Caplan Margaret R, Landovitz Raphael J, Palanee-Phillips Thesla, Nair Gonasagrie, Mhlanga Felix, Balkus Jennifer E, Riddler Sharon A, Gorbach Pamina M
a Los Angeles Biomedical Research Institute , Harbor-UCLA Medical Center , Torrance.
b David Geffen School of Medicine , University of California , Los Angeles.
AIDS Care. 2019 Jun;31(6):746-753. doi: 10.1080/09540121.2019.1580345. Epub 2019 Feb 13.
Contraceptive adherence during acute and recent HIV-1 infection is important to maternal and child health given the elevated risk of vertical HIV-1 transmission and additional complications of pregnancy. Injectable contraception (IC) is the most common non-barrier modern contraception method used in sub-Saharan Africa (SSA). Adherence to IC after HIV-1 seroconversion is not well understood. We examined factors associated with IC discontinuation among women in SSA diagnosed with HIV-1 infection while participating in a clinical trial of biomedical HIV-1 prevention. After diagnosis with HIV-1 infection in the VOICE trial, 255 women from South Africa, Uganda, and Zimbabwe enrolled in a longitudinal observational study (MTN-015). Contraceptive method was assessed at MTN-015 baseline and at 3, 12, and 24 months post-seroconversion. Correlates of IC discontinuation were examined by Cox proportional hazard modeling. IC use was reported at baseline by 78% of women enrolled (198/255), of which 92% (182/198) completed at least one follow-up visit. Two-thirds of women (66%, 121/182) continued on IC during the follow-up period (median 24 months). Lower rates of IC discontinuation were observed in women who reported having had at least one child (HR 0.39, 95% CI 0.20-0.82) or earning a personal income (HR 0.51, 95% CI 0.30-0.87) at baseline. These findings suggest that many women with HIV-1 infection face complex decision-making regarding family planning in the years that follow seroconversion and highlight that some women may discontinue IC use despite on-site provision of family planning services. Understanding the broader context of family planning choices in recently seroconverted women may be key to more effective linkages between family planning services and HIV-1 testing and care.
鉴于HIV-1垂直传播风险增加以及妊娠的其他并发症，在急性和近期HIV-1感染期间坚持避孕对母婴健康很重要。注射用避孕药（IC）是撒哈拉以南非洲（SSA）最常用的非屏障现代避孕方法。HIV-1血清转化后对IC的依从性尚不清楚。我们研究了在参与生物医学HIV-1预防临床试验时被诊断为HIV-1感染的SSA女性中与停用IC相关的因素。在VOICE试验中被诊断为HIV-1感染后，来自南非、乌干达和津巴布韦的255名女性参加了一项纵向观察性研究（MTN-015）。在MTN-015基线以及血清转化后3个月、12个月和24个月评估避孕方法。通过Cox比例风险模型研究IC停用的相关因素。78%（198/255）登记入组的女性在基线时报告使用IC，其中92%（182/198）完成了至少一次随访。三分之二的女性（66%，121/182）在随访期间（中位时间24个月）继续使用IC。在基线时报告至少有一个孩子（风险比0.39，95%置信区间0.20 - 0.82）或有个人收入（风险比0.51，95%置信区间0.30 - 0.87）的女性中，观察到较低的IC停用率。这些发现表明，许多HIV-1感染女性在血清转化后的几年里面临关于计划生育的复杂决策，并且突出显示尽管现场提供了计划生育服务，但一些女性可能仍会停用IC。了解近期血清转化女性计划生育选择的更广泛背景可能是计划生育服务与HIV-1检测及护理之间更有效联系的关键。
