Ability and willingness to pay for family planning services in low resource settings: evidence from an operational research

Objective: This paper establishes levels and patterns of ability and willingness to pay (AWTP) for contraceptives, and associated factors. Study design: A three-stage cluster and stratified sampling was applied in selection of enumeration areas, households and individuals in a baseline survey for a 5-year Family planning programme. Multivariable linear and modified Poisson regressions are used to establish factors associated with AWTP. Results: Ability to pay was higher among men (84%) than women (52%). A high proportion of women (96%) and men (82%) were able to pay at least Ug Shs 1000 ($0.27) for FP services while 93% of women and 83% of men who had never used FP services will in future be able to pay for FP services costed at least Shs 2000 ($0.55). The factors independently associated with AWTP were lower age group (<25 years), residence in urban areas, attainment of higher education level, and higher wealth quintiles. Conclusion: AWTP for FP services varied by different measures. Setting the cost of FP services at Shs 1000 ($0.27) will attract almost all women (96%) and most of men (82%). Key determinants of low AWTP include residence in poor regions, being from rural areas and lack of/low education. Implications statement: Private providers should institute price discrimination for FP services by region, gender and socio-economic levels. More economic empowerment for disadvantaged populations is needed if the country is to realise higher contraceptive uptake. More support for total market approach for FP services needed

Prevalence and Factors Associated with Opportunistic Infections in HIV Positive Patients on Antiretroviral Therapy in Uganda.

Introduction: Opportunistic infections (OIs) remain the single main cause of ill-health and death among HIV/AIDS patients in resource poor countries. We assessed the prevalence of 17 OIs and associated factors among HIV positive patients on highly active antiretroviral therapy (HAART) in Uganda. Methods: Observational data from 2004 to 2013 for adult HIV positive patients (>=15yrs) obtaining care and treatment from the AIDS support organization (TASO) in Uganda were reviewed. Electronic data were obtained from TASO HIV clinics representing 4 different geographical areas of Uganda. Descriptive statistics were summarized in terms of frequencies and percentages. Logistic regression was used to assess the factors associated with occurrence of OIs. Results: Between 2004 and 2013, a total of 36,133 HIV patients were enrolled on HAART of which two thirds (66%) were female and one third (34%) were male. In univariate analysis, significant differences were observed between male and female ART clients with men being older (median age 36yrs IQR 29-43 vs 32 yrs IQR 26-39, p<0.0001); likely to be more educated(>secondary 31% vs 19%, p<0.0001); likely to be more severely ill(CD4 count<100 26% vs 21%, p<0.0001); were more likely to be married (65% vs 42%, p<0.0001) and were more likely to be formally employed (27% vs 12%, p<0.0001). Mean annual prevalence for any OI in 2004 was 57.6% and in 2013 was 27.5% (X2 trend = 122, b= -0.0283, p <0.0001). The most commonly encountered OIs were geohelminths (35%), diarrhea<1 month (18%) and mycobacterium tuberculosis (11%). Factors associated with any OI after HAART were male gender, if from Northern Uganda, low education (<primary), baseline WHO stages III&IV, stavudine ART regimen, baseline CD4 count <100cells/μl, low baseline weight <55 kg and period 2004-2008 (p<0.05). Conclusion and Recommendations: In these settings, the burden of OIs is still high in spite of increased access to HAART. The prevalence of geohelminthes and diarrhoea is worrying among HIV patients on HAART. Men remain at greater risk of OIs and should be the main target for early HAART initiation.

Use of HIV-related services and modern contraception among women of reproductive age, Rakai Uganda

Voluntary counseling and testing (VCT) and HIV care (HIVC) can be an opportunity for reproductive health messages and services integration. The objective of this study is to assess the association between uptake of HIV-related services and use of modern contraception among reproductive-age women. Data are derived from community cohort data, where HIV+ respondents were referred to the Rakai Health Sciences program's HIVC clinic. Use of modern contraceptive and VCT receipt were by self-report. Multinomial logistic regression was used to estimate relative risk ratios (RRR) of contraception use by HIVC and VCT. Receipt of VCT was significantly associated with higher use of condoms for FP, adj.RRR 1.78 (1.07, 2.95), and other modern contraceptives, adj.RRR=1.56(1.15, 2.11). Increasing level of HIVC was associated with decreasing level of unmet need for contraception. Use of condoms for family planning is common among HIV-related services attendees. Utilization of other modern contraceptive methods needs to be increased (Afr J Reprod Health 2010; 14[4]: 91-101)