Contraceptive Use and Pregnancy Incidence among Women Participating in an HIV Prevention Trial

Carolyne A. Akello, Katherine E. Bunge, Clemensia Nakabiito, Brenda G. Mirembe, Mary Glenn Fowler, Anupam Mishra, Jeanne Marrazzo, Zvavahera M. Chirenje, Connie Celum, Jennifer E. Balkus

Research output: Contribution to journalArticle

Abstract

Background: Recent HIV prevention trials required use of effective contraceptive methods to fulfill eligibility for enrollment. We compared pregnancy rates in a subset of participants enrolled in the Microbicide Trials Network protocol (MTN-003), a randomized trial of chemoprophylaxis to prevent HIV acquisition among women aged 18-45 years who initiated depot medroxyprogesterone acetate (DMPA) or combined oral contraceptives (COCs) at enrollment, relative to those already using DMPA or COCs. Methods: Data were analyzed from MTN-003 participants from Uganda. Before enrollment, information on contraceptive type and initiation date was obtained. Urine pregnancy tests were performed at monthly follow-up visits. Cox proportional hazards models were used to compare pregnancy incidence among new users (initiated ≤60 days before enrollment) and established users (initiated >60 days before enrollment). Results: Of 322 women enrolled, 296 were COC or DMPA users, 82 (28%) were new users, and 214 (72%) were established users. Pregnancy incidence was higher among new contraceptive users compared to established users (20.70% vs. 10.55%; adjusted hazard ratio [HR] = 1.66; 95% confidence interval [95% CI] 0.93-2.96). Among DMPA users, pregnancy incidence was 10.20% in new users versus 3.48% in established users (HR = 2.56; 95% CI 0.86-7.65). Among new COC users, pregnancy incidence was 42.67% in new users versus 23.67% in established COC users (adjusted HR = 1.74; 95% CI 0.87-3.48). Conclusions: New contraceptive users, regardless of method, at the Uganda MTN-003 site had an increased pregnancy risk compared to established users, which may be due to contraceptive initiation primarily for trial eligibility. New users may benefit from intensive contraceptive counseling and additional contraceptive options, including longer acting reversible contraceptives.

Original languageEnglish (US)
Pages (from-to)670-676
Number of pages7
JournalJournal of Women's Health
Volume26
Issue number6
DOIs
StatePublished - Jun 1 2017

Fingerprint

Contraceptive Agents
Contraceptives, Oral, Combined
HIV
Medroxyprogesterone Acetate
Pregnancy
Incidence
Uganda
Confidence Intervals
Pregnancy Tests
Chemoprevention
Pregnancy Rate
Clinical Protocols
Anti-Infective Agents
Contraception
Proportional Hazards Models
Counseling
Urine

Keywords

  • contraceptive initiation
  • DMPA
  • HIV prevention
  • Hormonal contraception
  • oral contraception
  • Uganda

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Akello, C. A., Bunge, K. E., Nakabiito, C., Mirembe, B. G., Fowler, M. G., Mishra, A., ... Balkus, J. E. (2017). Contraceptive Use and Pregnancy Incidence among Women Participating in an HIV Prevention Trial. Journal of Women's Health, 26(6), 670-676. https://doi.org/10.1089/jwh.2016.5958

Contraceptive Use and Pregnancy Incidence among Women Participating in an HIV Prevention Trial. / Akello, Carolyne A.; Bunge, Katherine E.; Nakabiito, Clemensia; Mirembe, Brenda G.; Fowler, Mary Glenn; Mishra, Anupam; Marrazzo, Jeanne; Chirenje, Zvavahera M.; Celum, Connie; Balkus, Jennifer E.

In: Journal of Women's Health, Vol. 26, No. 6, 01.06.2017, p. 670-676.

Research output: Contribution to journalArticle

Akello, CA, Bunge, KE, Nakabiito, C, Mirembe, BG, Fowler, MG, Mishra, A, Marrazzo, J, Chirenje, ZM, Celum, C & Balkus, JE 2017, 'Contraceptive Use and Pregnancy Incidence among Women Participating in an HIV Prevention Trial', Journal of Women's Health, vol. 26, no. 6, pp. 670-676. https://doi.org/10.1089/jwh.2016.5958
Akello, Carolyne A. ; Bunge, Katherine E. ; Nakabiito, Clemensia ; Mirembe, Brenda G. ; Fowler, Mary Glenn ; Mishra, Anupam ; Marrazzo, Jeanne ; Chirenje, Zvavahera M. ; Celum, Connie ; Balkus, Jennifer E. / Contraceptive Use and Pregnancy Incidence among Women Participating in an HIV Prevention Trial. In: Journal of Women's Health. 2017 ; Vol. 26, No. 6. pp. 670-676.
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abstract = "Background: Recent HIV prevention trials required use of effective contraceptive methods to fulfill eligibility for enrollment. We compared pregnancy rates in a subset of participants enrolled in the Microbicide Trials Network protocol (MTN-003), a randomized trial of chemoprophylaxis to prevent HIV acquisition among women aged 18-45 years who initiated depot medroxyprogesterone acetate (DMPA) or combined oral contraceptives (COCs) at enrollment, relative to those already using DMPA or COCs. Methods: Data were analyzed from MTN-003 participants from Uganda. Before enrollment, information on contraceptive type and initiation date was obtained. Urine pregnancy tests were performed at monthly follow-up visits. Cox proportional hazards models were used to compare pregnancy incidence among new users (initiated ≤60 days before enrollment) and established users (initiated >60 days before enrollment). Results: Of 322 women enrolled, 296 were COC or DMPA users, 82 (28{\%}) were new users, and 214 (72{\%}) were established users. Pregnancy incidence was higher among new contraceptive users compared to established users (20.70{\%} vs. 10.55{\%}; adjusted hazard ratio [HR] = 1.66; 95{\%} confidence interval [95{\%} CI] 0.93-2.96). Among DMPA users, pregnancy incidence was 10.20{\%} in new users versus 3.48{\%} in established users (HR = 2.56; 95{\%} CI 0.86-7.65). Among new COC users, pregnancy incidence was 42.67{\%} in new users versus 23.67{\%} in established COC users (adjusted HR = 1.74; 95{\%} CI 0.87-3.48). Conclusions: New contraceptive users, regardless of method, at the Uganda MTN-003 site had an increased pregnancy risk compared to established users, which may be due to contraceptive initiation primarily for trial eligibility. New users may benefit from intensive contraceptive counseling and additional contraceptive options, including longer acting reversible contraceptives.",
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