Contraception: X最新文献_第7页

Corrigendum to “Using Google Ads to recruit and retain a cohort considering abortion in the United States” [Contraception: X (2) (2020) 100017] “在美国使用谷歌广告招募和留住考虑堕胎的人群”的勘误表[避孕:X (2) (2020) 100017]

Q2 Medicine

Contraception: X

Pub Date : 2021-01-01 DOI: 10.1016/j.conx.2021.100056

Ushma D. Upadhyay , Iris J. Jovel , Kevin D. McCuaig , Alice F. Cartwright

引用次数: 0

Characteristics associated with use of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) in Burkina Faso, Democratic Republic of Congo, and Uganda 在布基纳法索、刚果民主共和国和乌干达使用皮下储存醋酸甲羟孕酮(DMPA-SC)的相关特征

Q2 Medicine

Contraception: X

Pub Date : 2021-01-01 DOI: 10.1016/j.conx.2021.100055

Philip Anglewicz , Elizabeth Larson , Pierre Akilimali , Georges Guiella , Patrick Kayembe , Simon P.S. Kibira , Fredrick Makumbi , Scott Radloff

Objectives

To what extent is DMPA-SC reaching new users versus encouraging method switching among existing users? Though increasingly-popular, little is known about characteristics of women using DMPA-SC in SSA. We compared characteristics of women using DMPA-SC with those of other modern methods, and identified the extent to which women using DMPA-SC switched from another method or are first-time users of contraception.

Study design

We used data collected by the Performance Monitoring for Action (PMA) Project between 2016 and 2019 from three countries, Burkina Faso, Democratic Republic of Congo, and Uganda. We tabulated characteristics of DMPA-SC, DMPA-IM, implant, and male condom users, and used multivariate analysis to compare characteristics of women using DMPA-SC those of the other three methods. We also examined previous contraceptive method use (if any) among women currently using DMPA-SC.

Results

We found that never-married women were more likely to use male condoms instead of DMPA-SC. Women with two or more children (compared to no children or one child) were more likely to use implants instead of DMPA-SC in both Uganda and DRC. DMPA-SC was the first method used by the majority of current users in Burkina Faso and Uganda. DMPA-SC users who previously used another method generally switched from less effective methods.

Conclusions

Although the characteristics of women using DMPA-SC varied across countries, DMPA-SC appears to be reaching new populations of women instead of inspiring existing modern users to switch to DMPA-SC, and appears to be appealing to first time users of contraception.

Implications

It appears that DMPA-SC appeals to new contraceptive users in sub-Saharan Africa, which implies that DMPA-SC may have the potential to increase modern contraceptive prevalence in sub-Saharan African countries.

DMPA-SC在多大程度上影响了新用户，而不是鼓励现有用户之间的方法转换?尽管DMPA-SC越来越受欢迎，但对SSA中使用DMPA-SC的女性的特征知之甚少。我们比较了使用DMPA-SC的妇女与其他现代方法的妇女的特征，并确定了使用DMPA-SC的妇女从其他方法转换或首次使用避孕的程度。研究设计我们使用了2016年至2019年行动绩效监测(PMA)项目从布基纳法索、刚果民主共和国和乌干达三个国家收集的数据。我们将DMPA-SC、DMPA-IM、植入物和男性安全套使用者的特征制成表格，并使用多变量分析比较使用DMPA-SC的女性与其他三种方法的特征。我们还检查了目前使用DMPA-SC的妇女以前使用的避孕方法(如果有的话)。结果我们发现，从未结过婚的女性更倾向于使用男用避孕套，而不是DMPA-SC。在乌干达和刚果民主共和国，有两个或更多孩子的妇女(与没有孩子或只有一个孩子的妇女相比)更有可能使用植入物而不是DMPA-SC。DMPA-SC是布基纳法索和乌干达大多数现有用户使用的第一种方法。以前使用另一种方法的DMPA-SC用户通常从效果较差的方法转换而来。结论:尽管各国妇女使用DMPA-SC的特点各不相同，但DMPA-SC似乎正在接触新的妇女群体，而不是鼓励现有的现代用户切换到DMPA-SC，并且似乎对首次避孕的用户有吸引力。结论DMPA-SC似乎对撒哈拉以南非洲的新避孕使用者有吸引力，这意味着DMPA-SC可能有潜力提高撒哈拉以南非洲国家的现代避孕普及率。

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引用次数: 4

Medical abortion at 13 or more weeks gestation provided through telemedicine: A retrospective review of services 通过远程医疗提供的妊娠13周或以上药物流产:对服务的回顾性审查

Q2 Medicine

Contraception: X

Pub Date : 2021-01-01 DOI: 10.1016/j.conx.2021.100057

Nathalie Kapp , Kathryn Andersen , Risa Griffin , Amalia Puri Handayani , Marlies Schellekens , Rebecca Gomperts

Objectives

To evaluate medical abortion effectiveness and safety in women at 13 or more weeks gestation provided care through Women on Web's telemedicine service.

