Contraception: X最新文献_第2页

Evaluation of the LMUP in Ethiopia: Requirements, challenges and best practice 埃塞俄比亚LMUP评估：要求、挑战和最佳实践

Q2 Medicine

Contraception: X

Pub Date : 2023-01-01 DOI: 10.1016/j.conx.2023.100097

Geraldine Barrett, Ana Luiza Vilela Borges, Justine N. Bukenya, Ararso Baru Olani, Jennifer A. Hall

引用次数: 0

Differential discontinuation by covert use status in Kenya 肯尼亚因秘密使用状况而区别停用。

Q2 Medicine

Contraception: X

Pub Date : 2023-01-01 DOI: 10.1016/j.conx.2023.100102

Dana Sarnak , Shannon N. Wood , Phil Anglewicz , Elizabeth Gummerson , Peter Gichangi , Mary Thiongo , Caroline Moreau

Objectives

Qualitative research suggests that covert users may be more likely to discontinue contraception due to the logistics of discretion and fear of disclosure. This study sought to quantify whether covert users are more likely to discontinue contraception than overt users.

Study design

We used a national longitudinal survey from Kenya conducted from November 2019/February 2020 to November 2020/April 2021 to test whether the time to discontinuation between covert and overt users still in need of contraception differed using survival analyses over a period of 5 years since method initiation.

Results

Multivariate Cox regression results showed there was an interaction with time and covert use on the risk of discontinuation; for every additional month of use, there was an increased risk of discontinuation of covert users compared to overt users (3% increased hazard, p = 0.02). At 1 and 2 years, there were no differences in the hazard of discontinuation (adjusted hazard ratio [aHR]_1 year 0.95, 95% CI 0.54–1.65 and aHR_2 years 1.37, 95% CI 0.85–2.21), yet at 3, 4, and 5 years, the hazard of discontinuation was higher for covert compared to overt users (aHR_3 years 1.99, 95% 1.11–3.56; aHR_4 years 2.89, 95% CI 2.0–6.40; aHR_5 years 4.18, 95% CI 1.45–12.0).

Conclusions

These results suggest efforts are needed to support covert users in managing their contraceptive use and for improving contraceptive counseling surrounding covert use. Our findings shed light on the increasing challenge covert users face after approximately the first 2 years of use; covert users require additional follow-up in both research and care provision.

Implications

Covert users are at a higher risk of discontinuation of contraception while still trying to avoid pregnancy, particularly after the first 2 years of use. Family planning providers and programs must protect access to and maintain the privacy of reproductive services to this population, focusing on follow-up care provision and counseling.

目的：定性研究表明，由于谨慎和害怕披露，秘密使用者可能更有可能停止避孕。这项研究试图量化隐蔽使用者是否比公开使用者更有可能停止避孕。研究设计：我们使用了2019年11月/2020年2月至2020年11月-2021年4月在肯尼亚进行的一项全国纵向调查，通过自方法启动以来5年的生存分析，测试仍需要避孕的隐蔽使用者和公开使用者之间的停药时间是否不同。结果：多因素Cox回归结果显示，停药风险与时间和隐蔽使用有关；与显性使用者相比，每多使用一个月，隐性使用者停用的风险就会增加（危险增加3%，p=0.02）。在1年和2年时，停用的危险没有差异（调整后的危险比[aHR]1年0.95，95%CI 0.54-1.65和aHR2年1.37，95%CI 0.85-2.21），但在3年、4年和5年时，与显性使用者相比，隐性使用者的停药风险更高（aHR3岁1.99，95%1.11-3.56；aHR4岁2.89，95%CI 2.0-6.40；aHR5岁4.18，95%CI 1.45-12.0）。结论：这些结果表明，需要努力支持隐性使用者管理其避孕药具的使用，并改善围绕隐性使用的避孕咨询。我们的发现揭示了秘密用户在使用大约前2年后面临的越来越大的挑战；隐蔽使用者需要在研究和护理方面采取额外的后续行动。影响：隐蔽使用者在试图避免怀孕的同时，终止避孕的风险更高，尤其是在使用前2年之后。计划生育提供者和方案必须保护这一人群获得生殖服务的机会并维护其隐私，重点是后续护理和咨询。

