aRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine bDepartment of Gynecology and Obstetrics, Emory University, School of Medicine cDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA dDepartment of Gynecology and Obstetrics, School of Medicine, University of Zambia, Lusaka, Zambia eDepartment of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama fHubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA gMinistry of Community Development, Mother and Child Health, Lusaka, Zambia.
AIDS. 2013 Oct;27 Suppl 1(0 1):S93-103. doi: 10.1097/QAD.0000000000000039.
To describe predictors of contraceptive method discontinuation and switching behaviours among HIV-positive couples receiving couples' voluntary HIV counselling and testing services in Lusaka, Zambia.
Couples were randomized in a factorial design to two-family planning educational intervention videos, received comprehensive family planning services and were assessed every 3 months for contraceptive initiation, discontinuation and switching.
We modelled factors associated with contraceptive method upgrading and downgrading via multivariate Andersen-Gill models.
Most women continued the initial method selected after randomization. The highest rates of discontinuation/switching were observed for injectable contraceptive and intrauterine device users. Time to discontinuing the more effective contraceptive methods or downgrading to oral contraceptives or condoms was associated with the women's younger age, desire for more children within the next year, heavy menstrual bleeding, bleeding between periods and cystitis/dysuria. Health concerns among women about contraceptive implants and male partners not wanting more children were associated with upgrading from oral contraceptives or condoms. HIV status of the woman or the couple was not predictive of switching or stopping.
We found complicated patterns of contraceptive use. The predictors of contraception switching indicate that interventions targeted to younger couples that address common contraception-related misconceptions could improve effective family planning utilization. We recommend these findings be used to increase the uptake and continuation of contraception, especially long-acting reversible contraceptive (LARC) methods, and that fertility goal based, LARC-focused family planning be offered as an integral part of HIV prevention services.
描述在赞比亚卢萨卡接受夫妇自愿艾滋病毒咨询和检测服务的艾滋病毒阳性夫妇中，避孕方法中断和转换行为的预测因素。
夫妇按照析因设计随机分配到两种计划生育教育干预视频中，接受全面计划生育服务，并每 3 个月评估一次避孕方法的开始、中断和转换。
我们通过多变量 Andersen-Gill 模型对与避孕方法升级和降级相关的因素进行建模。
大多数女性在随机分配后继续使用最初选择的方法。在注射避孕和宫内节育器使用者中，观察到最高的停用/转换率。停止更有效的避孕方法或降级为口服避孕药或避孕套的时间与女性年龄较小、未来一年内想要更多孩子、月经过多、经期之间出血和膀胱炎/尿痛有关。女性对避孕植入物的健康担忧以及男性伴侣不想要更多孩子与从口服避孕药或避孕套升级有关。女性或夫妇的艾滋病毒状况与转换或停止无关。
我们发现避孕方法的使用模式很复杂。避孕转换的预测因素表明，针对年轻夫妇的干预措施，解决常见的避孕相关误解，可以改善有效的计划生育利用。我们建议将这些发现用于增加避孕措施的使用率和持续使用，特别是长效可逆避孕（LARC）方法，并将基于生育目标、以 LARC 为重点的计划生育作为艾滋病毒预防服务的一个组成部分提供。
