Hormonal Contraceptive Use and Discontinuation Among HIV-Infected Women in Uganda and Zimbabwe

Abstract

Introduction Hormonal contraception (HC) use by HIV-infected women has been identified by the WHO as important strategy for reducing vertical HIV transmission. Little is known about factors associated with HC discontinuation among HIV-infected women. Methods We analyzed data from a prospective study of HC use among 231 HIV-infected oral contraceptive (OC) or injectable depot medroxyprogesterone acetate (DMPA) users in Uganda and Zimbabwe. We used Kaplan-Meier survival curves to estimate the median duration of OC and DMPA use and use of any highly effective contraceptive method. Cox proportional hazards models were used to investigate factors associated with HC discontinuation. Results Median duration was 36 months (95% CI 14, 61) for OC use and 19 months (95% CI 14, 24) for DMPA use. Median duration of any highly effective method was 36 months (95% CI 26, N/A) for OC users and 22 months (95% CI 14, 38) for DMPA users. In multivariable analyses, living in Zimbabwe (HR 0.39; 95% CI 0.18, 0.83), no partner (HR 7.18; 95% CI 3.05, 16.88) and cervical infection (HR 1.99; 95% CI 0.90, 4.41) were associated with OC discontinuation. No partner (HR 2.00; 95% CI 1.12, 3.58), nausea (HR 1.84; 95% CI 1.02, 3.34) and excessive night sweats (HR 1.80; 95% CI 0.95, 3.40) were associated with DMPA discontinuation. Discussion Long-term use of HC methods is acceptable to HIV-infected women. Women discontinue for a variety of reasons, primarily unrelated to HIV. Alternative methods and ongoing contraceptive counseling is essential to reduce unplanned pregnancies and vertical HIV transmission.

Injectable and oral contraception and the incidence and progression of cervical disease in HIV-infected women in South Africa

“…Given the significant burden of both HIV and HPV in South Africa, and recommendations of increased integration of hormonal contraception with HIV care [17,19,39], we investigated whether use of hormonal contraception was associated with increased incidence or progression of cervical disease in a cohort of HIV-positive women in Johannesburg, South Africa.…”

Factors associated with discussion of sexual activity and contraception in women with HIV

“…The literature demonstrates that the decisions that women living with HIV make regarding contraceptives are often unrelated to the virus 9. These decisions, and the likelihood of compliance with the chosen method, are often multifaceted and are affected by socioeconomic status, partnership characteristics, past contraceptive use and pregnancy experience and attitudes 10.…”

Padrões e determinantes das descontinuidades contraceptivas no uso de pílula oral, hormonal injetável e preservativo masculino

“…Estudos que avaliaram diversos MAC simultaneamente observaram maior taxa de descontinuidade justamente quando o MAC era do tipo hormonal injetável (Ali, Cleland, 2005;Moreau, Cleland, Trussell, 2007;Leite, Gupta, 2007;Murphy, Brixner, 2008;Vaughan et al, 2008). (Hassan, El-Nahal, El-Hussinie, 1999;Beksinska, Rees, Smit, 2001;Ali, Cleland, 2005;Tolley et al, 2005;Moreau, Cleland, Trussell, 2007;Ezegwui, Ikeako, Obiora-Okafor, 2012;Bengtson et al, 2013). Entre as brasileiras, os efeitos colaterais foram responsáveis por 27,4% das descontinuidades no primeiro ano de uso (Leite, Gupta, 2007).…”

“…As alterações no sangramento menstrual são mais importantes para as usuárias desse MAC do que de outros MAC hormonais (Tolley et al, 2005;Bengtson et al, 2013). Tolley et al (2005) observaram que, durante os cinco primeiros meses de uso de hormonal injetável, as usuárias apresentaram mais dias de sangramento menstrual (11-12) se comparadas com as de DIU (cinco) e, na análise múltipla, o aumento nos dias de menstruação esteve associado à descontinuidade no seu uso.…”

“…Dessa forma, pelo fato de as inconsistências no uso de MAC serem relativamente comuns (Blanc, Curtis, Croft, 2002;Bradley, Schwandt, Klan, 2009;Moreau et al, 2009;Cleland, Ali, 2010a, 2010bPeipert et al, 2011;Bengtson et al, 2013;Wellings et al, 2015), estudos têm procurado mensurar o quanto mulheres que usam MAC interrompem seu uso a despeito de não quererem engravidar e/ou alternam os tipos de MAC inúmeras vezes, nem sempre com opção por um método de maior eficácia. As descontinuidades no uso de MAC corroboram a ocorrência de gravidezes não desejadas, que representaram 44% das gestações ocorridas nos cinco anos anteriores à PNDS 2006 (Brasil, 2008) e também a ocorrência de abortamentos induzidos (Blanc, Curtis, Croft, 2002;Cleland, Ali, 2004;Creanga et al, 2007;Ali, Cleland, 2010b;Modey, Aryeetey, Adanu, 2014), que resultam em sérias implicações na morbimortalidade maternapor sua restrição legal no Brasil.…”