BACKGROUND: Women living with HIV (WLHIV) have higher maternal mortality and unintended pregnancy rates than their uninfected counterparts. Incorporating their pregnancy preferences in shared decision-making around reproductive care may improve outcomes, yet such tools are missing. The Desire to Avoid Pregnancy (DAP) scale, the only psychometrically evaluated instrument that captures multifaceted pregnancy preferences, has the potential to fill this gap.
METHODS: As part of the mixed methods study Chaguo Langu -- My Choice, 264 women aged 15-49 years who initiated dolutegravir from October 2017-April 2019 at clinical sites affiliated with the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya answered the DAP scale via telephone. The scale includes three domains: (1) cognitive self-evaluation of preferences; (2) affective feelings; and (3) anticipated practical consequences of pregnancy/childbearing. Item responses use a Likert scale with a final score of 0-4 (higher score reflects higher desire to avoid pregnancy). We also asked the single 'standard' question: 'Are you trying to get pregnant now?' and compared the responses via t-test.
RESULTS: The average DAP score in the overall group was 2.29 (range 0-4). Among the 14% of women who answered 'yes,' they were currently trying to get pregnant, the average score was 0.77 (range 0 to 3.43) compared to 2.53 (range 0.36 to 4) for those who answered 'no' (absolute difference 1.76, 95% CI 1.44-2.07, p-value <0.001; Figure 1).

CONCLUSIONS: WLHIV who report currently trying to get pregnant have lower average scores on the DAP scale compared to those not currently trying to get pregnant. However, among women who report not currently trying to get pregnant, there is wide score range indicating that the DAP is able to better capture nuance and ambivalence about pregnancy preferences than standard one-item questions. These women may benefit from open-ended counseling, including for both contraception and preconceptual care.