Dual method use among long-acting reversible contraceptive users

Bernard, Caitlin; Zhao, Qiuhong; Peipert, Jeffrey F.

doi:10.1080/13625187.2018.1445850

Cited by 12 publications

(10 citation statements)

References 20 publications

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“…The relationship between wealth and LARC use may vary by locality, 16 and our findings support the need for more investigation into this relationship. Our results also support the association between LARC use and inconsistent condom use, 26,27 which emphasizes the importance of dual protection counseling when implementing family planning interventions in countries with a higher HIV incidence.…”

Section: Resultssupporting

confidence: 81%

Fertility intentions and long-acting reversible contraceptive use among HIV-negative single mothers in Zambia

Kilembe²,

Inambao

et al. 2020

American Journal of Obstetrics and Gynecology

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BACKGROUND: Integrating family planning interventions with HIV studies in developing countries has been shown to prevent mother-to-child HIV transmission and simultaneously reduce HIV and unintended pregnancy in high-risk populations. As part of a prospective cohort study on HIV incidence and risk factors in Zambian women having unprotected sex, we also offered family planning counseling and immediate access to longacting reversible contraceptives. Although long-acting reversible contraceptives are the most effective form of contraception, many Zambian women are limited to oral or injectable methods because of a lack of knowledge or method availability. This project offers to single mothers who are enrolled in a cohort study information about and access to long-acting reversible contraceptives at enrollment and at each follow-up visit. OBJECTIVE: This study evaluates how fertility intentions affect longacting reversible contraceptive use in HIV-negative single mothers in Zambia. Our primary outcome was long-acting reversible contraceptive use throughout the study participation. We also estimated rates of longacting reversible contraceptive uptake and discontinuation. We specifically studied single mothers because they are at high risk for unintended pregnancy, which can have significant negative ramifications on their financial, social, and psychologic circumstances. STUDY DESIGN: From 2012e2017, Zambia Emory HIV Research Project recruited 521 HIV-negative single mothers ages 18e45 years from government clinics in Lusaka and Ndola, Zambia's 2 largest cities. Participants were followed every 3 months for up to 5 years. At each visit, we discussed fertility goals and contraceptive options and offered a longacting reversible method to any woman who was not pregnant or who already was using a long-acting reversible or permanent contraceptive method. Data were collected on demographic factors, sexual behavior, and reproductive history. Multivariable logistic regression was used to model baseline fertility intentions with long-acting reversible contraceptive use. RESULTS: We enrolled 518 women; 57 women did not return for any follow-up visits. There was a significant increase in long-acting reversible contraceptive use during the study. At baseline, 93 of 518 women (18%) were using a long-acting reversible method, and 151 of 461 women (33%) used a long-acting reversible method at the end of follow-up period (P<.0001). Four women chose an intrauterine device, and 91 women chose an implant for their first uptake event. After we adjusted the data for other confounders, we found that women in Ndola who did not desire any more children were more likely to use a long-acting reversible contraceptive (adjusted prevalence ratio, 2.02; 95% confidence interval, 1.88e3.42). During follow up, 37 of 183 long-acting reversible contraceptive users (20%) discontinued their method; women who desired future children at baseline were more likely to discontinue earlier (P¼.016). CONCLUSION: This study demonstrates that integrated family ...

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Section: Resultssupporting

confidence: 81%

Fertility intentions and long-acting reversible contraceptive use among HIV-negative single mothers in Zambia

Kilembe²,

Inambao

et al. 2020

American Journal of Obstetrics and Gynecology

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“…The prevalence of any condom use in the past 6 months was 28.5% among LARC users and 40.0% among non-LARC contraceptive users in our sample. The Contraceptive CHOICE Project, a convenience sample of women ages 14-45 in St. Louis, reported 32% of LARC users reported condom use in the past 6 months (Bernard et al, 2018). Data from the NSFG showed that rates for condom use among IUD/implant users were low in both the interview month (1.8%) and at last intercourse 15 (1.9%) (Pazol, Kramer, & Hogue, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…However, there is concern that individuals may be less likely to use condoms after beginning LARC methods as they may potentially be less worried about unintended pregnancies (Potter & Soren, 2016;Williams & Fortenberry, 2013). Numerous studies on condom use with LARC methods have been conducted among adolescents and young women (Bastow, Sheeder, Guiahi, & Teal, 2018;Steiner, Liddon, Swartzendruber, Rasberry, & Sales, 2016;Thompson et al, 2017;Tyler et al, 2014;Walsh-Buhi & Helmy, 2018) who are disproportionately burdened with STIs and unintended pregnancies, but far fewer studies have been conducted among a broader age range of adults (Bernard, Zhao, & Peipert, 2018;McNicholas, Klugman, Zhao, & Peipert, 2017), especially at the population level. Although women in their late twenties, thirties, and forties have a lower rate of STIs compared to women under 25, their risk is not negligible particularly given the recent annual increases in STIs that affect individuals as well as newborns (i.e., congenital syphilis) (Centers for Disease Control and Prevention, 2019).…”