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引用次数: 0

Concern that contraception affects future fertility: How common is this concern among young people and does it stop them from using contraception? 对避孕影响未来生育的担忧：这种担忧在年轻人中的普遍程度如何？

Q2 Medicine

Contraception: X

Pub Date : 2023-01-01 DOI: 10.1016/j.conx.2023.100103

Annalisa Watson , Jennifer Yarger , Erica Sedlander , Josephine Urbina , Kristine Hopkins , Maria I. Rodriguez , Liza Fuentes , Cynthia C. Harper

Objectives

This study examines the concern that contraception affects future fertility among community college students and its association with contraceptive use.

Study design

We used baseline data from a randomized controlled trial with 2060 community college students assigned female at birth. We used mixed-effects multivariate logistic regression adjusted for clustered data to assess sociodemographic factors associated with concerns about contraception affecting future fertility and to test the association between this concern and contraceptive use.

Results

Most participants (69%) worried about contraception affecting their future fertility. Multivariable results indicated that first-generation college students (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.01–1.55) and non-English speakers at home (aOR, 1.30; 95% CI, 1.04–1.64) were more concerned. Racial and ethnic differences were significant, with Black non-Hispanic (aOR, 2.83; 95% CI, 1.70–4.70), Asian/Pacific Islander non-Hispanic (aOR, 2.12; 95% CI, 1.43–3.14), and Hispanic (aOR, 1.54; 95% CI, 1.17–2.02) participants more likely to be concerned than White non-Hispanic counterparts. Participants who received contraceptive services in the past year had lower odds of this concern (aOR, 0.72; 95% CI 0.59–0.88). Furthermore, participants with this concern had lower odds of using contraception (aOR, 0.67; 95% CI, 0.49–0.91), especially hormonal contraception (aOR, 0.77; 95% CI, 0.61–0.97).

Conclusions

Most students feared contraception’s impact on fertility, and this fear was associated with not using contraception. Disparities in this concern may be tied to discrimination, reproductive coercion, and limited reproductive health care access. Addressing concerns about contraception affecting future fertility is crucial to person-centered contraceptive counseling.

Implications

This study examines the concern that contraception affects future fertility among sexually active female community college students and its impact on contraceptive use. Most participants expressed concerns about contraception affecting future fertility. Addressing future fertility concerns in patient-centered contraceptive counseling is crucial for reaching young people.

本研究探讨了社区大学生对避孕影响未来生育的担忧及其与避孕药具使用之间的关系。研究设计我们使用了一项随机对照试验的基线数据，其中有 2060 名社区大学生在出生时被分配为女性。我们使用混合效应多变量逻辑回归对聚类数据进行调整，以评估与担心避孕影响未来生育相关的社会人口学因素，并检验这种担心与避孕药具使用之间的关联。多变量结果显示，第一代大学生（调整赔率[aOR]，1.24；95% 置信区间[CI]，1.01-1.55）和家中不讲英语者（aOR，1.30；95% 置信区间[CI]，1.04-1.64）更担心。种族和民族差异显著，非西班牙裔黑人（aOR，2.83；95% CI，1.70-4.70）、非西班牙裔亚裔/太平洋岛民（aOR，2.12；95% CI，1.43-3.14）和西班牙裔参与者（aOR，1.54；95% CI，1.17-2.02）比非西班牙裔白人更有可能感到担忧。在过去一年中接受过避孕服务的参与者出现这种担忧的几率较低（aOR，0.72；95% CI，0.59-0.88）。此外，有这种担忧的参与者使用避孕药具的几率较低（aOR，0.67；95% CI，0.49-0.91），尤其是激素避孕药具（aOR，0.77；95% CI，0.61-0.97）。这种担忧的差异可能与歧视、生殖胁迫和有限的生殖保健服务有关。本研究探讨了性活跃的社区女大学生对避孕影响未来生育的担忧及其对避孕药具使用的影响。大多数参与者表达了对避孕影响未来生育的担忧。在以患者为中心的避孕咨询中解决对未来生育的担忧对于帮助年轻人至关重要。

