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McGuire C, Atieno MA, Hoke T, Jeckonia P, K'orimba K, Lorenzetti L, Ngure K, Niyibeshaho MM, Njuguna N, Torjesen K, Fonner V. PrEP Method Switching: Will it Yield Greater Coverage of HIV Protection? Applying Lessons Learned from Family Planning to Guide Future Research in the Context of PrEP Choice. Curr HIV/AIDS Rep 2024; 21:282-292. [PMID: 39046639 PMCID: PMC11377463 DOI: 10.1007/s11904-024-00704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE OF REVIEW Despite the growing availability of oral PrEP, coverage remains suboptimal. Through the introduction of additional PrEP methods, including vaginal rings and long-acting injectable formulations, health systems globally are on the cusp of offering PrEP methods that vary by route of administration, efficacy, and frequency of use. With PrEP choice, it will be important to explore PrEP use patterns to better understand how the ability to choose and switch products affects coverage and continuation. In this review, we draw parallels with family planning (FP) by summarizing how method choice and product switching affected contraceptive coverage globally, synthesize what is known about PrEP product switching, and outline evidence gaps to help guide future research on PrEP switching in the context of choice. RECENT FINDINGS Decades of research in FP has demonstrated that product switching is common and can lead to more satisfaction and increases in contraceptive use. While research on PrEP product switching is nascent, findings suggest switching is common, and that providing more than one PrEP option can increase coverage. Key evidence gaps include understanding product switching in the context of full versus constrained choice, switching in the context of temporary need, and developing interventions that promote product switching for those who could benefit. Providing choice and allowing people to start, stop, and switch products according to their needs and desires is a core component of a rights-based approach to HIV prevention. More research is needed to better understand what drives use patterns, including switching, and how to leverage choice to improve coverage. Standard definitions -some of which have been proposed in this review-are needed to inform comparable measurement. Finally, there is a need to holistically frame PrEP use to acknowledge changes in need over the life course, thus making method switching a standard part of HIV prevention.
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Affiliation(s)
- Courtney McGuire
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
| | | | - Theresa Hoke
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | | | | | - Lara Lorenzetti
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | | | - Virginia Fonner
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
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Kungu W. Contraceptive use and discontinuation among women aged 15-24 years in Kenya. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1192193. [PMID: 38034414 PMCID: PMC10684736 DOI: 10.3389/frph.2023.1192193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction The 15-24-year-old age group of young women make up about 15% of the population of 47 million Kenyans which comes to 7 million. Addressing the reproductive health goals of this cohort is thus a policy priority because of the high potential they pose for unintended pregnancy through incorrect and intermittent use of contraception. Objective The study sought to present evidence on contraceptive use among women aged 15-24 in Kenya between 2012 and 2014 using Kenya Demographic and Health Survey (KDHS) 2014 Contraceptive calendar data and make recommendations on enhancing the correct and consistent use of contraception. Methodology The data used was obtained from the Choices and Challenges tool developed by Population Reference Bureau (PRB) and visualized innovatively using Sankey Diagrams that show contraceptive use/non-use, continuation, switching/discontinuation, and pregnancy. Results The use of contraceptives went up by about 30% during the study period while the use of modern methods went up by 83%. The uptake of Long-Acting Reversible Contraception (LARC) went up by 87% while that of Short Acting Methods (SAM) went up by 70% but the progress was clouded by discontinuation rates of 35% with side effects being the leading reason for the abandonment of contraception. Conclusion For Kenya to achieve transformative results in ending the unmet need for contraception and preventable maternal deaths, it is critical to sustaining the current gains in contraceptive prevalence rate (CPR) by promoting the retention of youth users and encouraging new users.
