Hormonal Contraceptive Use and Discontinuation Among HIV-Infected Women in Uganda and Zimbabwe

Bengtson, Angela MA*,†; Kwok, Cynthia MSPH; Salata, Robert A. MD; Byamugisha, Josaphat MBChB, PhD§; Chipato, Tsungai MBChB, MS; Rwambuya, Sandra MPH; Moyo, Precious MS; Morrison, Charles S. PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e318293df9e
Epidemiology and Prevention
Abstract

Background: Hormonal contraception (HC) use by HIV-infected women has been identified by the World Health Organization as an important strategy for reducing vertical HIV transmission. Little is known about the factors associated with HC discontinuation among HIV-infected women.

Methods: We analyzed data from a prospective study of HC use among 231 HIV-infected users with oral contraceptive (OC) or injectable depot medroxyprogesterone acetate (DMPA) in Uganda and Zimbabwe. We used Kaplan–Meier survival curves to estimate the median duration of OC and DMPA use and use of any highly effective contraceptive method. Cox proportional hazards models were used to investigate factors associated with HC discontinuation.

Results: Median duration was 36 months [95% confidence interval (CI): 14 to 61] for OC use and 19 months (95% CI: 14 to 24) for DMPA use. Median duration of any highly effective method was 36 months (95% CI: 26 to N/A) for OC users and 22 months (95% CI: 14 to 38) for DMPA users. In multivariable analyses, living in Zimbabwe [hazard ratio (HR): 0.39; 95% CI: 0.18 to 0.83], no partner (HR: 7.18; 95% CI: 3.05 to 16.88), and cervical infection (HR: 1.99; 95% CI: 0.90 to 4.41) were associated with OC discontinuation. No partner (HR: 2.00; 95% CI: 1.12 to 3.58), nausea (HR: 1.84; 95% CI: 1.02 to 3.34), and excessive night sweats (HR: 1.80; 95% CI: 0.95 to 3.40) were associated with DMPA discontinuation.

Conclusion: Long-term use of HC methods is acceptable to HIV-infected women. Women discontinue for a variety of reasons, primarily unrelated to HIV. Alternative methods and ongoing contraceptive counseling is essential to reduce unplanned pregnancies and vertical HIV transmission.

Author Information

*Department of Epidemiology, University of North Carolina, Chapel Hill, NC;

Clinical Sciences Department, FHI 360, Durham, NC;

Case Western Reserve University, Cleveland, OH;

§Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda;

Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe; and

UZ-UCSF Collaborative Research Programme, Harare, Zimbabwe.

Correspondence to: Angela Bengtson, MA, Department of Epidemiology, Gillings School of Global Public Health, 2101 McGavran–Greenberg Hall, Chapel Hill, NC 27599 (e-mail: abengtso@live.unc.edu).

Supported by federal funds from the Eunice Shriver Kennedy National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services through a contract with FHI 360 (Contract Number N01-HD-0–3310).

Presented at Consortium of Universities for Global Health 4th Annual Conference, March 14, 2013, Washington, DC.

A.B. was supported by a fellowship through the University of North Carolina, Chapel Hill and FHI360. The other authors have no conflicts of interest to disclose.

Received February 05, 2013

Accepted March 22, 2013

© 2013 by Lippincott Williams & Wilkins