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引用次数: 0

Missed opportunity for self-injectable contraception awareness and adoption: Insights from client exit interviews in Uganda and Nigeria 错过了自我注射避孕意识和采用的机会:来自乌干达和尼日利亚客户退出访谈的见解

Q2 Medicine

Contraception: X

Pub Date : 2023-01-01 DOI: 10.1016/j.conx.2023.100098

Susan Ontiri , Claire Rothschild , Doreen Nakimuli , Oluwatosin Adeoye

Objectives

To assess the extent to which self-injection contraceptive information and services are provided to women in Uganda and Nigeria.

Study design

We conducted a descriptive information cascade analysis using data from a cross-sectional exit interviews with 492 family planning clients in Uganda and 720 in Nigeria.

Results

More than a third of respondents in Uganda (31.2%) and Nigeria (40.5%) reported not receiving any information about the self-injection contraceptive during service provision. Only 45.6% clients who adopted self-injected DMPA-SC in Uganda and 1.7% in Nigeria were issued with additional doses to take home.

Conclusion

The findings suggest that there are missed opportunities to provide women with information and services on DMPA-SC self-injection.

Implication

A contraceptive counseling and services cascade can be a useful tool for identifying gaps in the quality and person-centeredness of family planning services, and ultimately improving the experience of clients.

目的评估乌干达和尼日利亚向妇女提供自我注射避孕信息和服务的程度。研究设计我们使用乌干达492名和尼日利亚720名计划生育客户的横断面离职访谈数据进行了描述性信息级联分析。结果乌干达（31.2%）和尼日利亚（40.5%）超过三分之一的受访者据报告，在提供服务期间没有收到任何关于自我注射避孕药的信息。乌干达和尼日利亚分别只有45.6%和1.7%的采用自行注射DMPA-SC的客户获得了额外的剂量，可以带回家。结论研究结果表明，错过了为女性提供DMPA-SC自我介绍信息和服务的机会。含义避孕咨询和服务级联可以成为一种有用的工具，用于识别计划生育服务质量和以人为本方面的差距，并最终改善客户的体验。

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引用次数: 1

“Adoption is just not for me”: How abortion patients in Michigan and New Mexico factor adoption into their pregnancy outcome decisions “收养不适合我”:密歇根州和新墨西哥州的堕胎患者如何将收养纳入其怀孕结果的决定

Q2 Medicine

Contraception: X

Pub Date : 2023-01-01 DOI: 10.1016/j.conx.2023.100090

Liza Fuentes, Megan L. Kavanaugh, Lori F. Frohwirth, Jenna Jerman, Nakeisha Blades

Objectives

In public discourses in the United States, adoption is often suggested as a less objectionable, equal substitute for abortion, despite this pregnancy outcome occurring much less frequently than the outcomes of abortion and parenting. This qualitative study explores whether and how abortion patients weighed adoption as part of their pregnancy decisions and, for those who did, identifies factors that contributed to their ultimate decision against adoption.

Study design

We interviewed 29 abortion patients from 6 facilities in Michigan and New Mexico in 2015. We conducted a thematic analysis using both deductive and inductive approaches to describe participants’ perspectives, preferences, and experiences regarding the consideration of adoption for their pregnancy.

Results

Participants’ reasons why adoption was not an appropriate option for their pregnancy were grounded in their ideas of the roles and responsibilities of parenting and fell into three themes. First, participants described continuing the pregnancy and giving birth as inseparable from the decision to parent. Second, choosing adoption would represent an irresponsible abnegation of parental duty. Third, adoption could put their child’s safety and well-being at risk.

Conclusions

Adoption was not an equally acceptable substitute for abortion among abortion patients. For them, adoption was a decision that represented taking on, and then abdicating, the role of parent. This made adoption a particularly unsuitable choice for their pregnancy.

Implications

Rhetoric suggesting that adoption is an equal alternative to abortion does not reflect the experiences, preferences, or values of how abortion patients assess what options are appropriate for their pregnancy.