Study Design

We conducted a retrospective case study of abortions at 13 or more weeks gestation provided by Women on Web between 2016 and 2019. Women received mifepristone and misoprostol or misoprostol alone for abortion. We extracted demographic characteristics and outcome data for cases with pregnancy continuation outcomes.

Results

We identified 144 women who used medical abortion at 13 or more weeks; 131 (91%) provided abortion outcome data. Almost all, 118 (90%) received mifepristone and misoprostol. The population had an average age of 26 ± 5.8 years, 102 (78%) reported a gestational age of 13 to 15 weeks, 114 (87%) had experienced prior pregnancy, and represented all world regions. Overall, 13 (10%) women reported a continuing pregnancy, with 5 (5%) among women 13 to 15 weeks and 8 (28%) among those ≥16 weeks (p = 0.001); 38 (29%) reported adverse events (heavy bleeding, fever), 53 (43%) sought additional care from a health provider, and 18% of all cases received treatment with D&C/aspiration.

Conclusions

Efficacy of self-administered medical abortion decreases as gestational age increases, risking continuation of pregnancy. Provision through telemedicine at 13 to 15 weeks appears safe and effective.

Implications

Limited data suggest that medical abortion through telemedicine services may be a safe option through 15 weeks gestation in settings where there is ready access to the formal health system. More research with adequate sample sizes and high rates of follow-up is needed to inform on the safety of telemedicine for pregnancies 13 weeks and greater.

目的评价妇女网上远程医疗服务对妊娠13周及以上妇女进行药物流产的有效性和安全性。研究设计我们对2016年至2019年期间由Women on Web提供的妊娠13周及以上流产病例进行了回顾性研究。妇女在流产时使用米非司酮和米索前列醇或单独使用米索前列醇。我们提取了有妊娠结局的病例的人口学特征和结局数据。结果144例妊娠13周及以上采用药物流产的孕妇;131例(91%)提供流产结局数据。几乎所有118例(90%)接受了米非司酮和米索前列醇治疗。人口平均年龄为26±5.8岁，102人(78%)报告胎龄为13至15周，114人(87%)有过妊娠史，代表了世界所有地区。总体而言，13名(10%)妇女报告继续妊娠，13至15周妇女中有5名(5%)，≥16周妇女中有8名(28%)(p = 0.001);38例(29%)报告了不良事件(大出血、发烧)，53例(43%)向卫生服务提供者寻求额外护理，18%的病例接受了D&C/抽吸治疗。结论自行药物流产的有效性随胎龄的增加而降低，存在继续妊娠的风险。13至15周通过远程医疗提供似乎是安全有效的。影响有限的数据表明，在可以随时进入正规卫生系统的环境中，通过远程医疗服务在妊娠15周内进行药物流产可能是一种安全的选择。需要进行更多具有足够样本量和高随访率的研究，以了解远程医疗对怀孕13周及以上孕妇的安全性。

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引用次数: 7

Trends in U.S. adolescent sexual behavior and contraceptive use, 2006-2019 2006-2019年美国青少年性行为和避孕药具使用趋势

Q2 Medicine

Contraception: X

Pub Date : 2021-01-01 DOI: 10.1016/j.conx.2021.100064

Laura D. Lindberg , Lauren Firestein , Cynthia Beavin

Objective

This study examines changes over time in the prevalence of select sexual behaviors and contraceptive use measures in a national sample of U.S. adolescents.

Study design

We used data on adolescents aged 15-19 from the 2006-2010 (n=4,662), 2011-2015 (n=4,134), and 2015-2019 (n=3,182) National Surveys of Family Growth. We used logistic regression to identify changes between periods in sexual behaviors and contraceptive use by gender, and for some measures by age. We estimated probabilities of age at first penile-vaginal intercourse with Kaplan-Meier failure analysis.

Results

Over half of adolescents have engaged in at least one of the sexual behaviors measured. Males reported declines in sexual behaviors with a partner of a different sex. Adolescent males reported delays in the timing of first penile-vaginal intercourse. Adolescent females reported increases from 2006-2010 to 2015-2019 in use at last intercourse of any contraceptive method (86%, 95%CI 83-89; 91%, 95%CI 88-94), multiple methods (26%, 95%CI 22-31; 36%, 95%CI 30-43), and IUDs or implants (3%, 95%CI 1-4; 15%, 95%CI 11-20). Adolescent males reported increases in partners' use of IUDs or implants use from <1% to 5% and recent declines in condom use at last intercourse (78%, 95%CI 75-82, 2011-2015; 72%, 95%CI 67-77, 2015-2019). Condom consistency declined over time. Males were more likely than females to report condom use at last intercourse and consistent condom use in the last 12 months.

Conclusions

These findings identify declines in male adolescent sexual experience, increased contraceptive use overall, and declines in consistent condom use from 2006 to 2019.

