Catherine S Todd1, Tracy C Anderman2, Sarah Long3, Landon Myer4, Linda-Gail Bekker5, Gregory A Petro6, Heidi E Jones7. 1. Reproductive, Maternal, Newborn, & Child Health Division, FHI360, 359 Blackwell Street, Suite 200, Durham, NC 27701, USA. Electronic address: ctodd@fhi360.org. 2. Department of Epidemiology & Biostatistics, City University of New York School of Public Health, 55 W 125(th) St, New York, NY 10027, USA. Electronic address: tracy.anderman@gmail.com. 3. Reproductive, Maternal, Newborn, & Child Health Division, FHI360, 359 Blackwell Street, Suite 200, Durham, NC 27701, USA. Electronic address: smullins@fhi360.org. 4. Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, South Africa. Electronic address: landon.myer@uct.ac.za. 5. Desmond Tutu HIV Centre, Institute for Infectious Diseases & Molecular Medicine and Department of Medicine, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, South Africa. Electronic address: Linda-Gail.Bekker@hiv-research.org.za. 6. Department of Obstetrics & Gynaecology, University of Cape Town & New Somerset Hospital, Lower Portswood Road, Green Point, 8001, Cape Town, South Africa. Electronic address: grepetro@westerncape.gov.za. 7. Department of Epidemiology & Biostatistics, City University of New York School of Public Health, 55 W 125(th) St, New York, NY 10027, USA. Electronic address: Heidi.Jones@sph.cuny.edu.
Abstract
BACKGROUND: Women living with HIV (WLHIV) experience high rates of unmet contraceptive need and unintended pregnancy. Contraceptive method-specific continuation rates and associated factors are critical for guiding providers tasked with both reproductive health (RH) and HIV care. We conducted this systematic review to determine whether contraceptive continuation rates differ between WLHIV and uninfected women and, for WLHIV, whether differences are impacted by method type, antiretroviral therapy use or other factors. METHODS: We searched Ovid MEDLINE, POPLINE and PubMed.gov for studies published between January 1, 2000, and August 31, 2016. Inclusion criteria comprised prospective data of WLHIV, nonbarrier method continuation as an outcome measure, and recorded method switching and/or discontinuation. RESULTS: Of 939 citations screened, 22 articles from 18 studies were eligible. For studies with comparator groups, data quality was moderate overall based on Grading of Recommendations, Assessment, Development and Evaluations and Newcastle-Ottawa Quality Assessment scales. Of four studies comparing women by HIV serostatus, two showed higher rates of contraceptive continuation among WLHIV versus uninfected women, while two others detected lower continuation rates for the same comparison. Generally, baseline method continuation exceeded 60% for studies with >12months of follow-up. Studies providing contraception had higher continuation rates than studies not providing contraception, while women allocated to contraceptive methods in trials had similar continuation rates to those choosing contraceptive methods. Across all studies, continuation rates differed by method and context, with the copper intrauterine device showing greatest variability between sites (51%-91% continuation rates at ≥12months). Implant continuation rates were ≥86%, though use was low relative to other methods and limited to few studes. CONCLUSIONS: Contraceptive continuation among WLHIV differs by method and context. More longitudinal studies with contraceptive continuation as a measured outcome following ≥12months are needed to strengthen integration of RH and HIV care.
BACKGROUND:Women living with HIV (WLHIV) experience high rates of unmet contraceptive need and unintended pregnancy. Contraceptive method-specific continuation rates and associated factors are critical for guiding providers tasked with both reproductive health (RH) and HIV care. We conducted this systematic review to determine whether contraceptive continuation rates differ between WLHIV and uninfected women and, for WLHIV, whether differences are impacted by method type, antiretroviral therapy use or other factors. METHODS: We searched Ovid MEDLINE, POPLINE and PubMed.gov for studies published between January 1, 2000, and August 31, 2016. Inclusion criteria comprised prospective data of WLHIV, nonbarrier method continuation as an outcome measure, and recorded method switching and/or discontinuation. RESULTS: Of 939 citations screened, 22 articles from 18 studies were eligible. For studies with comparator groups, data quality was moderate overall based on Grading of Recommendations, Assessment, Development and Evaluations and Newcastle-Ottawa Quality Assessment scales. Of four studies comparing women by HIV serostatus, two showed higher rates of contraceptive continuation among WLHIV versus uninfected women, while two others detected lower continuation rates for the same comparison. Generally, baseline method continuation exceeded 60% for studies with >12months of follow-up. Studies providing contraception had higher continuation rates than studies not providing contraception, while women allocated to contraceptive methods in trials had similar continuation rates to those choosing contraceptive methods. Across all studies, continuation rates differed by method and context, with the copper intrauterine device showing greatest variability between sites (51%-91% continuation rates at ≥12months). Implant continuation rates were ≥86%, though use was low relative to other methods and limited to few studes. CONCLUSIONS: Contraceptive continuation among WLHIV differs by method and context. More longitudinal studies with contraceptive continuation as a measured outcome following ≥12months are needed to strengthen integration of RH and HIV care.
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