目的在美国的公共话语中，收养通常被认为是堕胎的一种不那么令人反感的平等替代品，尽管这种怀孕结果的发生频率远低于堕胎和养育子女的结果。这项定性研究探讨了堕胎患者是否以及如何将收养作为其妊娠决定的一部分，并确定了导致他们最终决定不收养的因素。研究设计2015年，我们采访了来自密歇根州和新墨西哥州6个机构的29名堕胎患者。我们使用演绎和归纳方法进行了主题分析，以描述参与者在考虑怀孕收养方面的观点、偏好和经验。结果受试者之所以认为收养不是怀孕的合适选择，是基于他们对养育子女的角色和责任的看法，分为三个主题。首先，参与者将继续怀孕和分娩描述为与为人父母的决定密不可分。其次，选择收养将代表对父母责任的不负责任的放弃。第三，收养可能会危及孩子的安全和健康。结论在堕胎患者中，使用兴奋剂并不是一种同样可接受的堕胎替代品。对他们来说，收养是一个决定，代表着承担父母的角色，然后放弃。这使得收养成为他们怀孕时特别不合适的选择。暗示收养是堕胎的平等选择的修辞并不能反映堕胎患者如何评估哪些选择适合他们的妊娠的经验、偏好或价值观。

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引用次数: 0

A randomized crossover study to evaluate local tolerability following subcutaneous administration of a new depot medroxyprogesterone acetate contraceptive formulation 一项随机交叉研究，评估皮下给药新的长效醋酸甲羟孕酮避孕制剂后的局部耐受性。

Q2 Medicine

Contraception: X

Pub Date : 2023-01-01 DOI: 10.1016/j.conx.2023.100100

Vera Halpern , Angie Wheeless , Vivian Brache , Anja Lendvay , Leila Cochón , Douglas Taylor , Laneta J. Dorflinger

Objectives

This study aimed to evaluate and compare local tolerability of investigational drug TV-46046 and reference drug Depo-subQ Provera 104, both containing medroxyprogesterone acetate (MPA) as an active ingredient.

Study design

We conducted a randomized, crossover, single-center study. Twenty-seven healthy women aged 25 to 47 years at low risk of pregnancy received a subcutaneous injection of each of the four study drugs (120 mg/0.3 mL of TV-46046, 60 mg/0.3 mL of diluted TV-46046, 0.3 mL of TV-46046 placebo, and 104 mg/0.65 mL of Depo-subQ 104) in different quadrants of the abdomen. We assessed local tolerability by occurrence of injection site reactions (ISRs), as well as injection site pain and overall safety for at least 9 months postinjections.

Results

Of a total of 108 study injections, three injections were partial due to needle blockage. We observed a total of 30 ISRs following 105 full-dose injections, including hypopigmentation (n = 24), bruising (n = 4), and atrophy/dimple (n = 2). Eleven cases of hypopigmentation occurred following 25 full-dose injections of undiluted TV-46046 (44.0%), six following 27 full-dose injections of diluted TV-46046 (22.2%), and seven following 26 full-dose injections of Depo-subQ 104 (26.9%). Hypopigmentations occurred on average 8 months postinjection. Injection pain was minimal and dissipated quickly after all four injections.

Conclusions

Subcutaneous administration of MPA in a suspension formulation is associated with the delayed onset of hypopigmentation at the site of injection. Although not statistically significant, the rate of ISRs was over 60% higher for undiluted TV-46046 compared to Depo-subQ 104. This difference bears careful monitoring in future studies of TV-46046.

Implications

From a safety standpoint, investigational drug TV-46046 is appropriate for further clinical testing as a 6-month contraceptive injectable. The previously underreported hypopigmentation associated with subcutaneous administration of MPA warrants further investigation and acceptability assessment among users of existing Depo-subQ 104 as well as careful monitoring of local tolerability of TV-46046 in future clinical trials.