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Affiliation(s)
- Wambui Kungu
- Research and Centre of Excellence, National Council for Population and Development, Nairobi, Kenya
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Gemmill A, Sarnak D, Bradley SEK, Brecker E, Patierno K. Reproductive outcomes following contraceptive discontinuation for method-related reasons: An analysis of 49 Demographic and Health Surveys. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002143. [PMID: 37939155 PMCID: PMC10631694 DOI: 10.1371/journal.pgph.0002143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/21/2023] [Indexed: 11/10/2023]
Abstract
Contraceptive discontinuation for method-related reasons is a common experience in low- and middle-income countries (LMICs) and may heighten women's risk of unintended pregnancy. Few studies have provided a comprehensive assessment of reproductive outcomes following contraceptive discontinuation in LMICs over the last decade. Using cross-sectional data from 49 Demographic and Health Surveys, we applied competing risks estimation to calculate monthly probabilities of contraceptive resumption and pregnancy over a 12-month period among pooled, regional, and country-specific samples of women who discontinued contraception for method-related reasons (corresponding to 174,726 episodes of discontinuation). We also examined the pregnancy intention status of births/current pregnancies among those who became pregnant in the 12 months following contraceptive discontinuation for method-related reasons. In the pooled sample, the three-month probability of pregnancy and resumption of contraceptive use was 12% and 47%, respectively; by 12 months these probabilities increased to 22% and 55%, respectively. Country-specific analyses show that the probabilities of resuming contraception by three months ranged from 15% in Liberia, Mali, and Sierra Leone to 85% in Bangladesh. On average, the majority of pregnancies/births that occured following discontinuation for method-related reasons were subsequently reported as unintended. However, reports varied depending on when women became pregnant within the 12 months following discontinuation. Our findings suggest the need for more nuanced measures of contraceptive use dynamics-including measures that distinguish between women who resume use of contraception from women who remain at risk of pregnancy in the short period after discontinuation-to better inform specific policies and interventions, particularly aimed at those who remain at risk of pregnancy.
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Affiliation(s)
- Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dana Sarnak
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Eve Brecker
- Population Reference Bureau, Washington, District of Columbia, United States of America
| | - Kaitlyn Patierno
- Population Reference Bureau, Washington, District of Columbia, United States of America
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Martins SL, Boraas CM. Willingness to use novel reversible methods of male birth control: a community-based survey of cisgender men in the United States. Contracept Reprod Med 2023; 8:41. [PMID: 37563690 PMCID: PMC10413635 DOI: 10.1186/s40834-023-00242-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND There is high global demand for new methods of male birth control (MBC). However, contemporary evidence regarding men's method-specific attitudes and their determinants is sparse. METHODS Non-sterilized cisgender men ages 18-45 with recent history of female sex partners were surveyed at a large community event in the Midwestern US. We examined variation in participants' willingness to use MBC by method (gel, pill, injection, implant, and vas occlusion), potential side effects, and potential barriers. We estimated crude and adjusted prevalence ratios (aPRs) for associations between participant characteristics and willingness to use ≥ 1 MBC method. RESULTS Overall, 72% of participants (n = 187; mean age, 29) were very willing to use ≥ 1 MBC method although support for individual methods ranged widely from 62% (pill) to 24% (vas occlusion). In bivariate analysis of sociodemographic and health characteristics, few demonstrated associations with MBC willingness. In a multivariable model, willingness was independently related to age (30-39 vs. 18-29 years old, aPR = 1.24, 95% CI 1.04-1.48) and having ever been tested for HIV (aPR = 1.27, 95% CI 1.07-1.51). Willingness to tolerate side effects was < 10% for most items. The most commonly endorsed barriers to MBC use were high cost (77%) and side effects (66%). CONCLUSIONS Enthusiasm for MBC was high but waned in the context of potential side effects and barriers. Additional research on MBC attitudes in socioeconomically and culturally diverse populations worldwide is sorely needed.
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Affiliation(s)
- Summer L Martins
- Allina Health, 2925 Chicago Avenue, MS 10105, Minneapolis, MN, 55455, USA
| | - Christy M Boraas
- Department of Obstetrics, Gynecology & Women's Health, University of Minnesota Medical School, Riverside Professional Building, 606 24th Ave. S., Minneapolis, MN, 55454, USA.