Implications

This analysis contributes a timely update on adolescent sexual behavior trends and contraceptive use, showing that adolescent behaviors are complex and evolving. Sexual health information and services must be available so that young people have the resources to make healthy and responsible choices for themselves and their partners.

目的:本研究考察了美国青少年选择性行为和避孕措施的流行程度随时间的变化。研究设计我们使用了2006-2010年(n= 4662)、2011-2015年(n= 4134)和2015-2019年(n= 3182)全国家庭成长调查中15-19岁青少年的数据。我们使用逻辑回归来确定不同性别的性行为和避孕药具使用期间的变化，以及一些不同年龄的措施。我们用Kaplan-Meier失败分析估计第一次阴茎-阴道性交的年龄概率。结果超过一半的青少年至少有过一种性行为。男性与异性伴侣的性行为有所减少。据报道，青少年男性第一次阴茎-阴道性交的时间延迟。据报告，从2006-2010年到2015-2019年，青少年女性在最后一次性行为中使用任何避孕方法的人数有所增加(86%，95%CI 83-89;91%， 95%CI 88-94)，多种方法(26%，95%CI 22-31;36%， 95%CI 30-43)，以及宫内节育器或植入物(3%，95%CI 1-4;15%， 95%ci 11-20)。2011-2015年，青少年男性报告伴侣使用宫内节育器或植入物的比例从1%增加到5%，最近在最后性交时使用避孕套的比例下降(78%，95%可信区间75- 82,2011 -2015;72%， 95%ci 67-77, 2015-2019)。避孕套的一致性随着时间的推移而下降。男性比女性更有可能报告在最后一次性交中使用避孕套，并在过去12个月内持续使用避孕套。这些发现表明，从2006年到2019年，男性青少年性经历下降，避孕药具使用总体增加，避孕套使用持续下降。这项分析及时更新了青少年性行为趋势和避孕措施的使用情况，表明青少年行为是复杂和不断发展的。必须提供性健康信息和服务，使年轻人有资源为自己和伴侣做出健康和负责任的选择。

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引用次数: 31

Trauma exposure and adolescent attitudes toward having a baby: An exploratory survey 创伤暴露与青少年生育态度:一项探索性调查

Q2 Medicine

Contraception: X

Pub Date : 2021-01-01 DOI: 10.1016/j.conx.2021.100058

Karina M. Shreffler, Stacy Tiemeyer, Ronald B. Cox Jr.

Objectives

To examine the association between childhood trauma exposure (i.e., extent of interpersonal trauma experienced in childhood) and attitudes toward teen parenthood.

Study design

We used a cross-sectional sample of 416 urban middle and high school male and female students from Tulsa, OK recruited through a local public school district mailing list. Multinomial logistic regression analyses were used to examine odds of reporting having a baby would make life worse, better, or cause no change according to childhood trauma score.

Results

Approximately 8% of students and their guardians responded to the mailed survey invitation. Among the students, 67% reported having a baby would make their lives worse; 17% reported it would not change their lives much, and 16% reported having a baby would make their lives better. Each increase in trauma score was associated with a 9% increase in reporting an indifferent attitude (p < 0.001) and a 15% increase in reporting a positive attitude toward having a baby (p < 0.01). After controlling for a wide range of sociodemographic, attitudinal, and sexual history variables, childhood trauma remained associated with a positive attitude toward having a baby (p<.01), but not an indifferent attitude toward having a baby.

Conclusions

Greater childhood trauma exposure is associated with indifferent and positive attitudes toward having a baby during adolescence.

Implications

Screening for childhood trauma and utilizing interventions designed to reduce the harmful effects of trauma exposure in childhood may offer a more targeted approach to adolescent pregnancy prevention strategies.

目的探讨童年创伤暴露(即童年经历的人际创伤程度)与青少年父母态度之间的关系。研究设计我们使用了一个横断面样本，416名城市初中和高中男女学生来自塔尔萨，OK，通过当地公立学区的邮件列表招募。使用多项逻辑回归分析来检查报告生孩子会使生活更糟、更好或根据儿童创伤评分没有改变的几率。结果约8%的学生及其监护人回应了邮寄的调查邀请。在学生中，67%的人表示生孩子会让他们的生活更糟;17%的人表示，生孩子不会给他们的生活带来太大改变，16%的人表示，生孩子会让他们的生活变得更好。创伤评分每增加一次，报告冷漠态度的人数增加9% (p <0.001)，对生孩子持积极态度的人数增加了15% (p <0.01)。在控制了广泛的社会人口学、态度和性史变量后，童年创伤仍然与积极的生育态度相关(p< 0.01)，但与冷漠的生育态度无关。结论童年创伤暴露程度高的青少年对生育持积极态度。对儿童创伤进行筛查，并利用旨在减少儿童创伤暴露有害影响的干预措施，可能为青少年怀孕预防策略提供更有针对性的方法。