Trial registration

Registered at clinicaltrials.gov no: NCT02817464

目的：本研究旨在评估和比较试验药物TV-46046和参考药物Depo subQ Provera 104的局部耐受性，这两种药物都含有醋酸甲羟孕酮（MPA）作为活性成分。研究设计：我们进行了一项随机、交叉、单中心的研究。27名年龄在25至47岁、妊娠风险较低的健康女性在腹部不同象限皮下注射四种研究药物（120 mg/0.3 mL TV-46046、60 mg/0.3 mL稀释的TV-46043、0.3 mL TV-46046安慰剂和104 mg/0.65 mL Depo subQ 104）。我们通过注射部位反应（ISRs）的发生、注射部位疼痛和注射后至少9个月的总体安全性来评估局部耐受性。结果：在总共108次研究注射中，有三次是由于针头堵塞而部分注射的。在105次全剂量注射后，我们共观察到30次ISR，包括色素沉着不足（n=24）、瘀伤（n=4）和萎缩/酒窝（n=2）。在25次全剂量注射未稀释的TV-46046（44.0%）后出现11例色素沉着不足，在27次全剂量注入稀释的TV-46046（22.2%）后出现6例，在26次全剂量注射剂Depo subQ 104（26.9%）后出现7例。注射疼痛很小，四次注射后很快就消失了。结论：MPA混悬剂皮下给药与注射部位色素沉着减退的延迟发作有关。尽管没有统计学意义，但与Depo subQ 104相比，未稀释的TV-46046的ISR发生率高出60%以上。这种差异在未来的TV-46046研究中需要仔细监测。提示：从安全性的角度来看，试验药物TV-4604六适合作为6个月的避孕注射药物进行进一步的临床测试。先前少报的与皮下注射MPA相关的色素沉着不足，需要在现有Depo subQ 104的使用者中进行进一步的调查和可接受性评估，并在未来的临床试验中仔细监测TV-46046的局部耐受性。试验注册：注册于clinicaltrials.gov，编号：NCT02817464。

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引用次数: 0

Incidence of new outpatient long-acting reversible contraceptive insertions among a commercially insured, US population from 2010 to 2020 2010年至2020年美国商业保险人群中新门诊长效可逆避孕插入的发生率。

Q2 Medicine

Contraception: X

Pub Date : 2023-01-01 DOI: 10.1016/j.conx.2023.100101

Clara E. Busse , Chase D. Latour , Sara Z. Dejene , Andrea K. Knittel , Mollie E. Wood , Alan C. Kinlaw , Mekhala V. Dissanayake

Objectives

Characterize new use of long-acting reversible contraceptives (LARCs), highly effective contraceptive methods, in a broad population over time.

Study Design

We constructed a retrospective cohort of commercially insured individuals aged 15 to 54 years from 2010 to 2020 and estimated monthly incidence of new LARC insertions.

Results

The monthly standardized incidence increased from 6.0 insertions per 10,000 individuals in January 2010 to 14.1 in December 2020, with a dip in insertions after March 2020. Hormonal intrauterine devices were consistently the most inserted LARC; implants were increasingly favored over time.

Conclusions

LARCs are increasingly popular forms of contraception among commercially insured individuals.

Implications

Given the increasing popularity, ensuring access to LARCs is critical.

目的：随着时间的推移，描述长效可逆避孕药（LARC）这一高效避孕方法在广泛人群中的新用途。研究设计：我们构建了一个回顾性队列，从2010年到2020年，年龄在15至54岁之间的商业保险个人，并估计了新的LARC插入的月发生率。结果：每月标准化发病率从2010年1月的每10000人6.0次插入增加到2020年12月的14.1次，2020年3月后插入次数有所下降。激素宫内节育器始终是插入LARC最多的；随着时间的推移，植入物越来越受欢迎。结论：LARC在商业保险个人中越来越流行。影响：鉴于越来越受欢迎，确保获得LARC至关重要。

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引用次数: 0

Effects of the COVID-19 pandemic on publicly supported clinics providing contraceptive services in four US states COVID-19大流行对美国四个州提供避孕服务的公共支持诊所的影响

Q2 Medicine

Contraception: X

Pub Date : 2023-01-01 DOI: 10.1016/j.conx.2023.100096

Jennifer Mueller, Alicia VandeVusse, Samira Sackietey, Ava Braccia, Jennifer J. Frost

Objectives

The COVID-19 pandemic has disrupted contraceptive service provision in the United States (US). We aimed to explore the impact of COVID-19 on the publicly supported family planning network at the provider level. This study adds to the literature documenting the challenges of the pandemic as well as how telehealth provision compares across timepoints.

