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Todd CS, Lorenzetti L, Mussa A, Ridgeway K, Morroni C, Nanda K. Drug-Drug Interactions between Antiretrovirals and Hormonal Contraception: An Updated Systematic Review. Contraception 2024:110490. [PMID: 38762199 DOI: 10.1016/j.contraception.2024.110490] [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: 12/22/2022] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE To summarize and update information regarding drug-drug interactions (DDIs) between antiretrovirals (ARVs) and hormonal contraceptives (HCs). DESIGN Systematic review METHODS: We searched seven databases for peer-reviewed publications from January 1, 2015, through December 31, 2023, including studies of women using ARVs and HCs concurrently with outcomes including therapeutic effectiveness or toxicity, pharmacokinetics (PK), or pharmacodynamics. We summarized findings and used checklists to assess evidence quality. RESULTS We included 49 articles, with clinical, ARV or HC PK outcomes reported by 39, 25, and 30 articles, respectively, with some articles reporting outcomes in two or more categories. Fifteen of 18 articles assessing DDIs between efavirenz and progestin implants, emergency contraception, or combined hormonal intravaginal rings found higher pregnancy rates, luteal progesterone levels suggesting ovulation, or reduced progestin PK values. Five studies documented that CYP2B6 single nucleotide polymorphisms exacerbated this DDI. One cohort detected doubled bone density loss with concomitant depot medroxyprogesterone acetate (DMPA) and tenofovir disoproxil fumarate (TDF)-containing ART use versus TDF alone. No other studies described DDIs impacting clinical outcomes. Few adverse events were attributed to ARV-HC use with none exceeding Grade 2. Evidence quality was generally moderate, with dis-similar treatment and control groups, identifying and controlling for confounding, and minimizing attrition bias in the study design being the most frequent limitations. CONCLUSION Most ARVs and HCs may be used safely and effectively together. TDF-DMPA DDIs warrant longer-term study on bone health and consideration of alternate combinations. For efavirenz-based ART, client counselling on relative risks, including both potential increase in pregnancy rate with concomitant efavirenz and implant use and lower pregnancy rates compared to other HCs even with concomitant efavirenz use, should continue to allow users comprehensive method choice.
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Affiliation(s)
- Catherine S Todd
- Global Health, Population, & Nutrition, FHI 360, Durham, North Carolina, United States.
| | - Lara Lorenzetti
- Global Health, Population, & Nutrition, FHI 360, Durham, North Carolina, United States
| | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Kathleen Ridgeway
- Global Health, Population, & Nutrition, FHI 360, Durham, North Carolina, United States
| | - Chelsea Morroni
- Botswana Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana; MRC Centre for Reproductive Health and Centre for Global Health, The Queens Medical Research Institute, Edinburgh, United Kingdom
| | - Kavita Nanda
- Global Health, Population, & Nutrition, FHI 360, Durham, North Carolina, United States
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Yang L, Allen RH, Catherine Cambou M, Nielsen-Saines K, Brown BP. Contraception and Abortion Care for People Living With HIV: A Clinical Guide for Reproductive Health Practitioners. J Midwifery Womens Health 2023; 68:719-727. [PMID: 37903728 PMCID: PMC10872909 DOI: 10.1111/jmwh.13575] [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] [Revised: 08/13/2023] [Indexed: 11/01/2023]
Abstract
People capable of pregnancy are disproportionately affected by HIV. Family planning needs and services are often unmet in this population, and clinical care guidelines regarding contraceptive options and abortion care are not well elucidated. Individuals living with HIV often face unique barriers in accessing contraception and abortion services due to internalized stigma, medically complex care (eg, drug-drug interactions, adverse effects of antiretroviral therapy), and distrust of health care providers. There is also a lack of clarity among reproductive health, primary, and infectious disease care providers on best-practice contraceptive counseling and contraceptive care for individuals living with HIV, given limited opportunities to enhance expertise in reproductive infectious disease. In this review, we summarize existing and updated evidence and clinical considerations regarding contraceptive counseling and abortion care in this population.
