Reproductive Healthcare Needs and Desires in a Cohort of HIV-Positive Women

Background. The aim of this study was to determine current contraceptive use, contraceptive desires and knowledge, future fertility desires, and sterilization regret in a cohort of HIV-positive women. Study Design. 127 HIV-positive women receiving care at an urban infectious disease clinic completed a survey addressing their contraceptive and reproductive histories as well as their future contraceptive and fertility desires. Results. The most common forms of contraception used were sterilization (44.4%) and condoms (41.3%). Less than 1% used a long-term reversible method of contraception (LARC) despite these being the methods that best fit their desired attributes of a contraceptive method. Overall, 29.4% desired future fertility. Only 50.6% of those sexually active had spoken with a provider within the last year regarding their contraceptive plans. There was a high degree of sterilization regret (36.4%), and 18.2% of sterilized women desired future fertility. Multivariate analysis found women in a monogamous relationship had a statistically increased rate of regret compared to women who were not sexually active (OR 13.8, 95% CI 1.6–119, P = 0.17). Conclusion. Given the diversity in contraceptive and fertility desires, coupled with a higher rate of sterilization regret than is seen in the general population, integration of comprehensive family planning services into HIV care via increased contraceptive education and access is imperative

Contraceptive adherence among HIV-infected women in Malawi: a randomized controlled trial of the copper intrauterine device and depot medroxyprogesterone acetate

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

Medical eligibility, contraceptive choice, and intrauterine device acceptance among HIV-infected women receiving antiretroviral therapy in Lilongwe, Malawi

To determine medical eligibility for contraceptive use, contraceptive preference, and acceptance of a copper intrauterine device (IUD) among a cohort of HIV-infected women receiving antiretroviral therapy (ART)

Postpartum intrauterine device placement: a patient-friendly option

Abstract Women in the United States are increasingly choosing an intrauterine device (IUD) for contraception. Since the postpartum period is an important time to consider a patient’s need for contraception, offering postpartum IUD placement is considered best practice. Effective implementation of postpartum IUD placement occurs within a context of shared decision making wherein patients are given full information about all options and guided to methods that best fit their lifestyle. Within this context, both the non-hormonal and hormonal IUDs are safe, highly effective, well tolerated, and convenient options. National guidelines support the placement of IUDs, whether immediate (within 10 min of placental delivery) or early postpartum (after 10 min and before 4 weeks after placental delivery), for breastfeeding or non-breastfeeding women. Studies have noted increased IUD expulsion rates, but equivalent IUD usage rates with immediate or early postpartum placement. Postpartum placement requires additional skills that can be easily taught. Finally, successful implementation of a postpartum IUD placement program can be accomplished in hospitals using a team-based approach

Contraception for the Medically Challenging Patient

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Immediate versus delayed IUD insertion after uterine aspiration.

Intrauterine devices (IUDs) provide highly effective, reversible, long-term contraception that is appropriate for many women after first-trimester uterine aspiration. However, the effects of immediate versus delayed IUD insertion after uterine aspiration on rates of complications and IUD use are uncertain.We performed a randomized noninferiority trial involving women undergoing uterine aspiration for induced or spontaneous abortion at 5 to 12 weeks of gestation who desired an IUD. Subjects were randomly assigned (in a 5:6 ratio) to IUD insertion immediately after the procedure or 2 to 6 weeks afterward (delayed insertion). The primary outcome was the rate of IUD expulsion 6 months after IUD insertion; an expulsion rate 8 percentage points higher in the immediate-insertion group was defined as inferior.Among 575 women who underwent randomization, an IUD was inserted in 100% (258 of 258) of the women in the immediate-insertion group and in 71.3% (226 of 317) of those in the delayed-insertion group (difference, 28.7 percentage points; 95% confidence interval [CI], 23.7 to 33.7). The 6-month expulsion risk was 5.0% (13 of 258 women) after immediate insertion and 2.7% (6 of 226) after delayed insertion (difference, 2.3 percentage points; 95% CI, -1.0 to 5.8), which was consistent with the predefined criterion for noninferiority. Six-month rates of IUD use were higher in the immediate-insertion group (92.3%, vs. 76.6% after delayed insertion; P<0.001). Adverse events were rare and did not differ significantly between groups. No pregnancies occurred in the immediate-insertion group; five occurred in the delayed-insertion group (P=0.07), all in women who never received an IUD.The 6-month rate of expulsion of an IUD after immediate insertion was higher than but not inferior to that after delayed insertion. Immediate insertion resulted in higher rates of IUD use at 6 months, without an increased risk of complications. (Funded by the Susan Thompson Buffett Foundation; ClinicalTrials.gov number, NCT00562276.)

Amenorrhea rates and predictors during 1 year of levonorgestrel 52 mg intrauterine system use.