Study design

We conducted a survey among sexual and reproductive health (SRH) providers at 96 publicly supported clinics in four US states asking about two timepoints—one early in the pandemic and one later in the pandemic. We used descriptive statistics to summarize the data.

Results

We found that almost one-third of sites reduced contraceptive services because of the pandemic, with a few temporarily stopping contraceptive services altogether. More sites stopped provision of long-acting reversible contraception (LARC), Pap tests, and Human papillomavirus (HPV) vaccinations than other methods or services. We also found that sites expanded some practices to make them more accessible to patients, such as extending existing contraceptive prescriptions without consultations for established patients and expanding telehealth visits for contraceptive counseling. In addition, sites reported high utilization of telehealth to provide contraceptive services.

Conclusions

Understanding how service delivery changed due to the pandemic and how telehealth can be used to provide SRH services sheds light on how these networks can best support providers and patients in the face of unprecedented crises such as the COVID-19 pandemic.

Implications

This study demonstrates that providers increased provision of telehealth for sexual and reproductive health care during the COVID-19 pandemic; policymakers in the US should support continued reimbursement of telehealth care as well as resources to expand telehealth infrastructure. In addition, this study highlights the need for more research on telehealth quality.

目的新冠肺炎疫情扰乱了美国的避孕服务。我们旨在探讨新冠肺炎对公共支持的计划生育网络在提供者层面的影响。这项研究增加了记录疫情挑战的文献，以及远程医疗服务如何在不同时间点进行比较。研究设计我们在美国四个州的96家公共支持诊所对性健康和生殖健康（SRH）提供者进行了一项调查，询问了两个时间点——一个是在疫情早期，一个是疫情后期。我们使用描述性统计来总结数据。结果我们发现，由于疫情，近三分之一的场所减少了避孕服务，少数场所暂时停止了避孕服务。与其他方法或服务相比，更多的站点停止提供长效可逆避孕（LARC）、巴氏检测和人乳头瘤病毒（HPV）疫苗接种。我们还发现，网站扩大了一些做法，使患者更容易获得这些做法，例如在不咨询已有患者的情况下延长现有的避孕处方，以及扩大避孕咨询的远程医疗访问。此外，据网站报告，远程保健在提供避孕服务方面的利用率很高。结论了解服务提供是如何因疫情而变化的，以及如何利用远程医疗提供SRH服务，有助于了解这些网络如何在新冠肺炎疫情等前所未有的危机面前为提供者和患者提供最佳支持。含义这项研究表明，在新冠肺炎大流行期间，提供者增加了性健康和生殖健康护理的远程医疗服务；美国的政策制定者应该支持继续偿还远程医疗费用，并支持扩大远程医疗基础设施的资源。此外，这项研究强调了对远程医疗质量进行更多研究的必要性。

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引用次数: 1

Response to “Evaluation of the LMUP in Ethiopia: Requirements, challenges and best practice” 对“埃塞俄比亚LMUP评估：要求、挑战和最佳实践”的回应

Q2 Medicine

Contraception: X

Pub Date : 2023-01-01 DOI: 10.1016/j.conx.2023.100099

Celia Karp, Caroline Moreau, Solomon Shiferaw, Assefa Seme, Mahari Yihdego, Linnea Zimmerman

引用次数: 0

Is long‐acting reversible contraceptive method use associated with HIV testing frequency in KwaZulu‐Natal, South Africa and Lusaka, Zambia? Findings from the CUBE study 在南非夸祖鲁-纳塔尔省和赞比亚卢萨卡，长效可逆避孕方法的使用与艾滋病毒检测频率相关吗?CUBE研究的结果

Q2 Medicine

Contraception: X

Pub Date : 2023-01-01 DOI: 10.1016/j.conx.2023.100089

Mags Beksinska , Alice F. Cartwright , Jennifer Smit , Margaret Kasaro , Jennifer H. Tang , Maria Fawzy , Virginia Maphumulo , Manze Chinyama , Esther Chabu , Rebecca Callahan