{"title":"Trauma exposure and adolescent attitudes toward having a baby: An exploratory survey","authors":"Karina M. Shreffler, Stacy Tiemeyer, Ronald B. Cox Jr.","doi":"10.1016/j.conx.2021.100058","DOIUrl":"10.1016/j.conx.2021.100058","url":null,"abstract":"<div><h3>Objectives</h3><p>To examine the association between childhood trauma exposure (i.e., extent of interpersonal trauma experienced in childhood) and attitudes toward teen parenthood.</p></div><div><h3>Study design</h3><p>We used a cross-sectional sample of 416 urban middle and high school male and female students from Tulsa, OK recruited through a local public school district mailing list. Multinomial logistic regression analyses were used to examine odds of reporting having a baby would make life worse, better, or cause no change according to childhood trauma score.</p></div><div><h3>Results</h3><p>Approximately 8% of students and their guardians responded to the mailed survey invitation. Among the students, 67% reported having a baby would make their lives worse; 17% reported it would not change their lives much, and 16% reported having a baby would make their lives better. Each increase in trauma score was associated with a 9% increase in reporting an indifferent attitude (<em>p</em> < 0.001) and a 15% increase in reporting a positive attitude toward having a baby (<em>p</em> < 0.01). After controlling for a wide range of sociodemographic, attitudinal, and sexual history variables, childhood trauma remained associated with a positive attitude toward having a baby (<em>p</em><.01), but not an indifferent attitude toward having a baby.</p></div><div><h3>Conclusions</h3><p>Greater childhood trauma exposure is associated with indifferent and positive attitudes toward having a baby during adolescence.</p></div><div><h3>Implications</h3><p>Screening for childhood trauma and utilizing interventions designed to reduce the harmful effects of trauma exposure in childhood may offer a more targeted approach to adolescent pregnancy prevention strategies.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100058"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2021.100058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25440368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Regional and residential disparities in knowledge of abortion legality and availability of facility-based abortion services in Ethiopia 埃塞俄比亚在堕胎合法性知识和基于设施的堕胎服务可得性方面的地区和地区差异

Q2 Medicine

Contraception: X

Pub Date : 2021-01-01 DOI: 10.1016/j.conx.2021.100066

Grace Sheehy , Jessica L. Dozier , Alexandria K. Mickler , Mahari Yihdego , Celia Karp , Linnea A. Zimmerman

Objectives

To generate regional, residential, and nationally representative estimates of knowledge of abortion legality and availability among women of reproductive age in Ethiopia, and examine how knowledge varies across regions and by urban/rural residence.

Study Design

Our study draws on data from a nationally representative, cross-sectional survey implemented in 2019 in each of Ethiopia's regional and administrative states, yielding a sample of 8,837 women aged 15 to 49. We compare weighted estimates and regional distributions of 3 outcomes: (1) general awareness and (2) correct knowledge of the abortion law, and (3) knowledge of facility-based abortion service availability.

Results

Significant regional and urban/rural disparities in knowledge of abortion legality and availability exist. Nationally, 27% of women are aware of the abortion law and just 5% of women have comprehensive knowledge of the law, while 30% know where to access facility-based abortion services. Regionally, estimates range significantly, from 2% in Somali to 45% in Addis Ababa for general awareness of the law, 0% in Afar to 27% in Harare for comprehensive knowledge of the law, and 8% in Afar to 57% in Tigray for knowledge of abortion availability. Knowledge of all measures is higher in urban than in rural areas.

Conclusions

Regional disparities in abortion knowledge may contribute to geographic inequities in access to and use of safe abortion care. Efforts to expand knowledge of abortion legality and availability are needed and should be tailored to regional contexts.

Implications

Knowledge of abortion legality and availability is imperative to protecting and expanding access to safe abortion care, especially in contexts like Ethiopia where abortion is available for multiple indications. Efforts to improve knowledge of abortion legality and availability are needed, and should be locally tailored to address regional inequities.

目的对埃塞俄比亚育龄妇女堕胎合法性和可获得性的知识进行具有区域、居民和全国代表性的估计，并研究不同地区和城市/农村居民的知识差异。我们的研究利用了2019年在埃塞俄比亚每个地区和行政州实施的一项具有全国代表性的横断面调查的数据，样本为8837名年龄在15至49岁之间的女性。我们比较了3个结果的加权估计和区域分布:(1)对堕胎法的一般认识和(2)对堕胎法的正确认识，以及(3)对基于设施的堕胎服务可用性的了解。结果在堕胎合法性和可获得性知识方面存在显著的地区差异和城乡差异。在全国范围内，27%的妇女知道堕胎法，只有5%的妇女对法律有全面的了解，而30%的妇女知道在哪里可以获得基于设施的堕胎服务。各地区的估计差异很大，从索马里的2%到亚的斯亚贝巴的45%，从阿法尔的0%到哈拉雷的27%，从阿法尔的8%到提格雷的57%，对堕胎可获得性的了解。城市居民对所有措施的了解程度高于农村地区。结论流产知识的地区差异可能导致安全流产护理获取和使用的地域不平等。需要努力扩大对堕胎合法性和可获得性的了解，并应根据区域情况进行调整。了解堕胎的合法性和可获得性对于保护和扩大获得安全堕胎护理的机会至关重要，特别是在埃塞俄比亚这样的国家，堕胎可用于多种指征。需要努力提高对堕胎合法性和可获得性的认识，并应根据当地情况进行调整，以解决区域不平等问题。

