Structured and sustained family planning support facilitates effective use of postpartum contraception amongst women living with HIV in South Western Uganda: A randomized controlled trial.
Structured and sustained family planning support facilitates effective use of postpartum contraception amongst women living with HIV in South Western Uganda: A randomized controlled trial.
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DOI：
10.7189/jogh.11.04034
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发表时间：
2021-06-05
影响因子：
7.2
通讯作者：
Matthews LT
中科院分区：
文献类型：
--
作者：
Atukunda EC;Mugyenyi GR;Musiimenta A;Kaida A;Atuhumuza EB;Lukyamuzi EJ;Agaba AG;Obua C;Matthews LT
尽管怀孕意愿较低，但许多获得避孕药具的妇女停止使用避孕药具，增加了感染艾滋病毒的妇女意外怀孕的风险。我们评估计划生育支持干预，包括结构化的即时一对一产后咨询，以及通过额外的健康信息和短信提醒的随访机制，是否会影响产后妇女的持续避孕使用和怀孕发生率。我们于2016年10月至2018年6月在乌干达西南部的一家转诊医院进行了一项随机对照试验。我们以1:1的比例随机纳入成年WLWH，接受计划生育支持或标准护理（对照），并在入组、产后6个月和12个月完成访谈者管理的问卷调查。我们感兴趣的两个主要结局是；持续使用避孕措施，与怀孕发生率有关。次要结局包括避孕、方法改变、停药和妊娠意向。该试验已在clinicaltrials.gov注册（NCT02964169）。共有317人（99%）完成了所有研究程序。干预组和对照组的平均年龄分别为29.6 （SD = 6.0）和30.0 （SD = 5.9）岁。所有女性都参加了抗逆转录病毒治疗。干预组持续使用避孕措施的妇女总数为126人（79.8%），对照组为110人（69.2%）(优势比(OR) = 1.75；可信区间(CI) = 1.24 - -2.75, P = 0.003)。干预组妊娠率为2% (N = 3)，对照组为9% (N = 14) （OR = 0.20, 95% CI = 0.05-0.62, P = 0.006）。干预组妊娠意愿低于对照组（OR = 0.23, 95% CI = 0.08-0.64, P = 0.002）。与干预组相比，对照组积极参与避孕的妇女减少的更多（OR = 3.92, 95% CI = 1.66-9.77, P = 0.001）。采用每种避孕方法的妇女除了植入物外，各组之间没有差异。在干预组（N = 123, 97.6% vs N = 3,2.4%）或对照组（N = 86,78.2% vs N = 24,21.8%）中，产后3个月内开始使用避孕措施的妇女越多，继续使用避孕措施的妇女越好。干预组与方法相关的副作用较少（OR = 0.25, 95% CI = 0.10-0.60, P = 0.001）。我们发现，在乌干达西南部农村，持续和有组织的计划生育支持有助于持续使用避孕措施，并降低产后产妇的怀孕率。在产后三个月内开始避孕的妇女比那些在产后三个月内开始避孕的妇女更有可能继续使用避孕措施。进一步评估实际的和感知的促进持续避孕使用这种支持干预将有助于复制类似的设置。NCT02964169
Despite low pregnancy intentions, many women accessing contraception discontinue use, increasing the risk of unwanted pregnancies among women living with HIV (WLWH). We evaluate whether a family planning support intervention, inclusive of structured immediate one-on-one postpartum counseling, and a follow-up mechanism through additional health information and SMS reminders affects continuous contraceptive use and pregnancy incidence among recently postpartum WLWH. We performed a randomized controlled trial between October 2016 and June 2018 at a referral hospital in southwestern Uganda. We included adult WLWH randomized and enrolled in a 1:1 ratio to receive family planning support or standard of care (control) and completed an interviewer-administered questionnaire at enrolment, 6 and 12 months postpartum. Our two primary outcomes of interest were; continuous use of contraception, and incidence of pregnancy. Secondary outcomes included contraception uptake, method change, discontinuation and pregnancy intentions. The trial was registered with clinicaltrials.gov (NCT02964169). A total of 317(99%) completed all study procedures. Mean age was 29.6 (SD = 6.0) vs 30.0 (SD = 5.9) years for the intervention vs control groups respectively. All women were enrolled on ART. Total women using contraception continuously were 126 (79.8%) in the intervention compared to 110 (69.2%) in control group (odds ratio (OR) = 1.75; confidence interval (CI) = 1.24-2.75, P = 0.003). Pregnancy rates were 2% (N = 3) in the intervention vs 9% (N = 14) in the control group (OR = 0.20, 95% CI = 0.05-0.62, P = 0.006). Pregnancy intention was lower in the intervention vs control group (OR = 0.23, 95% CI = 0.08-0.64, P = 0.002). Women actively enrolled on contraception reduced more in the control compared to the intervention group (OR = 3.92, 95% CI = 1.66-9.77, P = 0.001). Women enrolled on each contraceptive method did not differ by group except for implants. More women initiating contraception use within three months postpartum had better continued use for either intervention (N = 123, 97.6% vs N = 3,2.4%) or control group (N = 86,78.2% vs N = 24,21.8%). Method-related side effects were less reported in the intervention group (OR = 0.25, 95% CI = 0.10-0.60, P = 0.001). We found that sustained and structured family planning support facilitates continuous use of contraception and lowers rates of pregnancy amongst postpartum WLWH in rural southwestern Uganda. Women who initiated contraception within three months postpartum were more likely to maintain continuous use of contraception than those initiating later. Further evaluation of actual and perceived facilitators to the continuous contraception use by this support intervention will help replication in similar settings. NCT02964169
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影响因子：
3.3
作者：
Ahluwalia, Indu B.;Helms, Kristen;Morrow, Brian
通讯作者：
Morrow, Brian
与乌干达西南部艾滋病毒的产后妇女怀孕意图有关的因素。
影响因子：
4.4
作者：
Atukunda EC;Mugyenyi GR;Atuhumuza EB;Kaida A;Boatin A;Agaba AG;Matthews LT
通讯作者：
Matthews LT
影响因子：
2.9
作者：
Gilliam, M;Knight, S;McCarthy, M
通讯作者：
McCarthy, M
影响因子：
7.2
作者：
Hou, Melody Y.;Hurwitz, Shelley;Goldberg, Alisa B.
通讯作者：
Goldberg, Alisa B.
影响因子：
4.4
作者：
Guthrie, Brandon L.;Choi, Robert Y.;Farquhar, Carey
通讯作者：
Farquhar, Carey