A systematic review of contraceptive continuation among women living with HIV

Todd, Catherine S.; Anderman, Tracy C.; Long, Sarah; Myer, Landon; Bekker, Linda‐Gail; Petro, Gregory; Jones, Heidi E.

doi:10.1016/j.contraception.2018.02.002

Cited by 9 publications

(9 citation statements)

References 86 publications

(266 reference statements)

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“…Consistent with other estimates of contraceptive use in South Africa, few women in our study were using a reliable method of contraception to prevent pregnancy at enrollment. Low uptake of hormonal contraception may reflect fear of side effects or health risks (e.g., heavy menstrual bleeding, irregular bleeding, bleeding between periods, lower abdominal pain), which are strongly associated with contraceptive discontinuation or switching in HIV-positive women [31,32,33]. Limited uptake or method discontinuation may also reflect structural barriers such as long clinic wait times [17,18] or other unknown factors, as well as additional fears around side effects resulting from ART/contraceptive drug interactions [34].…”

Section: Discussionmentioning

confidence: 99%

Longitudinal patterns of unmet need for contraception among women living with HIV on antiretroviral therapy in South Africa

et al. 2018

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ObjectivesFertility intentions and contraceptive use are often not assessed in the context of clinical HIV care, representing a possible programming gap if women’s family planning needs change over time. We aimed to identify longitudinal patterns of unmet need for contraception over a 12-month period among women living with HIV taking antiretroviral therapy (ART).Study design850 non-pregnant, HIV-positive women aged 18–35 on or initiating ART in Johannesburg, South Africa, were enrolled into a prospective cohort study in 2009–2010. Fertility intentions and contraceptive use were assessed during routine HIV care visits via an interviewer-administered questionnaire, and women were referred for on-site contraceptive counseling. We used group-based trajectory modeling to identify patterns of unmet need for contraception over 12 months, first in the entire population and then in a subset of recent ART initiators.ResultsIn the full population we identified four patterns of unmet need for contraception over one year. Half of the enrolled women were predicted to have a consistently high probability of unmet need, 22.9% a consistently low probability, 16.7% a decreasing probability, and 10.4% an increasing probability over time. Contraceptive method discontinuation and rapidly changing fertility intentions were the primary drivers of changing (increasing or decreasing) unmet need over follow-up. Results were similar in recent ART initiators.ConclusionsHalf of women were estimated to have a high probability of unmet need that persisted over time, and more than a quarter were estimated to experience patterns of changing unmet need over 12 months. Family planning needs should be assessed more regularly in HIV-positive women to prevent unintended pregnancies and support safer conception among women trying to conceive.

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Section: Discussionmentioning

confidence: 99%

Longitudinal patterns of unmet need for contraception among women living with HIV on antiretroviral therapy in South Africa

et al. 2018

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“…Strides have been made in achieving universal access to antiretroviral therapy (ART), improving the quality of life and years of reproductive potential for women living with HIV (WLHIV) ( 2 ). Similar strides remain to be realized for family planning, especially for WLHIV, who are less likely to use any contraception, more likely to rely on condoms alone, and more likely to experience unintended pregnancy, compared with HIV-negative women ( 3 – 5 ).…”

Section: Introductionmentioning

confidence: 98%

Preferences for Multipurpose Technology and Non-oral Methods of Antiretroviral Therapy Among Women Living With HIV in Western Kenya: A Survey Study

