Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia
Identifieur interne : 001A44 ( Pmc/Checkpoint ); précédent : 001A43; suivant : 001A45Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia
Auteurs : Lisa Haddad [États-Unis] ; Kristin M. Wall [États-Unis] ; Bellington Vwalika [États-Unis, Zambie] ; Naw Htee Khu [États-Unis] ; Ilene Brill [États-Unis] ; William Kilembe [États-Unis] ; Rob Stephenson [États-Unis] ; Elwyn Chomba [États-Unis, Zambie] ; Cheswa Vwalika [États-Unis] ; Amanda Tichacek [États-Unis] ; Susan Allen [États-Unis]Source :
- AIDS (London, England) [ 0269-9370 ] ; 2013.
Abstract
To describe predictors of contraceptive method discontinuation and switching behaviors among HIV positive couples receiving couples' voluntary HIV counseling and testing services in Lusaka, Zambia.
Couples were randomized in a factorial design to two family planning educational intervention videos, received comprehensive family planning services, and were assessed every 3-months for contraceptive initiation, discontinuation and switching.
We modeled factors associated with contraceptive method upgrading and downgrading via multivariate Andersen-Gill models.
Most women continued the initial method selected after randomization. The highest rates of discontinuation/switching were observed for injectable contraceptive and intrauterine device users. Time to discontinuing the more effective contraceptive methods or downgrading to oral contraceptives or condoms was associated with the women's younger age, desire for more children within the next year, heavy menstrual bleeding, bleeding between periods, and cystitis/dysuria. Health concerns among women about contraceptive implants and male partners not wanting more children were associated with upgrading from oral contraceptives or condoms. HIV status of the woman or the couple was not predictive of switching or stopping.
We found complicated patterns of contraceptive use. The predictors of contraception switching indicate that interventions targeted to younger couples that address common contraception-related misconceptions could improve effective family planning utilization. We recommend these findings be used to increase the uptake and continuation of contraception, especially long acting reversible contraceptive (LARC) methods, and that fertility-goal based, LARC-focused family planning be offered as an integral part of HIV prevention services.
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DOI: 10.1097/QAD.0000000000000039
PubMed: 24088689
PubMed Central: 4070372
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and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Wall, Kristin M" sort="Wall, Kristin M" uniqKey="Wall K" first="Kristin M" last="Wall">Kristin M. Wall</name><affiliation wicri:level="2"><nlm:aff id="A1">Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="A3">Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Vwalika, Bellington" sort="Vwalika, Bellington" uniqKey="Vwalika B" first="Bellington" last="Vwalika">Bellington Vwalika</name><affiliation wicri:level="2"><nlm:aff id="A1">Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="A4">Department of Gynecology and Obstetrics, School of Medicine, University of Zambia, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>Department of Gynecology and Obstetrics, School of Medicine, University of Zambia, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Htee Khu, Naw" sort="Htee Khu, Naw" uniqKey="Htee Khu N" first="Naw" last="Htee Khu">Naw Htee Khu</name><affiliation wicri:level="2"><nlm:aff id="A1">Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Brill, Ilene" sort="Brill, Ilene" uniqKey="Brill I" first="Ilene" last="Brill">Ilene Brill</name><affiliation wicri:level="2"><nlm:aff id="A5">Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama</wicri:regionArea><placeName><region type="state">Alabama</region></placeName></affiliation></author><author><name sortKey="Kilembe, William" sort="Kilembe, William" uniqKey="Kilembe W" first="William" last="Kilembe">William Kilembe</name><affiliation wicri:level="2"><nlm:aff id="A1">Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Stephenson, Rob" sort="Stephenson, Rob" uniqKey="Stephenson R" first="Rob" last="Stephenson">Rob Stephenson</name><affiliation wicri:level="2"><nlm:aff id="A6">Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Chomba, Elwyn" sort="Chomba, Elwyn" uniqKey="Chomba E" first="Elwyn" last="Chomba">Elwyn Chomba</name><affiliation wicri:level="2"><nlm:aff id="A1">Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="A7">Ministry of Community Development, Mother and Child Health, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>Ministry of Community Development, Mother and Child Health, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Vwalika, Cheswa" sort="Vwalika, Cheswa" uniqKey="Vwalika C" first="Cheswa" last="Vwalika">Cheswa Vwalika</name><affiliation wicri:level="2"><nlm:aff id="A1">Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Tichacek, Amanda" sort="Tichacek, Amanda" uniqKey="Tichacek A" first="Amanda" last="Tichacek">Amanda Tichacek</name><affiliation wicri:level="2"><nlm:aff id="A1">Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Allen, Susan" sort="Allen, Susan" uniqKey="Allen S" first="Susan" last="Allen">Susan Allen</name><affiliation wicri:level="2"><nlm:aff id="A1">Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author></analytic><series><title level="j">AIDS (London, England)</title><idno type="ISSN">0269-9370</idno><idno type="eISSN">1473-5571</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title><p id="P1">To describe predictors of contraceptive method discontinuation and switching behaviors among HIV positive couples receiving couples' voluntary HIV counseling and testing services in Lusaka, Zambia.