Acceptability of intrauterine contraception among women living with human immunodeficiency virus: a randomised clinical trial

Abstract

Objectives: The aim of our study was to compare acceptability of the copper intrauterine device (Cu-IUD) and levonorgestrel-releasing intrauterine system (LNG-IUS) among women living with the human immunodeficiency virus (HIV). Methods: We randomly assigned 703 HIV-positive women in Uganda to receive either a Cu-IUD or an LNG-IUS and followed them for at least one year. During the follow-up visits, face-to-face interviews were conducted with the women and acceptability of the Cu-IUD or LNG-IUS was assessed, using a Likert scale, at one, three, six and twelve months. At the final follow-up visit, women were also assessed for satisfaction with either method. Results: Between 9 September 2013 and 31 December 2014, 703 women were recruited and assigned as follows: 349 to a Cu-IUD group and 354 to an LNG-IUS group. Acceptability decreased from 94.3% at one month to 87.7% at 12 months in the Cu-IUD group and from 96.3% at one month to 86.7% at 12 months in the LNG-IUS group (p = 0.97). Satisfaction with intrauterine contraception was reported by 83.7% (283/338) in the Cu-IUD group and by 90.4% (302/334) in the LNG-IUS group (p = 0.50). Conclusions: There was no significant difference in acceptability between the LNG-IUS and Cu-IUD among HIV-positive women. Satisfaction rates were high and similar in the two groups. Both the Cu-IUD and LNG-IUS are acceptable forms of contraception for HIV-positive women and should be made available to women in HIV care to increase their contraceptive method options. Clinical trial registration: The trial is registered at the Pan African Clinical Trials Registry (PACTR 201308000561212).

Chinese abstract

目的：本研究的目的是比较在感染人类免疫缺陷病毒（HIV）的女性中含铜宫内节育器（Cu-IUD）和左炔诺孕酮宫内缓释系统（LNG-IUS）的接受度。方法：随机选取703个HIV阳性的乌干达妇女接受含铜宫内节育器或LNG-IUS宫内避孕，并至少随访一年。后续随访期间，在第一、三、六和第十二个月，采用和妇女面对面的访谈方式，用李克特量表对妇女对含铜宫内节育器或LNG-IUS的可接受性进行评估。在最后一次随访中，也对妇女对这两种方法的满意度进行了评估。结果：在2013年9月9日到2014年12月31日期间，一共招募了703个HIV阳性的妇女，并分配如下：349名加入含铜宫内节育器组，354名加入LNG-IUS组。在含铜宫内节育器组，宫内避孕的可接受性从第一个月的94.3%下降至第十二个月的87.7%，在LNG-IUS组，宫内避孕的可接受性从第一个月的96.3% 下降至第十二个月的86.7%(p=0.97)。报告显示在含铜宫内节育器组宫内避孕的满意度为83.7%（283/338），在LNG-IUS组宫内避孕的满意度为90.4%（302/334），(p=0.50)。结论：HIV阳性的女性对LNG-IUS和含铜宫内节育器的可接受性无明显差异。两组满意度均较高并且相近。无论是含铜宫内节育器和LNG-IUS均是HIV阳性妇女可接受的避孕形式，应提供给感染HIV的妇女以增加她们避孕方法的选择。临床试验注册：本实验是在泛非洲临床试验注册中心注册（PACTR 201308000561212）。

Keywords:

• Copper IUD
• HIV-positive women
• intrauterine contraception
• IUC acceptability
• LNG-IUS

Acknowledgements

We thank the women who participated in the study for sharing their experiences and attending follow-ups. We thank all the health providers involved in the study, who remained committed and motivated throughout.

Disclosure statement

The authors are solely responsible for the content and writing of the paper. OK, NMT and JKB have no conflicts of interest to declare. KG-D reports grants from Bayer AG, outside the submitted work.

Funding information

This work was funded by Medical Education for Equitable Services for All Ugandans, a Medical Education Partnership Initiative grant number 5R24TW008886 from the Office of the US Global AIDS Coordinator and the US Department of Health and Human Services, Health Resources and Services Administration, and the National Institutes of Health. The Swedish International Development Agency and Swedish Research Council (SIDA/VR) provided additional support. The LNG-IUS used in this study were donated by the International Contraceptive Access (ICA) Foundation. The funders were not involved in the design, implementation, data collection, analysis or interpretation of the results. All authors had full access to the data. The corresponding author had final responsibility for the decision to submit the manuscript for publication.