Long-acting Reversible Contraception: New Research to Reduce Unintended Pregnancy

描述（由申请人提供）：意外怀孕在美国仍然是一个顽固的问题，特别是在年轻女性中。更好地获得长效可逆避孕（LARC）可能有助于这一人群避免意外怀孕和考虑堕胎的困境。问题是LARC是否足够可取，并提供更好的保护，防止意外怀孕相对于替代品。目前，许多障碍阻碍了LARC的吸收，因此对其潜力的真正衡量尚不清楚。如果发现LARC比其他避孕方法更上级，那么就应该更加努力地更新现有的健康计划，确保LARC成为所有需要它的人的一个有保证的选择。在拟议的研究中，寻求口服或注射避孕的18-29岁的妇女将有机会尝试LARC; FDA批准的选择包括两种类型的子宫内产品和一种类型的皮下避孕植入物。在12个月的时间里，LARC用户的体验将与那些选择其初始短效方法的人的体验进行比较。预计38%使用短效避孕方法的参与者将在第一年停止使用，并有意外怀孕的风险;相比之下，不到20%的LARC使用者希望取消避孕措施。继续率将被测量，怀孕将被记录在两组中，以记录出现的任何差异。为了收集适当的证据进行公平的比较，需要创新的战略。首先，混合干预试验将用于招募两种类型的参与者：那些对特定方法有强烈偏好的人和那些愿意使用随机分配选项的人。随机分组和分析将用于分离LARC在预防意外妊娠方面的贡献。通过选择方法形成的队列将用于记录自然使用模式并提供比较数据。参与者对LARC的态度将确定更广泛吸收的障碍;由深入参与者访谈组成的定性子研究将收集关于吸收和停止短期和长效方法的原因的细微差别数据。从这项研究中收集的证据将有助于确定LARC的感知益处是否有助于缓解美国意外怀孕的难题。如果是这样的话，结果将有助于刺激朝着这一目标的进展。 公共卫生相关性：意外怀孕仍然是美国的一个主要公共卫生问题。有一种可能的解决办法，但仍未得到充分利用：长效可逆避孕。需要进行新的高质量研究，以确定改善长效方法对减少意外怀孕的作用;拟议的研究旨在找到一个将产生可操作影响的答案。

DESCRIPTION (provided by applicant): Unintended pregnancy remains a stubborn problem in the United States, particularly among younger women. Better access to long-acting reversible contraception (LARC) may help this population avoid unintended pregnancy and the dilemmas of considering abortion. The questions are whether LARC can be sufficiently desirable to use, and provide better protection from unintended pregnancy relative to the alternatives. Currently, many barriers prevent uptake of LARC, and thus a true measure of its potential is unknown. If LARC is found to be superior to other methods, more effort can be made to rejuvenate existing health programs and ensure that LARC is a guaranteed option for all those who want it. In the proposed study, women aged 18-29 seeking oral or injectable contraception will be offered an opportunity to try LARC instead; the FDA-approved options include two types of intrauterine products and one type of subdermal contraceptive implant. Over a 12 month period, the experiences of LARC users will be compared to the experiences of those opting for their initial short-acting method. It is expected that 38% of participants using short-acting methods will stop using them during the first year and be at risk of unintended pregnancy; in contrast, less than 20% of LARC users will want to have their contraceptive removed. Continuation rates will be measured and pregnancies will be tallied in the two groups to document any differences that emerge. To assemble the proper evidence for fair comparisons, innovative strategies are needed. First, a hybrid intervention trial will be used to recruit two types of participants: those who have strong preferences for a particular method and those who would be willing to use a randomly assigned option. The randomized component and analysis will be used to isolate the contribution LARC can have in preventing unintended pregnancy. The cohort formed by choice of method will be used to document natural use patterns and provide comparative data. Participant attitudes toward LARC will identify barriers to more widespread uptake; a qualitative sub-study consisting of in-depth participant interviews will collect nuanced data on reasons for uptake and discontinuation of short and long-acting methods. The evidence gathered from this study will help determine whether the perceived benefits of LARC can help alleviate the difficult problem of unintended pregnancy in the US. If so, the results will help stimulate progress toward that goal. PUBLIC HEALTH RELEVANCE: Unintended pregnancy continues to be a major public health problem in the US. A possible solution exists but remains underutilized: long-acting reversible contraception. New, high-quality research is needed to determine what role improved access to long-acting methods can have on reducing unintended pregnancy; the proposed study intends to find an answer that will have actionable impact.