Contraception methods used among women with HIV starting antiretroviral therapy in a large United States clinical trial, 2009–2011

Anandi N. Sheth*, Christine D. Angert, Lisa B. Haddad, C. Christina Mehta, Susan E. Cohn

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective(s): We describe contraception and dual method use among women with HIV initiating antiretroviral therapy (ART) in a U.S. clinical trial and examine associated factors. Study design: We analyzed data from ART-naïve women aged 45 years and under initiating one of 3 regimens as part of A5257 (May 2009–June 2011) which required that women at risk for pregnancy use contraception. We classified self-reported methods as more effective (Tier 1 [intrauterine device, hysterectomy, permanent contraception] and Tier 2 [hormonal rings, patches, injections, pills]) versus less effective (Tier 3 [condoms alone] and Tier 4 [withdrawal, none]). We used logistic regression models to assess associations with use of (a) more effective, and (b) dual methods (condoms with a more effective method). Results: Of 285 women, majority were Black (59%), had annual income <$20,000 (54%), and had government insurance (68%). The most common contraceptive methods reported at baseline were permanent contraception (37%), male condoms alone (31%), and injectable progestin (8%); 41% and 16% reported Tier 1 and 2 use, respectively; 36% reported dual method use. Use of more effective and dual methods did not change 48 and 96 weeks after ART initiation (p > 0.05). In multivariable analyses, baseline use of more effective and dual methods was associated with age at least 40 years versus 18 to 29 years (odds ratio [OR] 4.46, 95% confidence interval [CI] 2.12, 9.35) and having at least one child (OR 2.31, 95%CI 1.27, 4.20). Conclusions: In women initiating modern ART in a clinical trial, permanent contraception was common, while use of other more effective contraceptive methods was low and did not change after ART initiation. Efforts are needed to improve integration of family planning services for women within the context of HIV clinical trials. Implications: The findings highlight the importance of improving integration of HIV and family planning services, including in the context of clinical trials.

Original languageEnglish (US)
Pages (from-to)225-231
Number of pages7
JournalContraception
Volume103
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • Antiretroviral therapy
  • Clinical trial
  • Contraception
  • Dual protection
  • HIV
  • Women's health

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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