Objectives

To assess differences in HIV testing at 6-months intervals over 24 months among intramuscular depot medroxyprogesterone acetate (DMPA-IM) injectable, levonorgestrel implant, or copper intrauterine devices (IUD) users in KwaZulu-Natal, South Africa, and Lusaka, Zambia. Testing at recommended intervals has not been previously assessed in long-acting reversible contraceptive (LARC) users (implant and IUD users) compared to those using effective but shorter-acting methods (such as DMPA-IM) in sub-Saharan Africa.

Study design

As part of the longitudinal contraceptive use beyond ECHO (CUBE) study, we measured HIV testing over 24 months. Participants were considered continuous users of DMPA-IM, levonorgestrel implant, or copper IUD if they used the same method across all months of their study participation, or not continuous users of their baseline CUBE method if they switched or discontinued their method. We used multivariable logistic regression models with generalized estimating equations and robust standard errors, stratified by country, to assess differences in HIV testing.

Results

Among the 498 participants, HIV testing rates were higher in Zambia for all methods compared to South Africa. In bivariate analyses, continuous implant or IUD users (the LARC users) were significantly less likely to report having received HIV testing at the 6-months and 24-months surveys, compared to continuous DMPA-IM users. In adjusted longitudinal models, continuous IUD users (adjusted odds ratio: 0.42, 95% CI: 0.24, 0.74), continuous implant users (adjusted odds ratio: 0.23, 95% CI: 0.12, 0.42) in South Africa had significantly lower odds of HIV testing compared to continuous DMPA-IM users. There were no significant differences in Zambia in the adjusted models.

Conclusion

LARC use may reduce opportunities for HIV testing and users should be counseled on regular HIV testing and the option of HIV self-testing.

Implications

Due to infrequent clinical contacts which may lead to lower rates of HIV testing at recommended intervals, LARC users should be provided opportunities to test for HIV at home or when seeking other health services.

目的评估在南非夸祖鲁-纳塔尔和赞比亚卢萨卡，肌内储备醋酸甲羟孕酮（DMPA-IM）注射液、左炔诺孕酮植入物或铜宫内节育器（IUD）使用者在24个月内每隔6个月进行HIV检测的差异。与撒哈拉以南非洲使用有效但短效方法（如DMPA-IM）的使用者相比，长效可逆避孕药（LARC）使用者（植入物和宫内节育器使用者）以前没有评估过推荐间隔时间的检测。研究设计作为ECHO（CUBE）研究之外的纵向避孕药使用的一部分，我们测量了24个月内的HIV检测。如果参与者在参与研究的所有月内使用相同的方法，则他们被视为DMPA-IM、左炔诺孕酮植入物或铜宫内节育器的连续使用者，如果他们改变或停止使用其方法，则不被视为基线CUBE方法的连续使用者。我们使用具有广义估计方程和稳健标准误差的多变量逻辑回归模型，按国家分层，来评估HIV检测的差异。结果在498名参与者中，赞比亚的所有方法的艾滋病毒检测率都高于南非。在双变量分析中，与连续使用DMPA-IM的用户相比，连续使用植入物或宫内节育器的用户（LARC用户）在6个月和24个月的调查中报告接受过HIV检测的可能性显著降低。在调整后的纵向模型中，与持续使用DMPA-IM的人相比，南非连续使用宫内节育器（调整后的比值比：0.42，95%CI:0.24，0.74）、连续使用植入物（调整后比值比：0.23，95%CI:0.12，0.42）的人进行HIV检测的几率显著降低。赞比亚调整后的模式没有显著差异。结论LARC的使用可能会减少艾滋病毒检测的机会，应建议用户定期进行艾滋病毒检测和选择艾滋病毒自我检测。由于临床接触不频繁，可能会导致按建议间隔进行艾滋病毒检测的比率较低，因此应为LARC用户提供在家或寻求其他医疗服务时进行艾滋病毒检测。

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引用次数: 0