Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia.
Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia.
复制标题
DOI：
10.1097/qad.0000000000000039
复制
发表时间：
2013-10
期刊：
影响因子：
--
通讯作者：
Allen S
中科院分区：
文献类型：
--
作者：
Haddad L;Wall KM;Vwalika B;Khu NH;Brill I;Kilembe W;Stephenson R;Chomba E;Vwalika C;Tichacek A;Allen S
描述赞比亚卢萨卡接受夫妇自愿HIV咨询和检测服务的HIV阳性夫妇中避孕方法中止和转换行为的预测因素。夫妇被随机分到两个计划生育教育干预视频，接受全面的计划生育服务，并评估每3个月的避孕开始，停止和转换。我们通过多变量Andersen-Gill模型模拟了与避孕方法升级和降级相关的因素。大多数妇女继续随机化后选择的初始方法。观察到注射避孕药和宫内节育器使用者的停药/转换率最高。停用更有效的避孕方法或降级为口服避孕药或避孕套的时间与女性年龄较小、希望在未来一年内生育更多孩子、月经大量出血、月经间期出血和膀胱炎/排尿困难有关。妇女对植入避孕药的健康担忧和男性伴侣不想多生孩子与口服避孕药或避孕套的升级有关。妇女或夫妇的艾滋病毒状况不能预测转换或停止。我们发现了复杂的避孕方式。避孕转换的预测因素表明，针对年轻夫妇的干预措施，解决常见的与避孕有关的误解，可以提高有效的计划生育利用。我们建议利用这些研究结果来增加避孕方法的使用和延续，特别是长效可逆避孕（LARC）方法，并将以生育目标为基础，以LARC为重点的计划生育作为艾滋病毒预防服务的一个组成部分。
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.