Section: Dual Larc and Condom Usementioning

confidence: 99%

“…consistent use vs. any use; different timeframes for measurement) (Higgins & Cooper, 2012). Prior research has consistently found condom use to be less frequent among LARC users compared to users of other contraceptive methods (Bastow et al, 2018;Bernard, et al, 2018;Steiner et al, 2016;Walsh-Buhi & Helmy, 2018); thus LARC methods could serve a different purpose for women who cannot use other contraceptive methods (e.g. breastfeeding mothers, women unable to adopt to a method that emphasizes user adherence, those who face partner sabotage).…”

Section: Dual Larc and Condom Usementioning

confidence: 99%

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Long-Acting Reversible Contraceptive Users’ Knowledge, Conversations with Healthcare Providers, and Condom Use: Findings from a U.S. Nationally Representative Probability Survey

Herbenick

Dodge

et al. 2021

International Journal of Sexual Health

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Objectives: To describe long-acting reversible contraceptive (LARC) users' knowledge, patientprovider interactions, and condom use associated with LARC use. Methods: Data are from the 2018 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14-49. Results: Of 1,451 sexually active women, 11.2% used intrauterine devices and 3.1% used implants. Approximately 19-26% of LARC users reported inaccurately on LARC longevity and 30% reported relying on their provider to indicate timing of intrauterine device removal.Consistent condom use among LARC users was rare (6.1%). Conclusions: Our findings have implications for how clinicians educate patients on LARC and condom use.

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“…Behaviorally, women who use modern methods of contraception may have different condom use patterns, sexual frequency and numbers of sexual partners as compared to women not using modern contraception. 4 – 7 Uncontrolled and/or residual confounding due to inaccurate measurement of sexual behavior is a significant concern in evaluating the results of observational studies on the topic – results may be biased toward or away from the null depending on the type and frequency of misreporting or lack of adjustment for salient variables – and studies which randomize women to contraception are lacking. 6 Possible biological mechanisms linking contraceptives and STIs include alteration of the vaginal epithelium, changes in mucus production and in multiple immune responses (eg, production and availability of cytokines, chemokines and relevant cell types in the upper and lower female reproductive tract and alteration of the vaginal microbiota).…”

Section: Introductionmentioning

confidence: 99%

Contraceptive use and the risk of sexually transmitted infection: systematic review and current perspectives

Deese¹,

Pradhan²,

Goetz³

et al. 2018

OAJC

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PurposeEvidence on the association between contraceptive use and risk of sexually transmitted infections (STIs) and bacterial vaginosis (BV) is lacking, with few prospective studies. We systematically reviewed the last 10 years’ evidence on the association between contraception and STI/BV, building on the most recent systematic reviews published in 2006 and 2009.MethodsWe searched the MEDLINE and POPLINE databases for peer-reviewed articles p ublished between January 1, 2008 and January 31, 2018 reporting prospective studies that assessed the association between contraceptive use and incident STI and/or incident or recurrent BV.ResultsWe identified 33 articles that evaluated combined oral contraceptives (COC), depot medroxyprogesterone acetate (DMPA), the copper intrauterine device (Cu-IUD), the levonorgestrel intrauterine system (LNG-IUS) and other methods. The strength of the evidence for many specific contraceptive method/STI associations is limited by few prospective studies with comparably defined exposures and outcomes. Available data suggest no association of COCs and Neisseria gonorrhoeae, Trichomonas vaginalis, HSV-2 or syphilis, and mixed evidence on the association with HPV, Chlamydia trachomatis, and BV. For DMPA, none of the studies identified found an association with N. gonorrhoeae or syphilis, and data on C. trachomatis, T. vaginalis, HPV and BV were mixed. Two large studies showed a highly clinically significant increased risk of HSV-2 infection with DMPA use. Data on the effect of Cu-IUD and the LNG-IUS on the acquisition of C. trachomatis, N. gonorrhoeae and T. vaginalis are sparse, and data on HPV and BV are mixed.ConclusionFew data are available from prospective studies, including randomized trials, to draw strong conclusions about the relationships between contraceptive methods and specific STIs. The overall evidence on the association between contraceptive use and STI/BV risk is limited by the lack of any randomized trials, few published prospective studies designed to analyze these associations, wide variability in exposure definitions and comparator groups, potential for confounding due to inaccurate sexual behavior data, differential confounder adjustment and differences in study populations and sizes. Despite these limitations, new evidence is supportive of a significantly increased risk of HSV-2 infection among DMPA users which warrants additional research to better understand this association.

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Dual method use among long-acting reversible contraceptive users

Abstract: Clinicaltrials.gov Identifier NCT01986439.

Cited by 12 publications

References 20 publications

Fertility intentions and long-acting reversible contraceptive use among HIV-negative single mothers in Zambia

Fertility intentions and long-acting reversible contraceptive use among HIV-negative single mothers in Zambia

Long-Acting Reversible Contraceptive Users’ Knowledge, Conversations with Healthcare Providers, and Condom Use: Findings from a U.S. Nationally Representative Probability Survey

Contraceptive use and the risk of sexually transmitted infection: systematic review and current perspectives

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