Bernard

Jakait

Fadel

et al. 2022

Front. Glob. Womens Health

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IntroductionUnderstanding interests in and preferences for multipurpose technology (MPT) for the co-administration of contraception and antiretroviral therapy (ART) and alternative, non-oral ART methods among women living with HIV (WLHIV) is vital to successful implementation of future treatment options, such as long-acting injectable ART.MethodsBetween May 2016 and March 2017 we conducted a cross-sectional telephone survey of 1,132 WLHIV of reproductive potential with prior experience using intermediate- or long-acting contraceptive methods in western Kenya. We present descriptive statistics and multinomial logistic regression to evaluate predictors of interest in specific MPT and non-oral ART methods.ResultsTwo-thirds (67%) reported interest in MPT, with the most common reason for interest being ease of using a single medication for both purposes of HIV treatment and pregnancy prevention (26%). Main reasons for lack of interest in MPT were need to stop/not use contraception while continuing ART (21%) and risk of side effects (16%). Important characteristics of MPT were effectiveness for pregnancy prevention (26%) and HIV treatment (24%) and less than daily dosing (19%). Important characteristics of non-oral ART methods were less than daily dosing (47%), saving time accessing ART (16%), and effectiveness of HIV treatment (15%). The leading preferred methods for both MPT and non-oral ART were injectables (50 and 54%) and implants (32 and 31%). Prior use of a contraceptive implant or injectable predicted interest in similar methods for both MPT and non-oral ART methods, while this relationship did not appear to vary between younger vs. older WLHIV.DiscussionMost WLHIV in western Kenya are interested in MPT for HIV treatment and contraception. Prior exposure to contraceptive implants or injectables appears to predict interest in similar methods of MPT and non-oral ART. Developers of MPT and non-oral ART methods should strongly consider WLHIV's preferences, including their changing reproductive desires.

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“…Subsequently, women living with HIV (WLHIV) must balance contraceptive decision-making with the potential impact of HIV infection on pregnancy outcomes and timing, risk of transmission to partners or infants, and appropriate method choice for prevention of pregnancy and sexually transmitted infections [1,2]. WLHIV discontinue hormonal methods more frequently and may have higher rates of unmet contraceptive need than their uninfected peers [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Safety and continued use of the levonorgestrel intrauterine system as compared with the copper intrauterine device among women living with HIV in South Africa: A randomized controlled trial

Todd¹,

Jones

Langwenya

et al. 2020

PLoS Med

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BackgroundWomen living with HIV (WLHIV) have lower rates of contraceptive use than noninfected peers, yet concerns regarding contraceptive efficacy and interaction with antiretroviral therapy (ART) complicate counseling. Hormonal contraceptives may increase genital tract HIV viral load (gVL) and sexual transmission risk to male partners. We compared gVL, plasma VL (pVL), and intrauterine contraceptive (IUC) continuation between the levonorgestrel intrauterine system (LNG-IUS) and copper intrauterine device (C-IUD) in Cape Town, South Africa. Methods and findingsIn this double-masked, randomized controlled noninferiority trial, eligible WLHIV were ages 18-40, not pregnant or desiring pregnancy within 30 months, screened and treated (as indicated) for reproductive tract infections (RTIs) within 1 month of enrollment, and virologically suppressed using ART or above treatment threshold at enrollment (non-ART). Between October 2013, and December 2016, we randomized consenting women within ART groups, using 1:1 permuted block randomization stratified by ART use,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40], and recent injectable progestin contraceptive (IPC) exposure, and provided the allocated IUC. At all visits, participants provided specimens for gVL (primary outcome), pVL, RTI, and

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A systematic review of contraceptive continuation among women living with HIV

Abstract: Contraceptive continuation among WLHIV differs by method and context. More longitudinal studies with contraceptive continuation as a measured outcome following ≥12months are needed to strengthen integration of RH and HIV care.

Cited by 9 publications

References 86 publications

Longitudinal patterns of unmet need for contraception among women living with HIV on antiretroviral therapy in South Africa

Longitudinal patterns of unmet need for contraception among women living with HIV on antiretroviral therapy in South Africa

Preferences for Multipurpose Technology and Non-oral Methods of Antiretroviral Therapy Among Women Living With HIV in Western Kenya: A Survey Study

Safety and continued use of the levonorgestrel intrauterine system as compared with the copper intrauterine device among women living with HIV in South Africa: A randomized controlled trial

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