{"title":"Regional and residential disparities in knowledge of abortion legality and availability of facility-based abortion services in Ethiopia","authors":"Grace Sheehy , Jessica L. Dozier , Alexandria K. Mickler , Mahari Yihdego , Celia Karp , Linnea A. Zimmerman","doi":"10.1016/j.conx.2021.100066","DOIUrl":"10.1016/j.conx.2021.100066","url":null,"abstract":"<div><h3>Objectives</h3><p>To generate regional, residential, and nationally representative estimates of knowledge of abortion legality and availability among women of reproductive age in Ethiopia, and examine how knowledge varies across regions and by urban/rural residence.</p></div><div><h3>Study Design</h3><p>Our study draws on data from a nationally representative, cross-sectional survey implemented in 2019 in each of Ethiopia's regional and administrative states, yielding a sample of 8,837 women aged 15 to 49. We compare weighted estimates and regional distributions of 3 outcomes: (1) general awareness and (2) correct knowledge of the abortion law, and (3) knowledge of facility-based abortion service availability.</p></div><div><h3>Results</h3><p>Significant regional and urban/rural disparities in knowledge of abortion legality and availability exist. Nationally, 27% of women are aware of the abortion law and just 5% of women have comprehensive knowledge of the law, while 30% know where to access facility-based abortion services. Regionally, estimates range significantly, from 2% in Somali to 45% in Addis Ababa for general awareness of the law, 0% in Afar to 27% in Harare for comprehensive knowledge of the law, and 8% in Afar to 57% in Tigray for knowledge of abortion availability. Knowledge of all measures is higher in urban than in rural areas.</p></div><div><h3>Conclusions</h3><p>Regional disparities in abortion knowledge may contribute to geographic inequities in access to and use of safe abortion care. Efforts to expand knowledge of abortion legality and availability are needed and should be tailored to regional contexts.</p></div><div><h3>Implications</h3><p>Knowledge of abortion legality and availability is imperative to protecting and expanding access to safe abortion care, especially in contexts like Ethiopia where abortion is available for multiple indications. Efforts to improve knowledge of abortion legality and availability are needed, and should be locally tailored to address regional inequities.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100066"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2021.100066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

A risk scoring tool for predicting Kenyan women at high risk of contraceptive discontinuation 一个风险评分工具，用于预测肯尼亚妇女在避孕中止的高风险

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100045

Claire W. Rothschild , Barbra A. Richardson , Brandon L. Guthrie , Peninah Kithao , Tom Omurwa , James Mukabi , Erica M Lokken , Grace John-Stewart , Jennifer A. Unger , John Kinuthia , Alison L. Drake

Objective

We developed and validated a pragmatic risk assessment tool for identifying contraceptive discontinuation among Kenyan women who do not desire pregnancy.

Study design

Within a prospective cohort of contraceptive users, participants were randomly allocated to derivation (n = 558) and validation (n = 186) cohorts. Risk scores were developed by selecting the Cox proportional hazards model with the minimum Akaike information criterion. Predictive performance was evaluated using time-dependent receiver operating characteristic curves and area under the curve (AUC).

Results

The overall contraceptive discontinuation rate was 36.9 per 100 woman-years (95% confidence interval [CI] 30.3–44.9). The predictors of discontinuation selected for the risk score included use of a short-term method or copper intrauterine device (vs. injectable or implant), method continuation or switch (vs. initiation), < 9 years of completed education, not having a child aged < 6 months, and having no spouse or a spouse supportive of family planning (vs. having a spouse who has unsupportive or uncertain attitudes towards family planning). AUC at 24 weeks was 0.76 (95% CI 0.64–0.87) with 70.0% sensitivity and 78.6% specificity at the optimal cut point in the derivation cohort. Discontinuation was 3.8-fold higher among high- vs. low-risk women (95% CI 2.33–6.30). AUC was 0.68 (95% CI 0.47–0.90) in the validation cohort. A simplified score comprising routinely collected variables demonstrated similar performance (derivation-AUC: 0.73 [95% CI 0.60–0.85]; validation-AUC: 0.73 [95% CI 0.51–0.94]). Positive predictive value in the derivation cohort was 31.4% for the full and 28.1% for the simplified score.

Conclusions

The risk scores demonstrated moderate predictive ability but identified large proportions of women as high risk. Future research is needed to improve sensitivity and specificity of a clinical tool to identify women at high risk for experiencing method-related challenges.