</p></sec><sec id="S2"><title>Design</title><p id="P2">Couples were randomized in a factorial design to two family planning educational intervention videos, received comprehensive family planning services, and were assessed every 3-months for contraceptive initiation, discontinuation and switching.</p></sec><sec id="S3"><title>Methods</title><p id="P3">We modeled factors associated with contraceptive method upgrading and downgrading via multivariate Andersen-Gill models.</p></sec><sec id="S4"><title>Results</title><p id="P4">Most women continued the initial method selected after randomization. The highest rates of discontinuation/switching were observed for injectable contraceptive and intrauterine device users. Time to discontinuing the more effective contraceptive methods or downgrading to oral contraceptives or condoms was associated with the women's younger age, desire for more children within the next year, heavy menstrual bleeding, bleeding between periods, and cystitis/dysuria. Health concerns among women about contraceptive implants and male partners not wanting more children were associated with upgrading from oral contraceptives or condoms. HIV status of the woman or the couple was not predictive of switching or stopping.</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">We found complicated patterns of contraceptive use. The predictors of contraception switching indicate that interventions targeted to younger couples that address common contraception-related misconceptions could improve effective family planning utilization. We recommend these findings be used to increase the uptake and continuation of contraception, especially long acting reversible contraceptive (LARC) methods, and that fertility-goal based, LARC-focused family planning be offered as an integral part of HIV prevention services.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8710219</journal-id><journal-id journal-id-type="pubmed-jr-id">1493</journal-id><journal-id journal-id-type="nlm-ta">AIDS</journal-id><journal-id journal-id-type="iso-abbrev">AIDS</journal-id><journal-title-group><journal-title>AIDS (London, England)</journal-title></journal-title-group><issn pub-type="ppub">0269-9370</issn><issn pub-type="epub">1473-5571</issn></journal-meta><article-meta><article-id pub-id-type="pmid">24088689</article-id><article-id pub-id-type="pmc">4070372</article-id><article-id pub-id-type="doi">10.1097/QAD.0000000000000039</article-id><article-id pub-id-type="manuscript">NIHMS584246</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Haddad</surname><given-names>Lisa</given-names></name><degrees>MD, MS, MPH</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Wall</surname><given-names>Kristin M</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Vwalika</surname><given-names>Bellington</given-names></name><degrees>MD, M.MED, MSc</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Htee Khu</surname><given-names>Naw</given-names></name><degrees>MPH</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Brill</surname><given-names>Ilene</given-names></name><degrees>MPH</degrees><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Kilembe</surname><given-names>William</given-names></name><degrees>MD, MSc</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Stephenson</surname><given-names>Rob</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Chomba</surname><given-names>Elwyn</given-names></name><degrees>MRCP, DCH</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Vwalika</surname><given-names>Cheswa</given-names></name><degrees>MD, MPH</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Tichacek</surname><given-names>Amanda</given-names></name><degrees>MPH</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Allen</surname><given-names>Susan</given-names></name><degrees>MD, MPH, DTM&H</degrees><xref ref-type="aff" rid="A1">1</xref></contrib></contrib-group><aff id="A1"><label>1</label>Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA</aff><aff id="A2"><label>2</label>Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia, USA</aff><aff id="A3"><label>3</label>Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA</aff><aff id="A4"><label>4</label>Department of Gynecology and Obstetrics, School of Medicine, University of Zambia, Lusaka, Zambia</aff><aff id="A5"><label>5</label>Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA</aff><aff id="A6"><label>6</label>Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA</aff><aff id="A7"><label>7</label>Ministry of Community Development, Mother and Child Health, Lusaka, Zambia</aff><author-notes><corresp id="FN1">Corresponding Author: Lisa Haddad Address: 49 Jesse Hill Jr. Drive, Atlanta, GA 30306, Phone: 404-778-1385, <email>lbhadda@emory.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>17</day><month>5</month><year>2014</year></pub-date><pub-date pub-type="ppub"><month>10</month><year>2013</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>10</month><year>2014</year></pub-date><volume>27</volume><issue>0 1</issue><fpage>S93</fpage><lpage>103</lpage><pmc-comment>elocation-id from pubmed: 10.1097/QAD.0000000000000039</pmc-comment>
