Hubacher David, Spector Hannah, Monteith Charles, Chen Pai-Lien
FHI 360, 359 Blackwell Street, Suite 200, Durham, NC 27701.
Planned Parenthood South Atlantic, 100 S. Boylan Avenue, Raleigh, NC 27603.
Contraception. 2018 Jun;97(6):524-532. doi: 10.1016/j.contraception.2018.02.001. Epub 2018 Feb 19.
To measure the 24-month impact on continuation, unintended pregnancy and satisfaction of trying long-acting reversible contraception (LARC) in a population seeking short-acting reversible contraception (SARC).
We enrolled 916 women aged 18-29 who were seeking pills or injectables in a partially randomized patient preference trial. Women with strong preferences for pills or injectables started on those products, while others opted for randomization to LARC or SARC and received their methods gratis. We estimated continuation and unintended pregnancy rates through 24months. Intent-to-treat principles were applied after method initiation for comparing incidence of unintended pregnancy. We also examined how satisfaction levels varied by cohort and how baseline negative LARC attitudes were associated with satisfaction over time.
Forty-three percent chose randomization, and 57% chose the preference option. Complete loss to follow-up was<2%. The 24-month LARC continuation probability was 64.3% [95% confidence interval (CI): 56.6-70.9], statistically higher than SARC groups [25.5% (randomized) and 40.0% (preference)]. The 24-month cumulative unintended pregnancy probabilities were 9.9% (95% CI: 7.2-12.6) (preference-SARC), 6.9% (95% CI: 3.3-10.6) (randomized-SARC) and 3.6% (95% CI: 1.8-6.4) (randomized-LARC). Statistical tests for comparing randomized groups on unintended pregnancy were mixed: binomial at 24-month time point (p=.02) and log-rank survival probabilities (p=.14 for first pregnancies and p=.07 when including second pregnancies). LARC satisfaction was high (80% happy/neutral, 73% would use LARC again, 81% would recommend to a friend). Baseline negative attitudes toward LARC (27%) were not clearly associated with satisfaction or early discontinuation.
The decision to try LARC resulted in high continuation rates and substantial protection from unintended pregnancy over 24months. Despite participants' initial desires to begin short-acting regimens, they had high satisfaction with LARC. Voluntary decisions to try LARC will benefit large proportions of typical SARC users.
Even women who do not necessarily view LARC as a first choice may have a highly satisfying experience and avoid unintended pregnancy if they try it.
评估长效可逆避孕法（LARC）对寻求短效可逆避孕法（SARC）人群在24个月内的持续使用情况、意外妊娠情况及满意度的影响。
我们在一项部分随机的患者偏好试验中纳入了916名年龄在18至29岁之间、寻求口服避孕药或注射用避孕药的女性。对口服避孕药或注射用避孕药有强烈偏好的女性开始使用这些产品，而其他女性则选择随机分配至LARC组或SARC组，并免费获得相应避孕方法。我们估计了24个月内的持续使用率和意外妊娠率。在开始使用避孕方法后应用意向性分析原则来比较意外妊娠的发生率。我们还研究了不同队列的满意度如何变化，以及基线时对LARC的负面态度随时间与满意度之间的关联。
43%的女性选择随机分组，57%的女性选择偏好选项。随访完全失访率<2%。24个月时LARC的持续使用概率为64.3%[95%置信区间（CI）：56.6 - 70.9]，在统计学上高于SARC组[25.5%（随机分组）和40.0%（偏好组）]。24个月时累积意外妊娠概率分别为9.9%（95%CI：7.2 - 12.6）（偏好组 - SARC）、6.9%（95%CI：3.3 - 10.6）（随机分组组 - SARC）和3.6%（95%CI：1.8 - 6.4）（随机分组组 - LARC）。比较随机分组组意外妊娠情况的统计学检验结果不一：在24个月时间点采用二项式检验（p = 0.02），采用对数秩生存概率检验（首次妊娠时p = 0.14，包括第二次妊娠时p = 0.07）。LARC的满意度较高（80%满意/中立，其中73%会再次使用LARC，81%会推荐给朋友）。基线时对LARC的负面态度（27%）与满意度或早期停用之间没有明显关联。
尝试使用LARC的决定导致了较高的持续使用率，并在24个月内为预防意外妊娠提供了实质性保护。尽管参与者最初希望开始使用短效避孕方案，但他们对LARC的满意度很高。自愿尝试LARC的决定将使很大一部分典型的SARC使用者受益。
即使那些不一定将LARC视为首选的女性，如果尝试使用，也可能会有非常满意的体验并避免意外妊娠。