Implications

Contraceptive discontinuation is a major driver of unmet contraceptive need globally. Few tools exist for identifying women who may benefit most from additional support in order to meet their contraceptive needs and preferences. This study developed and assessed the validity of a provider-focused risk prediction tool for contraceptive discontinuation among Kenyan women using modern contraception. High rates of early discontinuation observed in this study emphasize the necessity of investing in efforts to develop new contraceptive technologies and stronger delivery systems to better align with women's needs and preferences for voluntary family planning.

目的:我们开发并验证了一种实用的风险评估工具，用于在不希望怀孕的肯尼亚妇女中识别避孕药停药。研究设计:在前瞻性避孕药使用者队列中，参与者被随机分配到衍生队列(n = 558)和验证队列(n = 186)。采用最小赤池信息准则的Cox比例风险模型进行风险评分。使用随时间变化的受试者工作特征曲线和曲线下面积(AUC)评估预测性能。结果总体避孕药停药率为36.9 / 100名妇女年(95%可信区间[CI] 30.3 ~ 44.9)。选择用于风险评分的停药预测因素包括使用短期方法或铜质宫内节育器(相对于注射或植入)，方法继续或转换(相对于起始)，<9 已完成教育年数，无子女;6 个月，没有配偶或配偶支持计划生育(配偶对计划生育不支持或态度不确定)。在衍生队列中，24 周时的AUC为0.76 (95% CI 0.64-0.87)，敏感性为70.0%，特异性为78.6%。高危妇女的停药率是低危妇女的3.8倍(95% CI 2.33-6.30)。验证队列的AUC为0.68 (95% CI 0.47-0.90)。由常规收集的变量组成的简化评分显示出类似的表现(导数auc: 0.73 [95% CI 0.60-0.85];验证- auc: 0.73 [95% CI 0.51-0.94])。在衍生队列中，完整评分的阳性预测值为31.4%，简化评分为28.1%。结论风险评分显示出中等的预测能力，但确定了很大比例的女性为高风险。未来的研究需要提高临床工具的敏感性和特异性，以识别经历方法相关挑战的高风险妇女。终止避孕是全球避孕需求未得到满足的主要驱动因素。现有的工具很少，无法确定哪些妇女可能从满足其避孕需要和偏好的额外支助中获益最多。本研究开发并评估了一种以提供者为中心的风险预测工具的有效性，该工具适用于使用现代避孕方法的肯尼亚妇女。本研究中观察到的早期中止率很高，强调必须投资开发新的避孕技术和更强有力的提供系统，以便更好地符合妇女自愿计划生育的需要和偏好。

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引用次数: 1

Effect of efavirenz on levonorgestrel concentrations among Malawian levonorgestrel implant users for up to 30 months of concomitant use: a subanalysis of a randomized clinical trial 依非韦伦对马拉维左炔诺孕酮植入物使用者同时使用30 个月左炔诺孕酮浓度的影响:一项随机临床试验的亚分析

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100027

Jennifer H. Tang , Nicole L. Davis , Amanda H. Corbett , Lameck Chinula , Mackenzie L. Cottrell , Yasaman Zia , Gerald Tegha , Frank Z. Stanczyk , Stacey Hurst , Mina C. Hosseinipour , Lisa B. Haddad , Athena P. Kourtis

Objectives

Our primary objective was to compare geometric mean levonorgestrel concentrations between levonorgestrel implant users who were or were not taking the antiretroviral efavirenz, for up to 30 months after implant initiation. Our secondary objective was to evaluate the pregnancy rate among levonorgestrel implant users on efavirenz.

Study design

We performed a subanalysis of 42 Malawian women randomized to initiate the levonorgestrel implant as part of a parent randomized clinical trial. Our subset included 30 HIV-infected women taking efavirenz and 12 HIV-uninfected women not taking efavirenz. They underwent urine pregnancy testing every 3 months and serum levonorgestrel testing at day 3 and months 1, 3, 6, 12, 18, 24, 27 and 30 after implant initiation. Geometric mean levonorgestrel concentrations were calculated for efavirenz users and non-efavirenz users at each time point.

Results

The geometric mean levonorgestrel concentrations were lower for efavirenz users than non-efavirenz users at every time point; the geometric mean ratio for efavirenz users:non-efavirenz users ranged from 0.60 [90% confidence interval (CI) 0.46–0.79] at 1 month to 0.27 (90% CI 0.12–0.61) at 30 months after implant insertion. No pregnancies occurred over 60 woman-years of concomitant levonorgestrel implant and efavirenz use, although 11 women had levonorgestrel concentrations < 180 pg/mL (the previously suggested minimum threshold concentration for efficacy).

Conclusions

Efavirenz users had lower levonorgestrel concentrations than non-efavirenz users, and one third of our concomitant efavirenz and levonorgestrel implant users had concentrations < 180 pg/mL. Continued evaluation of the contraceptive efficacy of the levonorgestrel implant may be needed for efavirenz users.

