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Perception of coercion during contraceptive counseling among individuals with HIV. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100791. [DOI: 10.1016/j.srhc.2022.100791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 09/02/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
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Darney BG, Biel FM, Oakley J, Rodriguez MI, Cottrell EK. US "Safety Net" Clinics Provide Access to Effective Contraception for Adolescents and Young Women, 2017-2019. Am J Public Health 2022; 112:S555-S562. [PMID: 35767786 PMCID: PMC9725103 DOI: 10.2105/ajph.2022.306913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To describe patterns of providing moderately effective versus the most effective contraception and of providing implants versus intrauterine devices in US community health centers. Methods. We conducted a historical cohort study (2017-2019). Outcomes were woman-level receipt of most effective contraception (long-acting reversible contraception; implants and intrauterine devices) or moderately effective contraception. We used logistic regression to identify patient and clinic factors associated with providing (1) most versus moderately effective methods, and (2) implants versus intrauterine devices. We calculated adjusted probabilities for both outcomes by age group. Results. We included 199 652 events of providing contraception to 114 280 women in 410 community health centers. Adjusted probabilities were similar across age groups for moderately versus most effective methods. However, the adjusted marginal means for receiving an implant compared with an intrauterine device were highest for adolescents (15-17 years: 78.2% [95% confidence interval (CI) = 75.6%, 80.6%]; 18-19 years: 69.5% [95% CI = 66.7%, 72.3%]). Women's health specialists were more likely to provide most versus moderately effective contraception. Conclusions. Community health centers are an important access point for most effective contraception for women of all ages. Adolescents are more likely to use implants than intrauterine devices. (Am J Public Health. 2022;112(S5):S555-S562. https://doi.org/10.2105/AJPH.2022.306913).
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Affiliation(s)
- Blair G Darney
- Blair G. Darney and Maria I. Rodriguez are with the Department of Obstetrics and Gynecology, Oregon Health & Science University (OHSU), Portland. Blair G. Darney is also with Health Systems & Policy, OHSU-Portland State University joint School of Public Health. Frances M. Biel, Jee Oakley, and Erika K. Cottrell are with the Oregon Community Health Information Network, Inc., Portland. Erika K. Cottrell is also with the School of Medicine, OHSU
| | - Frances M Biel
- Blair G. Darney and Maria I. Rodriguez are with the Department of Obstetrics and Gynecology, Oregon Health & Science University (OHSU), Portland. Blair G. Darney is also with Health Systems & Policy, OHSU-Portland State University joint School of Public Health. Frances M. Biel, Jee Oakley, and Erika K. Cottrell are with the Oregon Community Health Information Network, Inc., Portland. Erika K. Cottrell is also with the School of Medicine, OHSU
| | - Jee Oakley
- Blair G. Darney and Maria I. Rodriguez are with the Department of Obstetrics and Gynecology, Oregon Health & Science University (OHSU), Portland. Blair G. Darney is also with Health Systems & Policy, OHSU-Portland State University joint School of Public Health. Frances M. Biel, Jee Oakley, and Erika K. Cottrell are with the Oregon Community Health Information Network, Inc., Portland. Erika K. Cottrell is also with the School of Medicine, OHSU
| | - Maria I Rodriguez
- Blair G. Darney and Maria I. Rodriguez are with the Department of Obstetrics and Gynecology, Oregon Health & Science University (OHSU), Portland. Blair G. Darney is also with Health Systems & Policy, OHSU-Portland State University joint School of Public Health. Frances M. Biel, Jee Oakley, and Erika K. Cottrell are with the Oregon Community Health Information Network, Inc., Portland. Erika K. Cottrell is also with the School of Medicine, OHSU
| | - Erika K Cottrell
- Blair G. Darney and Maria I. Rodriguez are with the Department of Obstetrics and Gynecology, Oregon Health & Science University (OHSU), Portland. Blair G. Darney is also with Health Systems & Policy, OHSU-Portland State University joint School of Public Health. Frances M. Biel, Jee Oakley, and Erika K. Cottrell are with the Oregon Community Health Information Network, Inc., Portland. Erika K. Cottrell is also with the School of Medicine, OHSU
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Cottura N, Howarth A, Rajoli RKR, Siccardi M. The Current Landscape of Novel Formulations and the Role of Mathematical Modeling in Their Development. J Clin Pharmacol 2020; 60 Suppl 1:S77-S97. [PMID: 33205431 DOI: 10.1002/jcph.1715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/25/2020] [Indexed: 12/15/2022]
Abstract
Drug delivery is an integral part of the drug development process, influencing safety and efficacy of active pharmaceutical ingredients. The application of nanotechnology has enabled the discovery of novel formulations for numerous therapeutic purposes across multiple disease areas. However, evaluation of novel formulations in clinical scenarios is slow and hampered due to various ethical and logistical barriers. Computational models have the ability to integrate existing domain knowledge and mathematical correlations, to rationalize the feasibility of using novel formulations for safely enhancing drug delivery, identifying suitable candidates, and reducing the burden on preclinical and clinical studies. In this review, types of novel formulations and their application through several routes of administration and the use of modeling approaches that can find application in different stages of the novel formulation development process are discussed.