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Affiliation(s)
- Lanbo Yang
- Department of Obstetrics and Gynecology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Rebecca H. Allen
- Department of Obstetrics and Gynecology, Women and Infants Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mary Catherine Cambou
- Division of Infectious Diseases, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Karin Nielsen-Saines
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Benjamin P. Brown
- Department of Obstetrics and Gynecology, Women and Infants Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island
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FSRH Guideline (March 2023) Intrauterine contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:1-142. [PMID: 37188461 DOI: 10.1136/bmjsrh-2023-iuc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Pradhan S, Tolley EE, Langwenya N, Jones HE, Hoover DR, Petro G, Myer L, Todd CS. Intrauterine contraceptive discontinuation reasons among female trial participants living with HIV in Cape Town, South Africa: A qualitative analysis. Front Glob Womens Health 2023; 4:1010794. [PMID: 37034398 PMCID: PMC10081672 DOI: 10.3389/fgwh.2023.1010794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/17/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction While young women in South Africa may navigate both HIV infection and pregnancy risks, intrauterine contraceptive (IUC) use is low. Though IUCs have low failure rates, concerns exist about whether the IUC is an appropriate method choice for women living with HIV (WLHIV). In this qualitative study, we explore WLHIVs' experiences of using IUC and reasons for discontinuation. Methods This qualitative study included in-depth interviews (IDIs) with 17 WLHIV who electively discontinued their allocated IUC while participating in a randomized controlled trial comparing the safety of the levonorgestrel intrauterine system (LNG-IUS) and the copper intrauterine device (C-IUD) in Cape Town, South Africa. The transcripts were coded and emergent themes were grouped to examine women's experiences with IUC use and reasons for discontinuation, highlighting experiential differences between the two methods. Results Women's experience with the allocated IUC related most commonly to bleeding and/or abdominal pain just after insertion. Most C-IUD discontinuers, but only one LNG-IUS discontinuer, complained of pain and/or increased bleeding as the main reason for removal. Three women (two LNG-IUS, one C-IUD) requested removal because they desired pregnancy, while two others discontinued due to fears the IUC was exacerbating non-gynecologic conditions (hypertension, diabetes). Generally, women acknowledged advantages of IUC use and many expressed their desire to continue use if not for the side effects. Conclusions In the South African context, IUC use for WLHIV should be promoted with specific counseling considerations. Both providers and potential users should receive specific information about potential menstrual-related side effects and countering common misperceptions to enable informed contraceptive decision-making.
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Affiliation(s)
- Subarna Pradhan
- Global Health, Population, and Nutrition Department, FHI 360, Durham, NCUnited States
| | - Elizabeth E. Tolley
- Global Health, Population, and Nutrition Department, FHI 360, Durham, NCUnited States
| | - Nontokozo Langwenya
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heidi E. Jones
- Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, United States
| | - Donald R. Hoover
- Department of Statistics and Institute for Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ, United States
| | - Gregory Petro
- Department of Obstetrics and Gynaecology, University of Cape Town and New Somerset Hospital, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine S. Todd
- Global Health, Population, and Nutrition Department, FHI 360, Durham, NCUnited States
- Correspondence: Catherine S. Todd
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Rademacher KH, Sripipatana T, Danna K, Sitrin D, Brunie A, Williams KM, Afolabi K, Rasoanirina F, Ramarao S, Pfitzer A, Cain D, Simon M, Menotti E, Hazelwood A, Nwala AA, Saidu Z, Chowdhury R, Taiwo A, Chidanyika A, Ndirangu G, Steiner MJ, Lepine MC, Homan R, Saad A, Vivalo J, Dorflinger LJ. What Have We Learned? Implementation of a Shared Learning Agenda and Access Strategy for the Hormonal Intrauterine Device. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100789. [PMID: 36316136 PMCID: PMC9622288 DOI: 10.9745/ghsp-d-21-00789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/23/2022] [Indexed: 09/16/2023]
Abstract
In 2015, a global learning agenda for the hormonal intrauterine device (IUD) was developed with priority research questions regarding use of the method in low- and middle-income countries. In addition, members of the Hormonal IUD Access Group aligned on a strategy to expand access in the context of volunteerism and contraceptive method choice. This article synthesizes evidence generated since then and describes steps taken to address demand- and supply-side barriers to access. Findings demonstrated high continuation rates and satisfaction among hormonal IUD users that are comparable to other long-acting reversible contraceptives (LARCs). Across studies, a sizable number of users reported they would have chosen a short-acting method or no method at all if the hormonal IUD were not an option, which suggests that women did not see the hormonal IUD as interchangeable with other LARC options and thus it may fill an important niche in the market. With several countries now poised to scale up the method, resource mobilization will be key. On the demand side, investments in implementation research will be critical to understanding how best to launch and scale the method, while ensuring the sustainability of multiple quality-assured suppliers with affordable public-sector pricing will be necessary on the supply side.
