Expanding Method Choice in Africa with Long-Acting Methods: IUDs, Implants or Both?

Beňová, Lenka; Cleland, John; Daniele, Marina; Ali, Moazzam

doi:10.1363/43e5217

Cited by 30 publications

(40 citation statements)

References 15 publications

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“…Our findings are strengthened by the inclusion of a variety of contraceptive users across multiple geographic locations including implant users, a group that warrants special attention given the increasing uptake of implants in low‐income countries . The prospective nature of the study design and the inclusion of over 3440 person‐years of follow‐up allowed for more precise ascertainment of the timing of hormonal contraceptive exposure in relation occurrence of STIs.…”

Section: Discussionmentioning

confidence: 80%

Acquisition of Sexually Transmitted Infections among Women Using a Variety of Contraceptive Options: A prospective Study among High‐risk African Women

et al. 2019

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Introduction In many African settings, women concurrently face substantial risk of human immunodeficiency virus type 1 ( HIV ‐1) infection, sexually transmitted infections ( STI s) and unintended pregnancies. Few studies have evaluated STI risk among users of hormonal implants and copper intrauterine devices ( IUD s) although these long‐acting reversible contraceptive methods are being promoted widely because of their benefits. Within a prospective study of women at risk for HIV ‐1, we compared the risk of acquisition of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis among women using different contraceptive methods. Methods MTN ‐020/ ASPIRE was a randomized trial of the dapivirine vaginal ring for HIV ‐1 prevention among 2629 women aged 18 to 45 years from Malawi, South Africa, Uganda and Zimbabwe, of whom 2264 used copper IUD s or progestin‐based injectables or implants during follow‐up. Screening for the above STI s occurred semi‐annually. Results Over 3440 person‐years of follow‐up, 408 cases of C. trachomatis (incidence 11.86/100 person‐years), 196 of N. gonorrhoeae (5.70/100 person‐years) and 213 cases of T. vaginalis (6.19/100 person‐years) were detected. C. trachomatis and N. gonorrhoeae incidence were not significantly different across contraceptive methods. T. vaginalis incidence was significantly higher for copper IUD users compared to depot medroxyprogesterone acetate ( DMPA ), implant and norethisterone enanthate users. Conclusion Among African women at high HIV ‐1 risk, STI s were common. Risk of cervical infections did not differ across contraceptive methods. Significantly higher rates of T. vaginalis were observed among progestin‐based methods compared to copper IUD users. Overall, these findings call for more intensive routine screening for STI s, and they support current World Health Organization guidance that women should have a wide range of contraceptive options.

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Section: Discussionmentioning

confidence: 80%

Acquisition of Sexually Transmitted Infections among Women Using a Variety of Contraceptive Options: A prospective Study among High‐risk African Women

et al. 2019

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“…75 However, the predominance of lower cadres of health care workers and peer outreach workers who often staff community-led FSW services may limit the number of staff with specific training and skills for contraception administration, especially when considering voluntary LARCs. 77,78 Physical space with adequate privacy and space for an examination table required for LARC administration may also be limited in drop-in centers. 78 Within the setting of community-based services, means to improve contraception availability and coverage may include task-sharing 79 and collaborations with services already providing family planning or ANC to offer periodic clinics with outside staff within the community-based settings.…”

Section: Discussionmentioning

confidence: 99%

“…77,78 Physical space with adequate privacy and space for an examination table required for LARC administration may also be limited in drop-in centers. 78 Within the setting of community-based services, means to improve contraception availability and coverage may include task-sharing 79 and collaborations with services already providing family planning or ANC to offer periodic clinics with outside staff within the community-based settings. Active, facilitated referrals may reduce the number of women falling through the service gap 80 but may still pose barriers to some women.…”

Section: Discussionmentioning

confidence: 99%

Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study

Bowring

Schwartz

Lyons

et al. 2020

Glob Health Sci Pract

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Female sex workers (FSWs) in Cameroon have unmet need for effective contraception, and experience of unintended pregnancy and pregnancy termination is common. Reducing barriers to accessing high-quality, voluntary family planning services in FSW-focused community services is a key strategy to promote clientcentered care, promote informed choice, reduce unintended pregnancies, and improve quality of life for FSWs. Résumé en français à la fin de l'article.

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“…Injections are the most commonly used and often the only available non‐barrier method in this population but are reported to have acceptability concerns among FSWs due to side effects which interfere with their ability to work . Additional barriers to access and uptake of contraception among FSWs include stigma or refusal of service due to sex work, young age or marital status, limited availability or choice of contraceptive methods, lack of health workers trained in LARC provision and limited knowledge of contraceptive methods .…”

Section: Discussionmentioning

confidence: 99%

HIV pre‐exposure prophylaxis for female sex workers: ensuring women’s family planning needs are not left behind

et al. 2020

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Introduction Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre‐exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs. Discussion FSWs have high unmet need for effective contraception and unintended pregnancy is common in low‐ and middle‐income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk‐taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single‐focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real‐life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two‐fold increase in condomless sex among FSWs on PrEP, which, given low use of non‐barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW‐focused community‐based HIV services is likely to be the most effective model for improving access to non‐barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed. Conclusions As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women’s rights.

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Expanding Method Choice in Africa with Long-Acting Methods: IUDs, Implants or Both?

Cited by 30 publications

References 15 publications

Acquisition of Sexually Transmitted Infections among Women Using a Variety of Contraceptive Options: A prospective Study among High‐risk African Women

Acquisition of Sexually Transmitted Infections among Women Using a Variety of Contraceptive Options: A prospective Study among High‐risk African Women

Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study

HIV pre‐exposure prophylaxis for female sex workers: ensuring women’s family planning needs are not left behind

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