赞比亚接受整合艾滋病毒咨询、检测和计划生育服务的艾滋病毒阳性夫妇中的非意愿妊娠。
Unintended pregnancy among HIV positive couples receiving integrated HIV counseling, testing, and family planning services in Zambia.
机构信息
Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America ; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
出版信息
PLoS One. 2013 Sep 30;8(9):e75353. doi: 10.1371/journal.pone.0075353. eCollection 2013.
OBJECTIVE
We describe rates of unintended pregnancy among HIV positive couples in Lusaka, Zambia. We also identify factors associated with unintended pregnancy among oral contraceptive pill (OCP) using couples in this cohort.
DESIGN
Data were analyzed from couples randomized in a factorial design to two family planning intervention videos.
METHODS
Rates of unintended pregnancy were stratified by contraceptive method used at time of pregnancy. Predictors of time to unintended pregnancy among OCP users were determined via multivariate Cox modeling.
RESULTS
The highest rates of unintended pregnancy were observed among couples requesting condoms only (26.4/100CY) or OCPs (20.7/100CY); these rates were not significantly different. OCP users accounted for 37% of the couple-years (CY) observed and 87% of unintended pregnancies. Rates of unintended pregnancy for injectable (0.7/100CY) and intrauterine device (1.6/100CY) users were significantly lower relative to condom only users. No pregnancies occurred among contraceptive implant users or after tubal ligation. Factors associated (p<0.05) with time to unintended pregnancy among OCP users in multivariate analysis included the man wanting more children, the woman being HIV negative versus having stage IV HIV disease, and the woman reporting: younger age, no previous OCP use, missed OCPs, or sex without a condom.
CONCLUSIONS
Long-acting reversible contraceptive methods were effective in the context of integrated couples HIV prevention and contraceptive services. Injectable methods were also effective in this context. Given the high user failure rate of OCPs, family planning efforts should promote longer-acting methods among OCP users wishing to avoid pregnancy. Where other methods are not available or acceptable, OCP adherence counseling is needed, especially among younger and new OCP users.
TRIAL REGISTRATION
ClinicalTrials.gov NCT00067522.
目的
我们描述了赞比亚卢萨卡 HIV 阳性夫妇意外怀孕的发生率。我们还确定了在该队列中使用口服避孕药 (OCP) 的夫妇中与意外怀孕相关的因素。
设计
对按因子设计随机分配到两种计划生育干预视频的夫妇进行数据分析。
方法
根据怀孕时使用的避孕方法对意外怀孕率进行分层。通过多变量 Cox 建模确定 OCP 用户意外怀孕时间的预测因素。
结果
仅要求使用避孕套（26.4/100CY）或 OCP（20.7/100CY）的夫妇意外怀孕率最高；这些比率没有显着差异。OCP 用户占观察到的夫妇年数 (CY) 的 37%和意外怀孕的 87%。与仅使用避孕套的用户相比，注射用避孕药 (0.7/100CY) 和宫内节育器 (1.6/100CY) 用户的意外怀孕率显着降低。避孕药具使用者或输卵管结扎后均未发生妊娠。多变量分析中与 OCP 用户意外怀孕时间相关的因素（p<0.05）包括男方想要更多孩子、女方 HIV 阴性与 HIV 疾病 IV 期、以及女方报告：年龄较小、以前从未使用过 OCP、漏用 OCP 或未使用避孕套进行性行为。
结论
长效可逆避孕方法在综合夫妇 HIV 预防和避孕服务中是有效的。在这种情况下，注射用方法也很有效。鉴于 OCP 的使用者失败率较高，计划生育工作应在希望避免怀孕的 OCP 用户中推广更长效的方法。在其他方法不可用或不可接受的情况下，需要提供 OCP 依从性咨询，特别是在年轻和新使用 OCP 的用户中。
试验注册
ClinicalTrials.gov NCT00067522。
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