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Affiliation(s)
| | | | - Kendal Danna
- Population Services International, Washington, DC, USA
| | | | | | | | - Kayode Afolabi
- Formerly of the Reproductive Health Division, Federal Ministry of Health, Abuja, Nigeria
| | | | | | | | - Devon Cain
- Clinton Health Access Initiative, Boston, MA, USA
| | - Morgan Simon
- Global Health Supply Chain Program-Procurement and Supply Management project, Washington, DC, USA
| | - Elaine Menotti
- United States Agency for International Development, Washington, DC, USA
| | - Anna Hazelwood
- Formerly of the Foreign, Commonwealth & Development Office; Now with Clinton Health Access Initiative, Monrovia, Liberia
| | | | - Zainab Saidu
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | - Anne Taiwo
- Marie Stopes International Nigeria, Abuja, Nigeria
| | | | | | | | | | | | - Abdulmumin Saad
- Formerly of United States Agency for International Development; Now with Bill & Melinda Gates Foundation, Washington, DC, USA
| | - John Vivalo
- United States Agency for International Development, Washington, DC, USA
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Matovu B, Takuwa M, Mpaata CN, Denison F, Kiwanuka N, Lewis S, Norrie J, Ononge S, Muhimbise O, Tuck S, Etuket MD, Ssekitoleko RT. Review of investigational medical devices' clinical trials and regulations in Africa as a benchmark for new innovations. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:952767. [PMID: 35968546 PMCID: PMC9368574 DOI: 10.3389/fmedt.2022.952767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/05/2022] [Indexed: 01/05/2023] Open
Abstract
Medical technologies present a huge potential in improving global health playing a key role toward achieving Sustainable Development Goal 3 by 2030. A number of clinicians, innovators, business entities and biomedical engineers among others have developed a number of innovative medical devices and technologies to address the healthcare challenges especially in Africa. Globally, medical devices clinical trials present the most acceptable method for determining the risks and benefits of medical device innovations with the aim of ascertaining their effectiveness and safety as compared with established medical practice. However, there are very few medical device clinical trials reported in Africa compared to other regions like USA, UK and Europe. Most of the medical device clinical trials reported in Africa are addressing challenges around HIV/AIDS, maternal health and NCDs. In this mini review, we report about some of the published medical device clinical trials in Africa PubMed and Google Scholar and their associated challenges.
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Affiliation(s)
- Brian Matovu
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mercy Takuwa
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Norman Mpaata
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fiona Denison
- Department of Epidemiology and Biostatistics, The Queen's Medical Research Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Noah Kiwanuka
- Edinburgh Medical School, Clinical Trials Unit, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Steff Lewis
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - John Norrie
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Sam Ononge
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Owen Muhimbise
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sharon Tuck
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Maureen Dimitri Etuket
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert T. Ssekitoleko
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences College of Health Sciences, Makerere University, Kampala, Uganda,*Correspondence: Robert T. Ssekitoleko
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Mavodza CV, Busza J, Mackworth-Young CRS, Nyamwanza R, Nzombe P, Dauya E, Dziva Chikwari C, Tembo M, Simms V, Mugurungi O, Apollo T, Madzima B, Ferrand RA, Bernays S. Family Planning Experiences and Needs of Young Women Living With and Without HIV Accessing an Integrated HIV and SRH Intervention in Zimbabwe-An Exploratory Qualitative Study. Front Glob Womens Health 2022; 3:781983. [PMID: 35663923 PMCID: PMC9160719 DOI: 10.3389/fgwh.2022.781983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background People living with HIV have higher unmet family planning needs compared to those without HIV. This is heightened for young people. However, the provision of family planning for young people within HIV programmes is uncommon. We investigated family planning uptake, acceptability of, and engagement with a service offering integrated HIV and sexual and reproductive health services for youth in a community-based setting in Zimbabwe. Methods CHIEDZA, a community-based intervention offering integrated HIV and sexual and reproductive health services to young people aged 16-24 years, is being trialed in Zimbabwe. This exploratory qualitative study was nested within an ongoing study process evaluation. Data was collected between March-May 2021 with two sets of interviews conducted: I) twelve semi-structured interviews with young women living with HIV aged 17-25 years and II) fifteen interviews conducted with young women without HIV aged between 20 and 25 years who used a contraceptive method. A thematic analysis approach was used. Results Before engaging with CHIEDZA, young women had experienced judgmental providers, on account of their age, and received misinformation about contraceptive use and inadequate information about ART-contraceptive interactions. These presented as barriers to uptake and engagement. Upon attending CHIEDZA, all the young women reported receiving non-judgmental care. For those living with HIV, they were able to access integrated HIV and family planning services that supported them having broader sexual and reproductive needs beyond their HIV diagnosis. The family planning preference of young women living with HIV included medium to long-acting contraceptives to minimize adherence challenges, and desired partner involvement in dual protection to prevent HIV transmission. CHIEDZA's ability to meet these preferences shaped uptake, acceptability, and engagement with integrated HIV and family services. Conclusions Recommendations for an HIV and family planning integrated service for young people living with HIV include: offering a range of services (including method-mix contraceptives) to choose from; supporting their agency to engage with the services which are most acceptable to them; and providing trained, supportive, knowledgeable, and non-judgmental health providers who can provide accurate information and counsel. We recommend youth-friendly, differentiated, person-centered care that recognize the multiple and intersecting needs of young people living with HIV.
