- 作者：Lisa B. Haddad ; Carrie Cwiak ; Denise J. Jamieson ; Caryl Feldacker ; Hannock Tweya ; Mina Hosseinipour ; Irving Hoffman ; Amy G. Bryant ; Gretchen S. Stuart ; Isaac Noah ; Linly Mulundila ; Bernadette Samala ; Patrick Mayne ; Sam Phiri
- 关键词：HIV ; Contraception ; Adherence ; IUD ; Depot medroxyprogesterone acetate ; DMPA
- 刊名：Contraception
- 出版年：December, 2013
- 年：2013
- 卷：88
- 期：6
- 页码：737-743
- 全文大小：287 K
Objective
To evaluate contraceptive adherence to the copper intrauterine device (Cu-IUD) and the injectable depot medroxyprogesterone acetate (DMPA) among women with HIV in Lilongwe, Malawi.Methods
We randomized 200 HIV-infected women on highly active antiretroviral therapy (HAART) to either the Cu-IUD or DMPA and followed these women prospectively, evaluating adherence and factors associated with nonadherence.
Results
There was no difference in contraceptive adherence: 68% of Cu-IUD and 65% of DMPA users were adherent at 48 weeks. Receiving first-choice contraceptive was not associated with adherence. Women commonly cited partner's disapproval as an indication for discontinuation. Women who experienced heavy menstruation and first-time contraceptive users were more likely to be nonadherent. Among ongoing users at study conclusion, 95% were happy with their method, and 98% would recommend their method to a friend.
Conclusion
Contraceptive adherence between the Cu-IUD and DMPA was similar at 1 year. With similar adherence and similar high rates of satisfaction among users of both methods at 1 year, the Cu-IUD offers a hormone-free alternative to DMPA.
Implications
Adherence to the Cu-IUD and DMPA is similar at 1 year among HIV-infected women on HAART in a randomized controlled trial. Despite high method satisfaction, partner disapproval and heavy bleeding contribute to reduced adherence. Receiving a method that differs from participant's first-choice method did not influence adherence.