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Affiliation(s)
- Nicolas Cottura
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Alice Howarth
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Rajith K R Rajoli
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Marco Siccardi
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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Hill S, Kuo HC, Aban I, Gray S, Simpson T, Dionne-Odom J. A comparative analysis of documented contraceptive use among women aged 18-30 living with and without HIV in Alabama. Contraception 2019; 100:275-278. [PMID: 31242441 DOI: 10.1016/j.contraception.2019.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare contraception use in 18-30-year-old women living with and without HIV. We also explored factors associated with contraceptive use. STUDY DESIGN We reviewed outpatient medical records for women living with HIV aged 18-30 years seen in one of two university-affiliated HIV-subspecialty clinics in Birmingham, Alabama, between July 2015 and June 2016. We selected an age-matched sample of women living without HIV seen in one of two university-affiliated non-HIV primary care clinics as the comparator group and focused our analysis on women with a documented discussion of contraception in clinic. For women with more than one clinic visit during the 1-year study period, the most recent visit was used for analysis. Multinominal and binary logistic regressions were used to identify factors associated with contraception use, and models were adjusted for HIV status. RESULTS This study included 197 women (58 HIV-positive, 139 HIV-negative). Short-acting contraception methods were the most common methods used by women with (41.4%) and without HIV (47.5%, p=.43). Long-acting reversible contraception (LARC) use was 14% among women with HIV and 32% among women without HIV (p=.12). Contraception use predictors included HIV status, mental health comorbidities, obesity and number of pregnancies. CONCLUSION Documented contraceptive method use among 18-30-year -old women seen in clinics in urban Alabama varied by HIV status. Women with HIV were less likely to use LARC methods compared to women without HIV. IMPLICATIONS Future studies should focus on identifying factors that influence contraceptive choice and which methods are offered to young women in the South. Providers should document contraception discussions at each visit and remove any barriers to LARC provision.
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Affiliation(s)
- Samantha Hill
- Department of Pediatrics, Division of Adolescent Medicine, The University of Alabama at Birmingham.
| | - Hui-Chien Kuo
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham
| | - Inmaculada Aban
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham
| | - Shirlacia Gray
- Department of Public Health, The University of Alabama at Birmingham
| | - Tina Simpson
- Department of Pediatrics, Division of Adolescent Medicine, The University of Alabama at Birmingham
| | - Jodie Dionne-Odom
- Department of Internal Medicine, Division of Infectious Disease, The University of Alabama at Birmingham
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Lazenby G, Francis E, Brzozowski N, Rucker L, Dempsey A. Postpartum LARC discontinuation and short interval pregnancies among women with HIV: a retrospective 9-year cohort study in South Carolina. Contraception 2019; 100:279-282. [PMID: 31226321 DOI: 10.1016/j.contraception.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate rates of discontinuation and short interval pregnancy among women with HIV who received a postpartum IUD or implant. METHODS We conducted a retrospective cohort study of women who had an IUD or implant placed within 3 months postpartum during a 9-year period (1/1/09 to 2/14/18). We assessed the prevalence of discontinuation within 12 months and rates of subsequent delivery within 18 months. We examined differences in these outcomes between women with and without HIV. RESULTS Of the 794 women who received a long-acting reversible contraception (LARC) within 3 months postpartum, most chose an IUD (85%). Twenty-one percent (165) elected for immediate postpartum placement: 119 IUDs and 46 implants. Women with HIV were more likely to receive an implant (48% vs 13%, p<.0001) and were more likely to have immediate postpartum placement (76% vs 17%, p<.0001). Women with HIV (n=50) were not more likely to remove LARC devices within 12 months of placement (38% vs 36%, p=.9), and they did not experience any short interval pregnancies. CONCLUSIONS Women with HIV in South Carolina were more likely than HIV-negative women to receive immediate postpartum LARC and to receive an implant. They were not more likely to discontinue LARC within 12 months nor experience short interval pregnancies. IMPLICATIONS Further study is needed to evaluate preferences for implants and immediate postpartum insertion among women with HIV.