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Affiliation(s)
- Constancia V. Mavodza
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joanna Busza
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Constance R. S. Mackworth-Young
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Portia Nzombe
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mandikudza Tembo
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Victoria Simms
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Owen Mugurungi
- Ministry of Health and Child Care, HIV and TB Department, Harare, Zimbabwe
| | - Tsitsi Apollo
- Ministry of Health and Child Care, HIV and TB Department, Harare, Zimbabwe
| | | | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Bernays
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Public Health, University of Sydney, Sydney, NSW, Australia
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Brunie A, Lydon M, Stankevitz K, Chintu N, Brennan C, Danna K, Rademacher KH. What are the prospects for the hormonal IUD in the public sector? A mixed-method study of the user population in Zambia. BMC Womens Health 2022; 22:178. [PMID: 35570281 PMCID: PMC9107745 DOI: 10.1186/s12905-022-01745-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 04/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background The levonorgestrel-releasing intrauterine device (IUD)—also known as the hormonal IUD—is a highly effective contraceptive method that has not been widely available in the public sector in Zambia. Early introduction efforts can provide critical insights into the characteristics of users, reasons for method choice, and experiences getting their method. Methods We conducted a survey with 710 public sector clients who received a hormonal IUD, copper IUD, implant or injectable in two provinces of Zambia, and additional in-depth interviews with 29 women. We performed descriptive analyses of survey data and fitted multivariable logistic regression models to assess factors associated with hormonal IUD use. Qualitative interviews were analyzed thematically. Results Factors associated with hormonal IUD use included full-time or self-employment (relative to both implant and copper IUD use), as well as being older, wealthier, and partner not being aware of method use (relative to implant use only). Common reasons for choosing long-acting methods were duration, perception that the method was “right for my body,” and convenience. In addition, a portion of hormonal IUD acceptors mentioned effectiveness, potential for discreet use, few or manageable side effects, and treatment for heavy or painful periods. Between 83 and 95% of women said that they were counseled about menstrual changes and/or non-bleeding side effects; however, more hormonal IUD acceptors recalled being counseled on the possibility of experiencing reduced bleeding (88%) than amenorrhea (43%). Qualitative interviews indicate that women seek methods with minimal or tolerable side effects. While most women reported their partner was aware of method use, men may be more consistently involved in the decision to use contraception rather than in the choice of a particular method. Qualitative results show an appreciation of the lifestyle benefits of reduced bleeding (especially lighter bleeding), although amenorrhea can be cause for concern. Conclusions Initial efforts to introduce the hormonal IUD can provide valuable learnings that can inform broader method introduction to expand choice and better suit women’s needs in Zambia and elsewhere. Scale-up plans should include emphasis on high quality counseling and demand generation. Plain English Summary The government of Zambia is committed to increasing access to high-quality contraception and making more choices available to users. To date, the hormonal IUD, a highly effective, long-lasting contraceptive has not been widely available in the country. A study in pilot introduction settings provided insights into why women chose the methods, their characteristics, and their experiences getting their methods. The 710 women in the study received family planning services in public sector settings in two provinces in Zambia. Women in the study who received a hormonal IUD, copper IUD, implant, or injectable completed a quantitative survey; in-depth interviews were also conducted with 29 women. Results showed common reasons for choosing the long-acting methods (hormonal IUD, copper IUD or implants) were their duration, perception that the method was “right for my body,” and convenience. In addition, some hormonal IUD acceptors indicated that they were attracted to the method’s effectiveness, potential for discreet use, few or manageable side effects, and treatment for heavy or painful periods. Qualitative interviews with women also showed that women want contraceptive methods that lead to minimal or tolerable side effects. Male partners were typically aware of contraceptive use; however, men were less involved with decisions about the particular method women selected. Use of the hormonal IUD can lead to reduced menstrual bleeding, and in the interviews, women indicated that they liked reduced bleeding (especially lighter bleeding), although amenorrhea (paused bleeding) can be cause for concern. The results can help inform broader method introduction. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01745-7.