Implications

Among 42 Malawian women using the levonorgestrel implant for contraception, women who were taking the antiretroviral efavirenz had lower serum levonorgestrel concentrations than women who were not taking efavirenz. However, none of the women who were taking efavirenz became pregnant over 60 women-years of follow-up.

我们的主要目的是比较在植入后30 个月，服用抗逆转录病毒依非韦伦或未服用依非韦伦的左炔诺孕酮植入物使用者之间的几何平均左炔诺孕酮浓度。我们的次要目的是评估依非韦伦使用左炔诺孕酮植入物的妊娠率。研究设计:我们对42名马拉维妇女进行了亚组分析，这些妇女随机接受左炔诺孕酮植入，作为母体随机临床试验的一部分。我们的子集包括30名服用依非韦伦的艾滋病毒感染妇女和12名未服用依非韦伦的艾滋病毒感染妇女。每3个 月进行一次尿妊娠试验，在植入后第3天和第1、3、6、12、18、24、27、30个月进行血清左炔诺孕酮试验。计算依非韦伦使用者和非依非韦伦使用者在每个时间点的左炔诺孕酮几何平均浓度。结果依非韦伦服用者各时间点左炔诺孕酮几何平均浓度均低于非依非韦伦服用者;依法韦伦使用者的几何平均比值:非依法韦伦使用者在1 个月时为0.60[90%置信区间(CI) 0.46-0.79]，在植入后30 个月时为0.27 (90% CI 0.12-0.61)。同时使用左炔诺孕酮和依非韦伦的60年以上妇女中没有发生妊娠，尽管有11名妇女的左炔诺孕酮浓度很高。180 pg/mL(先前建议的最低有效阈值浓度)。结论头孢韦伦服用者左炔诺孕酮浓度低于非依非韦伦服用者，同时使用依非韦伦和左炔诺孕酮植入物的服用者中有三分之一的左炔诺孕酮浓度低于非依非韦伦。180 pg / mL。依非韦伦使用者可能需要继续评估左炔诺孕酮植入物的避孕效果。在42名使用左炔诺孕酮植入物避孕的马拉维妇女中，服用抗逆转录病毒依非韦伦的妇女血清左炔诺孕酮浓度低于未服用依非韦伦的妇女。然而，在60年的随访中，没有一个服用依非韦伦的妇女怀孕。

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引用次数: 3

Experiences of harassment and empowerment after sharing personal abortion stories publicly 在公开分享个人堕胎故事后的骚扰和赋权经历

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100021

Katie Woodruff, Rosalyn Schroeder, Stephanie Herold, Sarah C.M. Roberts, Nancy F. Berglas

Objective

In recent years, in an attempt to counter stigma and increase empathy, public education campaigns have encouraged people to share their personal abortion stories. This exploratory study sought to document negative and positive experiences of those who have shared their abortion stories publicly.

Study design

We conducted an anonymous online survey of people who have shared their abortion story publicly (N = 88), recruited via partners affiliated with two abortion story-sharing campaigns. The survey asked about the context in which respondents shared their abortion story, any negative and positive experiences online and in “real life” as a result of story sharing, and any problems or benefits resulting from these experiences. We analyzed survey data using descriptive statistics, bivariate analyses and categorizing responses to open-ended questions.

Results

Sixty percent of respondents reported experiencing harassment and other negative incidents after sharing their story publicly. These experiences contributed to emotional stress, problems with loved ones and difficulties at work and/or school. These harms were reported even by many respondents who used only a first name or alias when sharing their story. Despite this, positive experiences as a result of story sharing were reported by four out of five respondents and motivated many to continue sharing their story.

Conclusions

This exploratory study indicates that many people who share their abortion story publicly find it to be an empowering, rewarding experience. Yet they also experience harassment and threats at high rates. Future research should explore both positive and negative experiences in more depth.

Implications

Sharing one's personal abortion story as part of a public education campaign can be a positive, empowering experience. Nevertheless, policymakers, journalists and reproductive health advocates should recognize the potential harms experienced by people who share their abortion story publicly and consider measures to support these individuals.

近年来，为了消除耻辱感，增加同情心，公共教育活动鼓励人们分享自己的堕胎故事。这项探索性研究试图记录那些公开分享堕胎故事的人的消极和积极经历。研究设计我们对公开分享堕胎经历的人进行了一项匿名在线调查(N = 88)，这些人是通过两个堕胎故事分享活动的合作伙伴招募的。该调查询问了受访者分享堕胎故事的背景，在网上和“现实生活”中因分享故事而产生的任何消极和积极的经历，以及这些经历带来的任何问题或好处。我们使用描述性统计、双变量分析和对开放式问题的分类回答来分析调查数据。结果60%的受访者表示，在公开分享自己的故事后遭遇了骚扰和其他负面事件。这些经历导致了情绪压力，与亲人的问题以及工作和/或学校的困难。甚至许多在分享他们的故事时只使用名字或别名的受访者也报告了这些危害。尽管如此，五分之四的受访者报告了分享故事带来的积极体验，并激励许多人继续分享他们的故事。这项探索性研究表明，许多公开分享堕胎经历的人认为这是一种赋权和有益的经历。然而，她们也经常遭受骚扰和威胁。未来的研究应该对积极体验和消极体验进行更深入的探索。作为公共教育活动的一部分，分享个人堕胎的故事可能是一种积极的、赋权的经历。然而，政策制定者、记者和生殖健康倡导者应该认识到公开分享堕胎经历的人所经历的潜在伤害，并考虑采取措施支持这些人。