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Affiliation(s)
- Gweneth Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425.
| | - Elizabeth Francis
- Department of College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
| | - Nicole Brzozowski
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
| | - Lindsay Rucker
- Department of College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
| | - Angela Dempsey
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
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Rapidly separable microneedle patch for the sustained release of a contraceptive. Nat Biomed Eng 2019; 3:220-229. [DOI: 10.1038/s41551-018-0337-4] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 11/27/2018] [Indexed: 01/01/2023]
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Law A, Pilon D, Lynen R, Laliberté F, Gozalo L, Lefebvre P, Duh MS. Retrospective analysis of the impact of increasing access to long acting reversible contraceptives in a commercially insured population. Reprod Health 2016; 13:96. [PMID: 27549429 PMCID: PMC4994322 DOI: 10.1186/s12978-016-0211-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 08/10/2016] [Indexed: 12/31/2022] Open
Abstract
Background Unintended pregnancies have been shown to be associated with high costs for the healthcare system, among other adverse impacts, but could still account for up to 51 % of pregnancies in the US. Improvements in contraception among women are needed. Long acting reversible contraceptives (LARCs), which have proved their safety and efficacy, have been found to significantly decrease the risk of unintended pregnancy. Yet they are still marginally employed. This study aims at investigating the evolution of LARC use over 15 years and at assessing the impact of the introduction of newer LARCs on LARC use relative to all contraceptive use. Methods This retrospective study identified women with LARC or short acting reversible contraceptive (SARC) claims from a US insurance claims database (01/1999-03/2014). Yearly proportions of LARC users relative to all contraceptive users were reported. Generalized estimating equation models were used to assess the impact of user characteristics, such as age group (15–17, 18–24, 25–34, and 35–44), and of time periods related to the introduction of new LARCs (01/2001: Mirena, 07/2006: Implanon, 01/2013: Skyla) on LARC use. Results A total of 1,040,978 women were selected. LARC use increased yearly from 0.6 % (1999) to 16.6 % (2013) among contraceptive users. Time periods associated with the introduction of a newer LARC were significant predictors of LARC use; women in 2006-2012 and 2013-2014 were respectively 3.7-fold (95 % CI:3.57–3.74) and 6.6-fold (95 % CI:6.43–6.80) more likely to use LARCs over SARCs relative to women in 2001-2006. The increase in LARC use was especially pronounced in young women. Compared to women aged 18–24 in 2001-2006, women aged 18–24 in 2006-2012 and 2013-2014 were respectively 6.4-fold (95 % CI:5.91–6.86) and 14.7-fold (95 % CI:13.59–15.89) more likely to use LARCs over SARCs. Conclusions This broadly representative commercial claim-based study showed that the proportion of privately insured women of childbearing age using LARCs increased over time and that the introduction of newer LARCs corresponded with significant increases in overall LARC use. Future research is needed to assess LARC use in uninsured or publicly-insured populations.
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Affiliation(s)
- Amy Law
- Bayer HealthCare Pharmaceuticals Inc, 100 Bayer Blvd, Whippany, NJ, 07981, USA
| | - Dominic Pilon
- Groupe d'analyse, Ltée, 1000 De La Gauchetière West, Bureau 1200, Montreal, QC, H3B 4W5, Canada.
| | - Richard Lynen
- Bayer HealthCare Pharmaceuticals Inc, 100 Bayer Blvd, Whippany, NJ, 07981, USA
| | - François Laliberté
- Groupe d'analyse, Ltée, 1000 De La Gauchetière West, Bureau 1200, Montreal, QC, H3B 4W5, Canada
| | - Laurence Gozalo
- Groupe d'analyse, Ltée, 1000 De La Gauchetière West, Bureau 1200, Montreal, QC, H3B 4W5, Canada
| | - Patrick Lefebvre
- Groupe d'analyse, Ltée, 1000 De La Gauchetière West, Bureau 1200, Montreal, QC, H3B 4W5, Canada
| | - Mei Sheng Duh
- Analysis Group, Inc., 10th Floor, 111 Huntington Ave, Boston, MA, 02199, USA
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Long-acting reversible contraception in the pediatric emergency department: clinical implications and common challenges. Pediatr Emerg Care 2015; 31:286-92; quiz 293-5. [PMID: 25831033 DOI: 10.1097/pec.0000000000000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Long-acting reversible contraception (LARC) is recommended as first-line contraception for adolescents and young adults. As the use of LARC increases, pediatric emergency medicine clinicians should be able to recognize different types of LARC and address their common adverse effects, adverse reactions, and complications. This continuing medical education activity provides an overview of LARC and will assist clinicians in the evaluation and management of patients with LARC-associated complaints.