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Bhushan NL, Ridgeway K, Luecke EH, Palanee-Phillips T, Montgomery ET, Minnis AM. Synthesis of end-user research to inform future multipurpose prevention technologies in sub-Saharan Africa: a scoping review. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1156864. [PMID: 37325244 PMCID: PMC10264572 DOI: 10.3389/frph.2023.1156864] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Women in sub-Saharan Africa (SSA) experience disproportionately high rates of HIV infection and unintended pregnancy compared to their age-matched counterparts in other regions of the world. Multipurpose prevention technologies (MPTs) that offer protection against HIV and unintended pregnancy in a single product stand to address these dual sexual and reproductive health needs simultaneously. The aim of this scoping review is to identify factors that are important for optimizing the likelihood of MPT adoption by end users in SSA. Methods Study inclusion criteria included MPT research (HIV and pregnancy prevention dual indication) published or presented in English from 2000 to 2022 and conducted in SSA amongst end-users (women aged 15-44), male partners, health care providers, and community stakeholders. References were identified by searching peer reviewed literature, grey literature, conference presentations (2015-2022), grant databases, and outreach to MPT subject matter experts. Of 115 references identified, 37 references met inclusion criteria and were extracted for analysis. A narrative synthesis approach was used to summarize findings within and across MPT products. Results Studies were identified from six countries in SSA and a substantial proportion included a South African (n = 27) and/or Kenyan (n = 16) study site. Most studies utilized a qualitative study design (n = 22) and evaluated MPT acceptability and preferences by presenting hypothetical products through images or a list of product attributes (n = 21). The vaginal ring (n = 20), oral tablet (n = 20), and injection (n = 15) were examined most frequently. Across studies, there was high acceptability and demand for an HIV and pregnancy prevention MPT. End users valued choice in prevention product type as well as discreetness and long-acting options. Provider counseling and community sensitization were reported as essential for future introduction of novel MPT delivery forms. Conclusion Recognizing the heterogeneity of women's preferences and changing reproductive and sexual health needs over the life course, choice is important in the delivery of pregnancy and HIV prevention products as well as amongst MPT products with distinct product profiles. End user research with active MPTs, vs. hypothetical or placebo MPTs, is necessary to advance understanding of end-user preferences and acceptability of future products.
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Affiliation(s)
| | - Kathleen Ridgeway
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ellen H. Luecke
- RTI International, Research Triangle Park, NC, United States
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Stevens R, Machiyama K, Mavodza CV, Doyle AM. Misconceptions, Misinformation, and Misperceptions: A Case for Removing the "Mis-" When Discussing Contraceptive Beliefs. Stud Fam Plann 2023; 54:309-321. [PMID: 36753058 DOI: 10.1111/sifp.12232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Beliefs about contraception are commonly conceptualized as playing an important role in contraceptive decision-making. Interventions designed to address beliefs typically include counseling to dispel any "myths" or "misconceptions." These interventions currently show little evidence for impact in reducing beliefs. This commentary delves into the problems associated with using implicitly negative terminology to refer to contraceptive beliefs, which come laden with assumptions as to their validity. By conceptualizing women as getting it wrong or their beliefs as invalid, it sets the scene for dubious treatment of women's concerns and hampers the design of fruitful interventions to address them. To replace the multitude of terms used, we suggest using "belief" going forward to maintain value-free curiosity and remove any implicit assumptions about the origin or validity of a belief. We provide recommendations for measuring beliefs to help researchers understand the drivers and impacts of the belief they are measuring. Finally, we discuss implications for intervention design once different types of belief are better understood. We argue that tailored interventions by belief type would help address the root causes of beliefs and better meet women's broader contraceptive needs, such as the need for contraceptive autonomy and satisfaction.
