Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Division of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.
Acta Obstet Gynecol Scand. 2024 May;103(5):873-883. doi: 10.1111/aogs.14792. Epub 2024 Feb 13.
Highly effective long-acting reversible contraceptive (LARC) methods reduce unintended pregnancy rates; however, these methods are underutilized. The LOWE trial intervention provided structured contraceptive counseling resulting in increased uptake of LARC. This longitudinal follow up of the LOWE study assessed the long-term impact of the intervention by investigating the contraceptive use at 12 months with a focus on continued use of LARC.
In the cluster randomized LOWE trial, abortion, youth, and maternal health clinics were randomized to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of an educational video on contraceptive methods, key questions asked by the health care provider, a tiered effectiveness chart and a box of contraceptive models. Women ≥ age 18, who were sexually active or planned to be in the upcoming 6 months, could participate in the study. We assessed self-reported contraceptive use at three, six and 12 months. Contraceptive choice and switches were analyzed with descriptive statistics. Contraceptive use at 12 months and continued use of LARC were analyzed using mixed logistic regressions, with clinic included as a random effect. Analysis with imputed values were performed for missing data to test the robustness of results.
Overall, at 12 months, women in the intervention group were more likely to be using a LARC method (aOR 1.90, 95% CI: 1.31-2.76) and less likely to be using a short-acting reversible contraceptive (SARC) method (aOR 0.66, 95% CI: 0.46-0.93) compared to the control group. Women counseled at abortion (aOR 2.97, 95% CI: 1.36-6.75) and youth clinics (aOR 1.81, 95% CI: 1.08-3.03) were more likely to be using a LARC method, while no significant difference was seen in maternal health clinics (aOR 1.84, 95% CI: 0.96-3.66). Among women initiating LARC, continuation rates at 12 months did not differ between study groups (63.9% vs. 63.7%). The most common reasons for contraceptive discontinuation were wish for pregnancy, followed by irregular bleeding, and mood changes.
The LOWE trial intervention resulted in increased LARC use also at 12 months. Strategies on how to sustain LARC use needs to be further investigated.
高效长效可逆避孕（LARC）方法可降低意外怀孕率；然而，这些方法的利用率仍然较低。LOWE 试验干预措施提供了结构化的避孕咨询，从而增加了 LARC 的使用。本研究对 LOWE 研究进行了纵向随访，通过调查 12 个月时的避孕使用情况，重点关注 LARC 的持续使用，评估了干预的长期影响。
在这项基于群组的随机 LOWE 试验中，堕胎、青年和母婴保健诊所被随机分配提供结构化避孕咨询（干预组）或标准避孕咨询（对照组）。干预措施包括关于避孕方法的教育视频、医疗保健提供者提出的关键问题、分层效果图表和一盒避孕模型。年龄≥18 岁、有性行为或计划在未来 6 个月内有性行为的女性可以参加这项研究。我们在三个月、六个月和 12 个月时评估自我报告的避孕使用情况。采用描述性统计方法分析避孕选择和转换。采用混合逻辑回归分析 12 个月时的避孕使用情况和 LARC 的持续使用情况，将诊所作为随机效应纳入分析。对缺失数据进行了插补值分析，以检验结果的稳健性。
总体而言，在 12 个月时，与对照组相比，干预组的女性更有可能使用 LARC 方法（aOR 1.90，95%CI：1.31-2.76），而不太可能使用短效可逆避孕方法（SARC）（aOR 0.66，95%CI：0.46-0.93）。在堕胎诊所（aOR 2.97，95%CI：1.36-6.75）和青年诊所（aOR 1.81，95%CI：1.08-3.03）接受咨询的女性更有可能使用 LARC 方法，而在母婴保健诊所则没有显著差异（aOR 1.84，95%CI：0.96-3.66）。在开始使用 LARC 的女性中，12 个月时的继续使用率在研究组之间没有差异（63.9% vs. 63.7%）。避孕措施停止的最常见原因是希望怀孕，其次是不规则出血和情绪变化。
LOWE 试验干预措施导致 12 个月时 LARC 的使用也有所增加。需要进一步研究如何维持 LARC 的使用。