<abstract><sec id="S1"><title>Objective</title><p id="P1">To describe predictors of contraceptive method discontinuation and switching behaviors among HIV positive couples receiving couples' voluntary HIV counseling and testing services in Lusaka, Zambia.</p></sec><sec id="S2"><title>Design</title><p id="P2">Couples were randomized in a factorial design to two family planning educational intervention videos, received comprehensive family planning services, and were assessed every 3-months for contraceptive initiation, discontinuation and switching.</p></sec><sec id="S3"><title>Methods</title><p id="P3">We modeled factors associated with contraceptive method upgrading and downgrading via multivariate Andersen-Gill models.</p></sec><sec id="S4"><title>Results</title><p id="P4">Most women continued the initial method selected after randomization. The highest rates of discontinuation/switching were observed for injectable contraceptive and intrauterine device users. Time to discontinuing the more effective contraceptive methods or downgrading to oral contraceptives or condoms was associated with the women's younger age, desire for more children within the next year, heavy menstrual bleeding, bleeding between periods, and cystitis/dysuria. Health concerns among women about contraceptive implants and male partners not wanting more children were associated with upgrading from oral contraceptives or condoms. HIV status of the woman or the couple was not predictive of switching or stopping.</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">We found complicated patterns of contraceptive use. The predictors of contraception switching indicate that interventions targeted to younger couples that address common contraception-related misconceptions could improve effective family planning utilization. We recommend these findings be used to increase the uptake and continuation of contraception, especially long acting reversible contraceptive (LARC) methods, and that fertility-goal based, LARC-focused family planning be offered as an integral part of HIV prevention services.</p></sec></abstract><kwd-group><kwd>Contraceptive discontinuation</kwd><kwd>couples' voluntary HIV counseling and testing</kwd><kwd>family planning</kwd><kwd>long-acting reversible contraception</kwd><kwd>Zambia</kwd></kwd-group></article-meta></front></pmc><affiliations><list><country><li>Zambie</li><li>États-Unis</li></country><region><li>Alabama</li><li>Géorgie (États-Unis)</li></region></list><tree><country name="États-Unis"><region name="Géorgie (États-Unis)"><name sortKey="Haddad, Lisa" sort="Haddad, Lisa" uniqKey="Haddad L" first="Lisa" last="Haddad">Lisa Haddad</name></region><name sortKey="Allen, Susan" sort="Allen, Susan" uniqKey="Allen S" first="Susan" last="Allen">Susan Allen</name><name sortKey="Brill, Ilene" sort="Brill, Ilene" uniqKey="Brill I" first="Ilene" last="Brill">Ilene Brill</name><name sortKey="Chomba, Elwyn" sort="Chomba, Elwyn" uniqKey="Chomba E" first="Elwyn" last="Chomba">Elwyn Chomba</name><name sortKey="Haddad, Lisa" sort="Haddad, Lisa" uniqKey="Haddad L" first="Lisa" last="Haddad">Lisa Haddad</name><name sortKey="Htee Khu, Naw" sort="Htee Khu, Naw" uniqKey="Htee Khu N" first="Naw" last="Htee Khu">Naw Htee Khu</name><name sortKey="Kilembe, William" sort="Kilembe, William" uniqKey="Kilembe W" first="William" last="Kilembe">William Kilembe</name><name sortKey="Stephenson, Rob" sort="Stephenson, Rob" uniqKey="Stephenson R" first="Rob" last="Stephenson">Rob Stephenson</name><name sortKey="Tichacek, Amanda" sort="Tichacek, Amanda" uniqKey="Tichacek A" first="Amanda" last="Tichacek">Amanda Tichacek</name><name sortKey="Vwalika, Bellington" sort="Vwalika, Bellington" uniqKey="Vwalika B" first="Bellington" last="Vwalika">Bellington Vwalika</name><name sortKey="Vwalika, Cheswa" sort="Vwalika, Cheswa" uniqKey="Vwalika C" first="Cheswa" last="Vwalika">Cheswa Vwalika</name><name sortKey="Wall, Kristin M" sort="Wall, Kristin M" uniqKey="Wall K" first="Kristin M" last="Wall">Kristin M. Wall</name><name sortKey="Wall, Kristin M" sort="Wall, Kristin M" uniqKey="Wall K" first="Kristin M" last="Wall">Kristin M. Wall</name></country><country name="Zambie"><noRegion><name sortKey="Vwalika, Bellington" sort="Vwalika, Bellington" uniqKey="Vwalika B" first="Bellington" last="Vwalika">Bellington Vwalika</name></noRegion><name sortKey="Chomba, Elwyn" sort="Chomba, Elwyn" uniqKey="Chomba E" first="Elwyn" last="Chomba">Elwyn Chomba</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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