmerman M7,6,8, Jaoko W9, Hellard M1, Gichangi P7,9, Luchters S1,2,6,8. Author information 1 Burnet Institute, Melbourne, SA, Australia. 2 School of Public Health and Preventive Medicine, Monash University, Melbourne, SA, Australia. 3 Melbourne School of Global and Population Health, University of Melbourne, Melbourne, SA, Australia. 4 Judith Lumley Centre, La Trobe University, Melbourne, SA, Australia. 5 Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa. 6 International Centre for Reproductive Health, Department of Primary Care and Public Health, Ghent University, Ghent, Belgium. 7 International Centre for Reproductive Health, Mombasa, Kenya. 8 Aga Khan University, Nairobi, Kenya. 9 University of Nairobi, Nairobi, Kenya.
Ranking: 
Published In: 
Int J Gynaecol Obstet. 2019 Aug;146(2):184-191. doi: 10.1002/ijgo.12862. Epub 2019 Jun 17.
Publication date: 
Monday, June 17, 2019