Transportation cost as a barrier to contraceptive use among women initiating treatment for HIV in Tanzania

ABSTRACT

Transportation cost is a barrier to HIV treatment, yet no studies have examined its association with contraceptive use among women living with HIV. We analyzed cross-sectional data from women attending three public healthcare facilities in Shinyanga, Tanzania where they initiated antiretroviral therapy for HIV infection in the previous 90 days; all facilities offered free contraception. Women self-reported current contraceptive use and the round-trip cost of transportation to the facility. Among 421 women aged 18–49, 86 (20.4%) were using any modern contraceptive method, of which half were using modern methods other than condoms. Women who paid more than 2,000 Tanzanian shillings for transportation had a significantly lower prevalence of any modern method use than women who paid nothing (9.1% vs. 21.3%; adjusted difference: −12.9; 95% confidence interval: −21.3, −4.4). A similar difference was observed for non-condom modern method use. We conclude that high transportation cost may impede contraceptive use even among women accessing HIV treatment.

KEYWORDS:

• Contraception
• HIV
• food insecurity
• transportation
• PMTCT

Acknowledgements

The authors gratefully acknowledge Carolyn Fahey, Dr. Nancy Czaicki, Dr. Ramadhan Kabala, and Dr. Ntuli Kapologwe for their support of the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Funding for the study is provided by the National Institute of Mental Health (McCoy K01MH094246) and PEPFAR’s Food and Nutrition Technical Working Group. Dr. McCoy received research assistant support from National Institutes of Health Fogarty Grant TW009338. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.