Uptake of family planning methods among adults presenting with genital ulcers at community posts and public outpatient health facilities in central Uganda

BACKGROUND: Genital ulcer disease (GUD), a common clinical presentation at health facilities in Uganda, is often caused by sexually transmitted infections (STIs) and increases the risk of HIV. Family planning (FP) methods are effective for preventing unintended pregnancies, while some methods, namely male and female condoms, also reduce the risk of STI transmission. However, little has been documented about FP use among individuals with GUD in Uganda. METHODS: Patients with clinician-confirmed genital ulcers were enrolled for a GUD study at six sites across government clinics and community outreaches in Kampala, Wakiso, and Kalangala, Uganda, between July/2023 and June/2024. Demographic, behavioral, and family planning use data were collected in English and Luganda using prespecified questionnaires. Urine and genital swabs were collected for gonorrhea and chlamydia testing and blood for HIV and syphilis antibodies using rapid diagnostic tests (RDT). Pregnant women were excluded from the analysis. Associations with FP use were explored using rank sum tests, chi-square, and Fisher's exact tests as appropriate. RESULTS: Of 104 participants with confirmed genital ulceration, 75(72.1%) were women, 12(16.0%) of whom were pregnant. Overall, of 92 non-pregnant participants, 36(39.1%) had a reactive HIV RDT; 10(27.8%) were new diagnoses. Nine (9.8%) had positive tests for gonorrhea, chlamydia, or syphilis. No men reported condom use. Of the 63 non-pregnant female participants analyzed, 29(46.0%) reported current FP use. Subdermal implants were the most used method in 15/29(51.7%). Twenty-one (33.3%) reported ≥ 2 sexual partners in the past 3 months. FP use was significantly associated with younger age, being married, transactional sex, ≥ 2 sexual partners in the past 3 months, and being sexually active in the past month. CONCLUSION: More than one-sixth of women with GUD were pregnant. The uptake of FP among individuals with GUD was low, and HIV/STI prevalence was high. Effective FP has a key role in preventing unintended pregnancies and mother-to-child transmission of STIs. These findings highlight the need for educational and policy strategies to increase sensitization on sexual health, including increasing uptake of FP and encouraging male condom use in a population at high risk of STIs.