OBJECTIVE:The objective was to evaluate amenorrhea patterns and predictors of amenorrhea during the first year after levonorgestrel 52 mg intrauterine system (IUS) placement. STUDY DESIGN:This cohort analysis includes 1714 nulliparous and parous women who received a Liletta® levonorgestrel 52 mg IUS in a multicenter trial to evaluate efficacy and safety for up to 8 years. Participants maintained a daily diary with bleeding information. We assessed bleeding patterns in 90-day intervals; amenorrhea was defined as no bleeding or spotting in the preceding 90 days. We employed multivariable regression to identify predictors of amenorrhea at 12 months. The predictor analysis only included women not using a levonorgestrel IUS in the month prior to study enrollment. RESULTS:In the month before enrollment, 148 and 1566 women, respectively, had used and not used a levonorgestrel IUS. Prior users averaged 50±19 months of use before IUS placement; 38.4% of these women reported amenorrhea at 12 months. Amenorrhea rates for non-prior-users at 3, 6, 9 and 12 months were 0.2%, 9.1%, 17.2% and 16.9%, respectively. During the first 12 months, 29 (1.7%) women discontinued for bleeding irregularities; no women discontinued for amenorrhea. The only significant predictor of amenorrhea at 12 months was self-reported baseline duration of menstrual flow of fewer than 7 days vs. 7 or more days (18.2% vs. 5.2%, adjusted odds ratio 3.70 [1.69, 8.07]). We found no relationships between 12-month amenorrhea rates and age, parity, race, body mass index, baseline flow intensity or hormonal contraception use immediately prior to IUS placement. CONCLUSIONS:Amenorrhea rates during the first year of levonorgestrel 52 mg IUS use are similar at 9 and 12 months. Amenorrhea at 12 months is most common among women with shorter baseline duration of menstrual flow. IMPLICATIONS STATEMENT:This information provides more data for clinicians when counseling women about amenorrhea expectations, especially since women seeking a levonorgestrel 52 mg IUS for contraception are different than women desiring treatment for heavy menstrual bleeding. Amenorrhea at 12 months is most common among women with shorter baseline duration of menstrual flow

Anticipated HIV Vaccine Acceptability among Sexually Active African-American Adult Women

An HIV vaccine, once it becomes available, could reduce vulnerability to HIV among African-American women. The purpose of this study was to assess determinants of HIV vaccine acceptability among African-American women across hypothetical levels of vaccine efficacy. Participants were recruited from a hospital-based family planning clinic in Atlanta, GA serving low-income patients (N = 321). Data were collected from audio-computer assisted surveys administered in the clinic waiting room. Psychosocial survey items were guided by Risk Homeostasis Theory (RHT) and Social Cognitive Theory (SCT). Multivariate logistic regression was used to identify determinants of acceptability for two hypothetical HIV vaccines with 50% and 90% efficacy. Overall, 63% of participants would accept a vaccine with 50% efficacy and 85% would accept a vaccine with 90% efficacy. In multivariate analyses, odds of acceptability for a vaccine with 50% efficacy were higher among participants with greater perceived HIV vaccine benefits (AOR = 1.13, p < 0.001) and lower among participants with more than high school education (AOR = 0.47, p = 0.033) and greater perceived costs of HIV vaccination (AOR = 0.95, p = 0.010). Odds of acceptability for a vaccine with 90% efficacy were higher among participants with greater perceived costs of unprotected sex (AOR = 1.08, p = 0.026), HIV vaccine benefits (AOR = 1.23, p < 0.001) and self-efficacy for sex refusal (AOR = 1.11, p = 0.044). HIV vaccine acceptability was high, particularly for a vaccine with 90% efficacy. Findings suggest that demographic and psychosocial factors may impact acceptability of an eventual HIV vaccine. Once an HIV vaccine is available, interventions to maximize uptake may benefit from using RHT and SCT constructs to target relevant psychosocial factors, such as perceived benefits and perceived costs of vaccination

Corrigendum to ‘Levonorgestrel 52 mg intrauterine system efficacy and safety through 8 years of use’ [American Journal of Obstetrics and Gynecology 2022;227:871.e1-871.e7]

The authors regret an error in the text of the manuscript. In the Results section, in reference to adverse events and reactions, urinary tract infection rates were reported but not also present in Table 3. The events listed in the table are those considered potentially related to the intrauterine system. As urinary tract infections are not considered by regulatory agencies (and, thus, are not in the label) as potentially related, urinary tract infections were incorrectly included in the text and correctly do not appear in the table. The text should read “The most commonly reported events over 8 or more years of use among the 1714 participants receiving an IUS were vulvovaginal infections with bacteria (n=315, 18.4%) or yeast (n=304, 17.7%).

Immediate versus delayed IUD insertion after uterine aspiration.

Intrauterine devices (IUDs) provide highly effective, reversible, long-term contraception that is appropriate for many women after first-trimester uterine aspiration. However, the effects of immediate versus delayed IUD insertion after uterine aspiration on rates of complications and IUD use are uncertain.We performed a randomized noninferiority trial involving women undergoing uterine aspiration for induced or spontaneous abortion at 5 to 12 weeks of gestation who desired an IUD. Subjects were randomly assigned (in a 5:6 ratio) to IUD insertion immediately after the procedure or 2 to 6 weeks afterward (delayed insertion). The primary outcome was the rate of IUD expulsion 6 months after IUD insertion; an expulsion rate 8 percentage points higher in the immediate-insertion group was defined as inferior.Among 575 women who underwent randomization, an IUD was inserted in 100% (258 of 258) of the women in the immediate-insertion group and in 71.3% (226 of 317) of those in the delayed-insertion group (difference, 28.7 percentage points; 95% confidence interval [CI], 23.7 to 33.7). The 6-month expulsion risk was 5.0% (13 of 258 women) after immediate insertion and 2.7% (6 of 226) after delayed insertion (difference, 2.3 percentage points; 95% CI, -1.0 to 5.8), which was consistent with the predefined criterion for noninferiority. Six-month rates of IUD use were higher in the immediate-insertion group (92.3%, vs. 76.6% after delayed insertion; P<0.001). Adverse events were rare and did not differ significantly between groups. No pregnancies occurred in the immediate-insertion group; five occurred in the delayed-insertion group (P=0.07), all in women who never received an IUD.The 6-month rate of expulsion of an IUD after immediate insertion was higher than but not inferior to that after delayed insertion. Immediate insertion resulted in higher rates of IUD use at 6 months, without an increased risk of complications. (Funded by the Susan Thompson Buffett Foundation; ClinicalTrials.gov number, NCT00562276.)