Kusemererwa Sylvia, Kansiime Sheila, Nakamanya Sarah, Mbabazi Elizabeth, Fox Julie, McCormack Sheena, Kaleebu Pontiano, Ruzagira Eugene
Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Plot 51-59, Nakiwogo Road, Entebbe, Uganda.
London School of Hygiene and Tropical Medicine, London, UK.
Reprod Health. 2024 Dec 27;21(1):199. doi: 10.1186/s12978-024-01942-7.
HIV prevention trials usually require that women of childbearing potential use an effective method of contraception. This is because the effect of most investigational products on unborn babies is unknown. We assessed contraceptive use, prevalence and incidence of pregnancy and associated factors among women in a HIV vaccine preparedness study in Masaka, Uganda.
HIV sero-negative women (18-45 years) at high risk of HIV infection identified through HIV counselling and testing (HCT) were recruited between July 2018 and October 2022. Study procedures included collection of baseline socio-demographics and contraceptive use data, quarterly HCT, counselling on and provision of contraceptive methods onsite/through referral, and 6-monthly urine pregnancy tests. Multivariable Logistic and Poisson regression analyses were conducted to determine factors associated with contraceptive use, prevalence, and incidence of pregnancy.
652 (73%) of 891 women reported contraceptive use at baseline. Contraceptive use was higher in women who were in a relationship/married/cohabiting [adjusted odds ratio (aOR) = 1.60; 95% confidence interval (CI) 1.07-2.40] or divorced/separated/widowed [aOR = 1.86; 95% CI 1.24-2.79] versus those that were single, and among women reporting transactional sex [aOR = 2.10; 95% CI 1.16-3.80] versus those who did not. Baseline pregnancy prevalence was 4% (95% CI 3-6%) and lower in women who reported using long-acting contraceptive methods (aOR = 0.17; 95% CI 0.07-0.39) versus women who did not use these methods. A total of 65 pregnancies over 301.3 person-years of observation (PYO), an incidence rate of 21.6/100 (95% CI 16.9-27.5) PYO, higher among younger women (≤ 24 versus 25 + years, adjusted incidence rate ratio = 1.97; 95% CI 1.15-3.40).
We observed a high pregnancy incidence in this cohort. Innovative strategies that promote sustained and consistent use of highly effective contraceptive methods especially for young women will be critical to the success of HIV prevention trials in this and similar populations.
艾滋病病毒（HIV）预防试验通常要求有生育潜力的女性采用有效的避孕方法。这是因为大多数研究产品对未出生婴儿的影响尚不清楚。我们评估了乌干达马萨卡一项HIV疫苗准备研究中女性的避孕措施使用情况、妊娠患病率和发病率以及相关因素。
2018年7月至2022年10月期间，招募了通过HIV咨询和检测（HCT）确定为HIV血清阴性且感染HIV风险高的18 - 45岁女性。研究程序包括收集基线社会人口统计学和避孕措施使用数据、每季度进行HCT、现场/通过转诊提供避孕方法咨询和供应，以及每6个月进行一次尿妊娠试验。进行多变量逻辑回归和泊松回归分析以确定与避孕措施使用、妊娠患病率和发病率相关的因素。
891名女性中有652名（73%）在基线时报告使用了避孕措施。处于恋爱/已婚/同居关系的女性[调整优势比（aOR）= 1.60；95%置信区间（CI）1.07 - 2.40]或离婚/分居/丧偶的女性[aOR = 1.86；95% CI 1.24 - 2.79]的避孕措施使用率高于单身女性，报告有交易性行为的女性[aOR = 2.10；95% CI 1.16 - 3.80]高于未报告的女性。基线妊娠患病率为4%（95% CI 3 - 6%），报告使用长效避孕方法的女性患病率低于未使用这些方法的女性（aOR = 0.17；95% CI 0.07 - 0.39）。在301.3人年的观察期内共发生65例妊娠，发病率为21.6/100人年（95% CI 16.9 - 27.5），年轻女性（≤24岁与25岁及以上相比，调整发病率比 = 1.97；95% CI 1.15 - 3.40）的发病率更高。
我们在该队列中观察到较高的妊娠发病率。创新策略促进高效避孕方法的持续和一致使用，特别是对于年轻女性，对于此类及类似人群中HIV预防试验的成功至关重要。