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引用次数: 1

Comparison of pregnancy incidence among African women in a randomized trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) or a levonorgestrel (LNG) implant for contraception 在一项随机试验中，非洲妇女在肌内注射醋酸甲羟孕酮(DMPA-IM)、铜宫内节育器(iud)或左炔诺孕酮(LNG)植入避孕中的妊娠发生率比较

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100026

Maricianah Onono , Kavita Nanda , Kate B. Heller , Doug Taylor , Irina Yacobson , Renee Heffron , Margaret Phiri Kasaro , Cheryl E. Louw , Zelda Nhlabasti , Thesla Palanee-Phillips , Jenni Smit , Imelda Wakhungu , Peter B. Gichangi , Nelly R. Mugo , Charles Morrison , Jared M. Baeten , for the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial Consortium

Objective

The objective was to address bias in contraception efficacy studies through a randomized study trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) and a levonorgestrel (LNG) implant.

Study design

We analyzed data from the Evidence for Contraceptive Options and HIV Outcomes Trial, which assessed HIV incidence among 7829 women from 12 sites in eSwatini, Kenya, South Africa and Zambia seeking effective contraception and who consented to be randomized to DMPA-IM, copper IUD or LNG implant. We used Cox proportional hazards regression adjusted for condom use to compare pregnancy incidence during both perfect and typical (i.e., allowing temporary interruptions) use.

Results

A total of 7710 women contributed to this analysis. Seventy pregnancies occurred during perfect and 85 during typical use. There was no statistically significant difference in perfect use pregnancy incidence among the methods: 0.61 per 100 woman-years for DMPA-IM [95% confidence interval (CI) 0.36–0.96], 1.06 for copper IUD (95% CI 0.72–1.50) and 0.63 for LNG implants (95% CI 0.39–0.96). Typical use pregnancy rates were also largely similar: 0.87 per 100 woman-years for DMPA-IM (95% CI 0.58–1.25), 1.11 for copper IUD (95% CI 0.77–1.54) and 0.63 for LNG implants (95% CI 0.39–0.96).

Conclusions

In this randomized trial of highly effective contraceptive methods among African women, both perfect and typical use resulted in low pregnancy rates. Our findings provide strong justification for improving access to a broader range of longer-acting contraceptive options including LNG implants and copper IUD for African women.

Implications statement

Data from this study support recommendations to providers, policy makers and patients that all of these methods provide safe and highly effective contraception for African women.

目的:通过一项肌肉内注射醋酸甲羟孕酮(DMPA-IM)、铜宫内节育器(iud)和左炔诺孕酮(LNG)植入物的随机研究试验，解决避孕疗效研究中的偏倚问题。研究设计:我们分析了避孕选择证据和HIV结局试验的数据，该试验评估了来自斯瓦蒂尼、肯尼亚、南非和赞比亚12个地点的7829名寻求有效避孕的妇女的HIV发病率，这些妇女同意随机分配到DMPA-IM、铜宫内节育器或LNG植入物。我们使用Cox比例风险回归对避孕套的使用进行调整，比较完美和典型(即允许暂时中断)使用期间的怀孕发生率。结果共有7710名女性参与了本分析。70例妊娠发生在完美妊娠期，85例发生在典型妊娠期。两种方法的完美使用妊娠发生率无统计学差异:DMPA-IM的发生率为0.61 / 100女性年[95%可信区间(CI) 0.36-0.96]，铜宫内节育器的发生率为1.06 (95% CI 0.72-1.50)， LNG植入物的发生率为0.63 (95% CI 0.39-0.96)。典型使用妊娠率也非常相似:DMPA-IM的0.87 / 100名妇女年(95% CI 0.58-1.25)，铜宫内节育器的1.11 (95% CI 0.77-1.54)和LNG植入物的0.63 (95% CI 0.39-0.96)。结论在非洲妇女中进行的一项高效避孕方法的随机试验中，完美和典型的使用都导致了低怀孕率。我们的研究结果为改善非洲妇女获得更广泛的长效避孕选择提供了强有力的理由，包括LNG植入物和铜宫内节育器。结论:本研究的数据支持向医疗服务提供者、政策制定者和患者提出的建议，即所有这些方法都为非洲妇女提供了安全、高效的避孕方法。

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引用次数: 1