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Affiliation(s)
| | | | | | - Namwinga Chintu
- Society for Family Health, Lusaka, Zambia.,UNAIDS, Geneva, Switzerland
| | - Claire Brennan
- FHI 360, Durham, NC, USA.,RTI, Research Triangle Park, NC, USA
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Cvetkovic A, King E, Skerritt L, Loutfy M, Tseng A, Murray M, van Schalkwyk J, Boucoiran I, Marcotte S, Hankins C, Savoie É, de Pokomandy A, Pick N, Tkachuk S, Rowe T, Smaill F, Walmsley S. A practical clinical guide to counselling on and managing contraception, pre-conception planning, and menopause for women living with HIV. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:278-295. [PMID: 36338461 PMCID: PMC9629258 DOI: 10.3138/jammi-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Women represent one quarter of the population living with HIV in Canada and are an increasingly important sector of the HIV community. While some women's health issues such as cervical cancer screening and management are well addressed in HIV management guidelines, others are not. These include sexual and reproductive health factors such as contraception, pre-conception planning, and menopause. Existing literature has shown that while women living with HIV in Canada receive good HIV care based on HIV care cascade indicators, their women's health and sexual and reproductive health care needs are not being met. METHODS In this article, we present a clinical guide for clinicians providing care for women living with HIV on three key women's health topics that are under-discussed during HIV care visits: (1) contraception, (2) pre-conception planning, and (3) menopause. RESULTS We have summarized the most pertinent clinical factors on each topic to support straightforward counselling and present important considerations in the context of HIV-related diseases and treatment. Finally, when relevant, we have provided practical stepwise approaches for addressing each of these women's health care topics when seeing a patient during a visit. CONCLUSIONS It is important that HIV specialists stay well-versed in the complex clinical interactions between HIV treatment and management of women's health issues.
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Affiliation(s)
- Anna Cvetkovic
- Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth King
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Lashanda Skerritt
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alice Tseng
- Immunodeficiency Clinic, University Health Network, Toronto, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Murray
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Julie van Schalkwyk
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, UBC, Vancouver, British Columbia, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Suzanne Marcotte
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Catherine Hankins
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Édénia Savoie
- McGill University Health Centre, Montréal, Québec, Canada
| | | | - Neora Pick
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Stacey Tkachuk
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Timothy Rowe
- Department of Obstetrics and Gynecology, UBC, Vancouver, British Columbia, Canada
| | - Fiona Smaill
- Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Sharon Walmsley
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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10
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Bahamondes MV, Bahamondes L. Intrauterine device use is safe among nulligravidas and adolescent girls. Acta Obstet Gynecol Scand 2021; 100:641-648. [PMID: 33483956 DOI: 10.1111/aogs.14097] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
The use of intrauterine devices (IUDs), including the copper-bearing device and the levonorgestrel intrauterine system (LNG-IUS), is safe among nulligravidas and adolescent girls. However, several misconceptions limit their use in clinical practice; health-care providers are hesitant to prescribe IUDs, and several myths associated with their usage in nulligravidas and adolescents exist among both providers and women themselves. The high rates of unplanned pregnancies (which in many settings constitute a public health issue, primarily among adolescent females) can be attributed at least partially to lack of awareness and limited use of highly effective contraceptives such as IUDs. In this review, we discuss the role of non-hormonal and hormonal IUDs as effective contraceptives in nulligravidas and adolescent girls. We present a literature review of data that highlight contraceptive efficacy, side effects (including reasons for discontinuation), and continuation rates with the method. We searched the PubMed/MEDLINE, Cochrane Library, Embase, and Scopus databases for all articles published in English between January 1990 through September 2020. A large body of evidence confirmed the effectiveness of IUD/IUS, independent of age and parity. Studies showed a high expulsion rate among adolescents but not among nulligravidas. Additionally, bleeding patterns among adolescents and nulligravidas were similar to those observed among adults and parous women. The high early removal rates observed in adolescents were attributable to bleeding and/or pain, which indicate that compared with adults, adolescents are less likely to accept IUD-induced side effects. IUD placement is an excellent strategy to avoid the high rates of unplanned pregnancies in adolescents and nulligravidas. IUDs are more effective than short-acting reversible contraceptives with failure rates that are equivalent to those observed with permanent contraception. However, few long-term studies have investigated this category of women to definitively establish the role of IUD/IUS as effective means of contraception.
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Affiliation(s)
- M Valeria Bahamondes
- Latin American Center of Perinatology, Women's Health and Reproduction (CLAP/SMR), Pan American Health Organization/World Health Organization, Montevideo, Uruguay
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
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