Contraceptive Use and Pregnancy Incidence Among Women Participating in an HIV Prevention Trial
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Women's Health
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.
Description
Keywords
Hormonal contraception, Contraceptive initiation, DMPA, Oral contraception, Uganda, HIV prevention
Citation
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.DOI: 10.1089/jwh.2016.5958