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Kavanaugh A, Cush JJ, Ahmed MS, Bermas BL, Chakravarty E, Chambers C, Clowse M, Curtis JR, Dao K, Hankins GDV, Koren G, Kim SC, Lapteva L, Mahadevan U, Moore T, Nolan M, Ren Z, Sammaritano LR, Seymour S, Weisman MH. Proceedings From the American College of Rheumatology Reproductive Health Summit: The Management of Fertility, Pregnancy, and Lactation in Women With Autoimmune and Systemic Inflammatory Diseases. Arthritis Care Res (Hoboken) 2015; 67:313-25. [DOI: 10.1002/acr.22516] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 11/04/2014] [Indexed: 01/31/2023]
Affiliation(s)
| | | | | | | | | | | | - Megan Clowse
- Duke University Medical Center; Durham North Carolina
| | | | | | | | - Gideon Koren
- The Hospital for Sick Children, Toronto; Ontario Canada
| | | | | | | | - Thomas Moore
- School of Medicine, University of California at San Diego
| | - Martha Nolan
- Society for Women's Health Research; Washington DC
| | - Zhaoxia Ren
- National Institute of Child Health and Human Development, National Institutes of Health; Bethesda Maryland
| | - Lisa R. Sammaritano
- Hospital for Special Surgery, Weill Medical College of Cornell University; New York New York
| | - Sally Seymour
- US Food and Drug Administration; Silver Spring Maryland
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Boffito M, Jackson A, Owen A, Becker S. New approaches to antiretroviral drug delivery: challenges and opportunities associated with the use of long-acting injectable agents. Drugs 2015; 74:7-13. [PMID: 24327298 DOI: 10.1007/s40265-013-0163-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research on improved treatment of HIV infection and pre-exposure prophylaxis continues. Poor adherence to treatment is the critical risk factor for virological failure and resistance development, and long-acting formulations of anti-HIV medications that need only infrequent dosing may facilitate long-term therapeutic responses. Importantly, long-acting formulations of therapeutic agents have been used to avoid missing doses or treatment fatigue to prescribed lifelong medications in a number of different medical fields, with demonstrable success. However, such formulations are associated with challenges, such as the prolongation of adverse events with the persistence of drug concentrations and concerns over the development of resistance as a result of selective pressure as drug concentrations decline. Furthermore, long-acting injectable formulations of antiretroviral (ARV) agents with infrequent dosing may be advantageous over daily oral drug intake to prevent transmission of HIV. However, the knowledge on protective drug concentrations and frequency of dosing is poor to date and implementation globally is challenging. Importantly, if nanoformulations of ARVs requiring lower drug doses become available globally, the potential for treatment cost reductions is high, as, especially in resource-limited settings, the active pharmaceutical ingredient accounts for the greater proportion of the total cost of the medicine. In conclusion, different long-acting ARVs are being studied in phase I/II for both the treatment and prevention of HIV infection, and research on administering these agents in combination has started.
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Affiliation(s)
- Marta Boffito
- St. Stephen's Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK,
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Rafie S, McIntosh J, Shealy KM, Borgelt LM, Forinash A, Shrader SP, Koepf ER, McClendon KS, Griffin BL, Horlen C, Karaoui LR, Rowe EL, Lodise NM, Wigle PR. Roles of the pharmacist in the use of safe and highly effective long-acting reversible contraception: an opinion of the women's health practice and research network of the American College of Clinical Pharmacy. Pharmacotherapy 2014; 34:991-9. [PMID: 24989020 DOI: 10.1002/phar.1457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The U.S. population continues to experience an alarmingly high rate of unintended pregnancies that have an impact on individual families and society alike. Lack of effective contraception accounts for most unintended pregnancies, along with incorrect use of contraceptives. The most common reversible contraceptive method used in the United States is the oral contraceptive pill, which has significant failure and discontinuation rates. Use of long-acting reversible contraceptive (LARC) methods has been increasing in recent years after efforts to educate providers and patients. Women are more likely to use LARC methods when barriers such as access and cost are removed. An uptake in the use of LARC methods would allow for markedly reduced contraception failure rates and higher user satisfaction and thus higher continuation rates than those seen with current contraception use. Promoting the use of LARC methods is an important strategy in improving both individual and public health outcomes by reducing unintended pregnancies. The pharmacist's role in family planning is expanding and can contribute to these efforts. Although knowledge regarding LARC has not been studied among pharmacists, a knowledge deficit exists among health care professionals in general. Thus pharmacist education and training should include LARC methods along with other contraceptives. The American College of Clinical Pharmacy Women's Health Practice and Research Network advocates for the pharmacist's role in the use of safe and highly effective LARC methods. These roles include educating patients, informing providers, facilitating access by providing referrals, and modifying institutional procedures to encourage provision of LARC methods.
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Affiliation(s)
- Sally Rafie
- Department of Pharmacy, University of California San Diego Health System, San Diego, California
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