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 language | English (US) |
|---|---|
| Pages (from-to) | 225-231 |
| Number of pages | 7 |
| Journal | Contraception |
| Volume | 103 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2021 |
Funding
Funding sources: Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number UM1 AI068634, UM1 AI068636 and UM1 AI106701. This work was also funded in part by the Clinical Sciences Core of the Third Coast Center for AIDS Research (National Institutes of Health [NIH] Grant P30AI117943 and NIH/National Institute of Allergy and Infectious Diseases [NIAID] Grant AI69471 [to S. E. C.]); the Center for AIDS Research at Emory University (NIH Grant P30AI050409); NIH/NIAID Grant K23AI114407 [to A. N. S.]; and Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant 1K23HD078153 [to L. B. H.]). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Keywords
- Antiretroviral therapy
- Clinical trial
- Contraception
- Dual protection
- HIV
- Women's health
ASJC Scopus subject areas
- Obstetrics and Gynecology
- Reproductive Medicine