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Affiliation(s)
- Rose Stevens
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
| | - Kazuyo Machiyama
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Constancia Vimbayi Mavodza
- Department of Public Health and Policy, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Aoife M Doyle
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Hernandez JH, LaNasa KH, Koba T. Task-shifting and family planning continuation: contraceptive trajectories of women who received their method at a community-based event in Kinshasa, DRC. Reprod Health 2023; 20:24. [PMID: 36717937 PMCID: PMC9887934 DOI: 10.1186/s12978-023-01571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
While community-based interventions are a proven high-impact strategy to increase contraceptive uptake in low-income countries, their capacity to support women's contraceptive choices (including continued use, switching and discontinuation) in the long run remains insufficiently discussed. This cohort study follows 883 women 3 and 6 months after they received a modern method during community campaigns organized in Kinshasa (D.R. Congo), to analyze their contraceptive trajectories and the factors associated with ever discontinuing contraceptive use in the first 6 months following a campaign. In the community-based distribution (CBD) model currently institutionalized in DRC, campaign clients are not provided with additional doses or support, besides baseline counseling, to (dis-)continue using the method they received, but must rely on Family Planning resources within the existing local health system. Almost a third (28.9%) of all women discontinued modern contraception during the study period, with much higher discontinuation rates for short-acting methods (38.7% for pills and up to 68.9% for DMPA-SC). Variables previously associated with high discontinuation (marital status, fertility intentions and side-effects) led to higher odds of "ever discontinuing". However, these variables became non-significant when controlling for resupply issues. Women's self-reported reasons for discontinuation confirmed the multivariate regression results. Detailed sub-analysis of resupply issues for pills, injectables and Cyclebeads pointed to the role of cost, unreliable campaign schedules and weak integration of community-based strategies into the formal health system. Extremely low rates of implants removal suggest similar access to FP services issues. The study highlights the need to identify CBD strategies best suited to support women's choices and preferences towards successful contraceptive trajectories in fragile health systems.
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Affiliation(s)
- Julie H. Hernandez
- grid.265219.b0000 0001 2217 8588Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 2200, New Orleans, LA 70112 USA
| | - Katherine H. LaNasa
- grid.265219.b0000 0001 2217 8588Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112 USA
| | - Tesky Koba
- grid.9783.50000 0000 9927 0991Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Bolarinwa OA, Afaya A, Ajayi KV, Ojo A, Alawode OA. Prevalence and factors associated with the use of long-acting reversible and permanent contraceptive methods among women who desire no more children in high fertility countries in sub-saharan Africa. BMC Public Health 2022; 22:2141. [PMID: 36414944 PMCID: PMC9682718 DOI: 10.1186/s12889-022-14575-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The proportion of women with family planning needs increased from 74 to 76% between 2000 and 2019, and this improvement has not transcended to a fertility rate stall or decrease in sub-Saharan Africa (SSA). In the face of a continuous increase in the fertility rate in SSA, population experts agreed that the efficient use of reliable family planning methods such as long-acting reversible and permanent contraceptive methods (LARC/PMs) could help reduce the high fertility rate and associated adverse reproductive health outcomes in the region. However, despite the effectiveness of LARC/PMs, its use remains elusive in SSA. Thus, this study examines the prevalence and factors associated with the use of LARC/PMs among women who desire no more children in high-fertility countries in SSA. METHODS Secondary datasets from the demographic health surveys conducted in 20 countries in SSA between 2010 and 2019 were included in the study. A total sample size of 46,290 sexually active women of reproductive age who desire no more children and who met the study inclusion criteria was pooled and analysed. Prevalence of LARC/PMs use was displayed using a graph whilst binary logistic regression was used to determine the associated factors, and results were presented as unadjusted odds ratio and adjusted odds ratio with a statistical significance of p < 0.05. RESULTS The prevalence of LARC/PMs use among women who desire no more children was 7.5%. Ranging from 20.9% in Senegal and as low as 0.4% in Congo. Women within the richest wealth index [aOR = 1.18, 95% CI = 1.03-1.36] and those exposed to mass media [aOR = 1.54, 95% CI = 1.41-1.68] had higher odds of LARC/PMs use among sexually active women of reproductive age who desire no more children compared to those within poorest wealth index and women with no mass media exposure. CONCLUSION The study concluded that LARC/PMs use among sexually active women who desire no more children was very low, and women within the richest wealth index and those with mass media exposure were likely to use LARC/PMs. Interventions that will encourage using LARC/PMs should be prioritised to reduce fertility rates in SSA.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Global Public Health, Canterbury Christ Church University, Canterbury, UK.
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Agani Afaya
- College of Nursing, Yonsei University, 50‑1, Yonsei‑ro, Seodaemun‑gu, 03722, Seoul, South Korea
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Kobi V Ajayi
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, 77843, TX, USA
| | - Abimbola Ojo
- Department of Public Health, School of Health & Life Science, University of Teesside, Middlesbroug, UK
| | - Oluwatobi Abel Alawode
- Department of Sociology and Criminology & Law, University of Florida, 32611, Gainesville, FL, USA
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