Efavirenz decreases etonogestrel exposure

Chappell, Catherine A.; Lamorde, Mohammed; Nakalema, Shadia; Chen, Beatrice A.; Mackline, Hope; Riddler, Sharon A.; Cohn, Susan E.; Darin, Kristin M.; Achilles, Sharon L.; Scarsi, Kimberly K.

doi:10.1097/qad.0000000000001591

Cited by 40 publications

(13 citation statements)

References 30 publications

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“…Aside from some reduction in effectiveness due to drug interactions with some drugs, the implant is as much as 180 times more effective than short-acting methods. [18] Even though efavirenz use reduces the effectiveness of the implant, by lowering levels of the active drug in Implanon (etonogestrel), [19,20] the implant still appears more effective in these patients than other contraceptive methods. Relative effectiveness -as well as the likelihood of side-effects -can be hard to convey in counselling.…”

Section: Discussionmentioning

confidence: 99%

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

et al. 2017

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Background. Implanon NXT, a long-acting reversible contraceptive, was introduced in South Africa (SA) in early 2014, aiming to expand the method mix and increase its effectiveness. Initial uptake was high, but has since declined considerably. In these early years after the implant's introduction, it is important to identify reasons for the decline, and remedy gaps in services. Objectives. To determine periods of use, reasons for the use and early removal of the implant Implanon NXT. Methods. In 2016, we recruited 152 women from six clinics in the City of Johannesburg, and six in North West Province, SA. A semistructured interview was administered to 91 women currently using the implant and 61 previous users. We examined user perspectives, factors influencing women's experiences with the implant and reasons for discontinuation. Results. The participants' mean age was 30 years, with only 15% aged <25. Implant uptake was motivated by convenience (less frequent visits required than for short-acting methods) and by favourable views of the method among friends, family and healthcare providers. Only about a quarter of women recalled being counselled pre-insertion about implant effectiveness, and half about side-effects pre-insertion. Among discontinuers, the median time to device removal was 8 months (interquartile range 6 -12), and this was primarily as a result of sideeffects (90%), especially bleeding-pattern changes and headaches. Removals were most common among married and cohabiting women, often ascribed to the effects of bleeding on their sexual relationships. Rumours and misinformation contributed to some removals. Overall, women's experiences with the implant were rated 'good' or 'very good' by 74% of those continuing use, many of whom reported not having experienced any side-effects or that these had diminished over time. Conclusion. Levels of acceptability among continuing users were high, mainly linked to the method's convenience. While early favourable views drove uptake, negative perceptions, if unaddressed, may now undermine services. Deficiencies in counselling around effectiveness and side-effects may extend to contraceptive services more generally. Women require more intensive support when experiencing sideeffects, including effective systematic approaches to ameliorating bleeding and headaches. Implant services could specifically target young women and first-time contraceptive users. These actions together could reverse the persistent decline in implant use in SA.

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Section: Discussionmentioning

confidence: 99%

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

et al. 2017

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“…[73] There are substantial drug interactions between efavirenz and Implanon, considerably reducing drug levels of etonogestrel, the active drug in Implanon. [74][75][76] Interactions between efavirenz and Jadelle appear even more pronounced than with Implanon. [77,78] Women using an implant, who are also taking efavirenz, have higher pregnancy rates than those taking other antiretrovirals.…”

Section: Cmementioning

confidence: 98%

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

et al. 2017

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“…Four PK studies now demonstrate markedly reduced etonogestrel or levonorgestrel concentrations in women concomitantly using efavirenz-containing ART [44–47], with one study documenting three pregnancies among the 20 women using efavirenz-containing ART [45]. The same study also demonstrated statistically nonsignificant higher exposure to levonorgestrel among women concomitantly using nevirapine-containing ART as compared to women not on any ART [45].…”

Section: Current Contraceptive Optionsmentioning

confidence: 99%

Current and future contraceptive options for women living with HIV

Patel

Bukusi

Baeten

2017

Expert Opinion on Pharmacotherapy

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Introduction Among women living with HIV, half of the pregnancies are unintended. Effective contraception can prevent unintended pregnancies and consequently reduce maternal mortality and perinatal transmission of HIV. While contraceptive options available for all women also apply to women living with HIV, specific considerations exist to the use of contraception by women living with HIV. Areas covered First, general principles guiding the use of contraception among women living with HIV are discussed, such as choice, method mix, relative effectiveness, and drug-drug interactions. Second, a detailed discussion of each contraceptive method and issues surrounding the use of that method, such as drug-drug interactions, follows. Third, future contraceptive options in advanced development for use by women or men are briefly discussed. Expert opinion Contraceptive methods available to all women should also be accessible to women living with HIV. When the relative effectiveness of a contraceptive method is reduced, for example due to drug-drug interactions with antiretrovirals, the method should still be made available to women living with HIV with the appropriate information sharing and counseling. Greater research on various aspects of contraceptive use by women living with HIV and more comprehensive testing of co-administration of hormonal contraceptives and common medications used by these women are warranted.

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Efavirenz decreases etonogestrel exposure

Cited by 40 publications

References 30 publications

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

Current and future contraceptive options for women living with HIV

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