Discontinuation of oral contraceptives and depot medroxyprogesterone acetate among women with and without HIV in Uganda, Zimbabwe and Thailand

Nanda, Kavita; Morrison, Charles; Kwok, Cynthia; Byamugisha, Josaphat; Jones, LaShawn B.; Sriplienchan, Somchai; Magwali, Thulani

doi:10.1016/j.contraception.2010.09.003

Cited by 21 publications

(38 citation statements)

References 21 publications

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“…Reasons for contraceptive downgrading in our study were similar to those reported in studies among HIV positive and negative women in developing countries including menstrual irregularities, headaches and dizziness, younger age, desire for fertility, or ceasing sexually activity [23, 30-35]. Counseling women specifically about expected bleeding changes and common side effects from their selected contraceptive method is important, as is correcting misconceptions regarding potential side effects that may be unrelated to contraception.…”

Section: Discussionsupporting

confidence: 79%

“…Comparable to our findings, Nanda et al found 1-year OCP and DMPA continuation rates of 81% and 78%, respectively, in Uganda, Zimbabwe, and Thailand among HIV positive and negative women [23]. The high rates of OCP continuation we observed should be interpreted with caution however, since continuation of and adherence to OCPs were measured by self-report.…”

Section: Discussioncontrasting

confidence: 54%

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Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia

Haddad

Wall

Vwalika³

et al. 2013

Aids

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Objective To describe predictors of contraceptive method discontinuation and switching behaviors among HIV positive couples receiving couples' voluntary HIV counseling and testing services in Lusaka, Zambia. Design Couples were randomized in a factorial design to two family planning educational intervention videos, received comprehensive family planning services, and were assessed every 3-months for contraceptive initiation, discontinuation and switching. Methods We modeled factors associated with contraceptive method upgrading and downgrading via multivariate Andersen-Gill models. Results Most women continued the initial method selected after randomization. The highest rates of discontinuation/switching were observed for injectable contraceptive and intrauterine device users. Time to discontinuing the more effective contraceptive methods or downgrading to oral contraceptives or condoms was associated with the women's younger age, desire for more children within the next year, heavy menstrual bleeding, bleeding between periods, and cystitis/dysuria. Health concerns among women about contraceptive implants and male partners not wanting more children were associated with upgrading from oral contraceptives or condoms. HIV status of the woman or the couple was not predictive of switching or stopping. Conclusions We found complicated patterns of contraceptive use. The predictors of contraception switching indicate that interventions targeted to younger couples that address common contraception-related misconceptions could improve effective family planning utilization. We recommend these findings be used to increase the uptake and continuation of contraception, especially long acting reversible contraceptive (LARC) methods, and that fertility-goal based, LARC-focused family planning be offered as an integral part of HIV prevention services.

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Section: Discussionsupporting

confidence: 79%

Section: Discussioncontrasting

confidence: 54%

Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia

Haddad

Wall

Vwalika³

et al. 2013

Aids

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“…Reasons for nonadherence to either method in our study were similar to those reported among healthy and HIV-positive women in developing countries [5,21,22], including menstrual irregularities, desire for fertility or no current sexual activity [21,23–25]. Partners’ desire to discontinue contraception was also common.…”

Section: Discussionsupporting

confidence: 79%

Contraceptive adherence among HIV-infected women in Malawi: a randomized controlled trial of the copper intrauterine device and depot medroxyprogesterone acetate

et al. 2013

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Objective To evaluate contraceptive adherence to the copper intrauterine device (Cu-IUD) and the injectable depot medroxyprogesterone acetate (DMPA) among women with HIV in Lilongwe, Malawi. Methods We randomized 200 HIV-infected women on HAART to either the Cu-IUD or DMPA and followed these women prospectively, evaluating adherence and factors associated with nonadherence. Results There was no difference in contraceptive adherence: 68% of Cu-IUD and 65% of DMPA users were adherent at 48 weeks. Receiving first-choice contraceptive was not associated with adherence. Women commonly cited partner’s disapproval as an indication for discontinuation. Women who experienced heavy menstruation and first-time contraceptive users were more likely to be nonadherent. Among ongoing users at study conclusion, 95% were happy with their method, and 98% would recommend their method to a friend. Conclusion Contraceptive adherence between the Cu-IUD and DMPA was similar at 1 year. With similar adherence and similar high rates of satisfaction among users of both methods at 1 year, the Cu-IUD offers a hormone-free alternative to DMPA. Implications Adherence to the Cu-IUD and DMPA is similar at 1 year among HIV-infected women on HAART in a randomized controlled trial. Despite high method satisfaction, partner disapproval and heavy bleeding contribute to reduced adherence. Receiving a method that differs from participant’s first-choice method did not influence adherence.

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“…Data from Thailand, Uganda and Zimbabwe showed that women who chose DMPA as their contraceptive usually aimed to achieve long-term contraception, whereas those who chose combined oral contraceptive pills tended to use them as reversible or shorter term contraception. 24 Therefore, this protective effect of DMPA on the risk of developing EOC may be of clinical significance in the real-life use of contraception, and should be considered an important non-contraceptive benefit of DMPA. It should be noted that breastfeeding also has a protective effect.…”

Section: Discussionmentioning

confidence: 99%

Depot medroxyprogesterone acetate and epithelial ovarian cancer: a multicentre case–control study

Wilailak

Vipupinyo

Suraseranivong³

et al. 2012

BJOG

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Objective To evaluate the effect of depot medroxyprogesterone acetate (DMPA) in protecting against epithelial ovarian cancer (EOC) and to evaluate factors associated with the risk of EOC.Design A multicentre, case-control study.Setting Twelve hospitals located across Thailand.Population Three hundred and thirty patients with EOC ('cases') and 982 matched controls were recruited from the 12 hospitals. Cases were newly diagnosed patients with EOC, demonstrated pathologically. Controls were age-matched patients admitted to different wards in the same hospital.Methods Cases and controls were interviewed by trained interviewers using a standardised pre-tested questionnaire. The factors associated with EOC were evaluated using univariate and multivariate analyses.Main outcome measures The odds ratio (OR) and 95% confidence interval (95% CI) were calculated to assess the relationship between DMPA and EOC.Results The use of DMPA was found to be associated with a 39% reduction in the risk of EOC with an OR of 0.61 and a 95% CI of 0.44-0.85 (P = 0.002). A significant risk reduction (83%) was observed when the duration of DMPA use was >3 years (OR 0.17; 95% CI 0.07-0.39; P < 0.001). Other factors associated with a reduced risk of EOC were the use of combined oral contraceptive pills and breastfeeding. A factor associated with an increased risk of EOC was a family history of gynaecological cancer. ConclusionsThe results suggest that DMPA may have a protective effect against EOC. If this effect is real, then it represents an important non-contraceptive benefit of DMPA.

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Discontinuation of oral contraceptives and depot medroxyprogesterone acetate among women with and without HIV in Uganda, Zimbabwe and Thailand

Cited by 21 publications

References 21 publications

Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia

Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia

Contraceptive adherence among HIV-infected women in Malawi: a randomized controlled trial of the copper intrauterine device and depot medroxyprogesterone acetate

Depot medroxyprogesterone acetate and epithelial ovarian cancer: a multicentre case–control study

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