Complex decisions: correlates of injectable contraceptive discontinuation following HIV-1 seroconversion in an HIV prevention trial

ABSTRACT

Contraceptive adherence during acute and recent HIV-1 infection is important to maternal and child health given the elevated risk of vertical HIV-1 transmission and additional complications of pregnancy. Injectable contraception (IC) is the most common non-barrier modern contraception method used in sub-Saharan Africa (SSA). Adherence to IC after HIV-1 seroconversion is not well understood. We examined factors associated with IC discontinuation among women in SSA diagnosed with HIV-1 infection while participating in a clinical trial of biomedical HIV-1 prevention. After diagnosis with HIV-1 infection in the VOICE trial, 255 women from South Africa, Uganda, and Zimbabwe enrolled in a longitudinal observational study (MTN-015). Contraceptive method was assessed at MTN-015 baseline and at 3, 12, and 24 months post-seroconversion. Correlates of IC discontinuation were examined by Cox proportional hazard modeling. IC use was reported at baseline by 78% of women enrolled (198/255), of which 92% (182/198) completed at least one follow-up visit. Two-thirds of women (66%, 121/182) continued on IC during the follow-up period (median 24 months). Lower rates of IC discontinuation were observed in women who reported having had at least one child (HR 0.39, 95% CI 0.20–0.82) or earning a personal income (HR 0.51, 95% CI 0.30–0.87) at baseline. These findings suggest that many women with HIV-1 infection face complex decision-making regarding family planning in the years that follow seroconversion and highlight that some women may discontinue IC use despite on-site provision of family planning services. Understanding the broader context of family planning choices in recently seroconverted women may be key to more effective linkages between family planning services and HIV-1 testing and care.

KEYWORDS:

• Injectable
• female contraception
• HIV infection
• Africa
• seroconversion

Acknowledgements

We thank the women who participated in this study. We also acknowledge the MTN-015 study team and study sites for their work on data and sample collection. The study was designed and implemented by the Microbicide Trials Network (MTN) funded by the National Institute of Allergy and Infectious Diseases through individual grants (UM1AI068633, UM1AI068615 and UM1AI106707), with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the U.S. National Institutes of Health (NIH). This work was also supported by the UCLA Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) NIMH grant P30MH58107; the UCLA Center for AIDS Research (CFAR) grant 5P30AI028697; and the UCLA Clinical Translational Science Institute (CTSI) Grant UL1TR001881. Author M.C. received support from the National Institute of Mental Health at the NIH under grant number 5T32MH80634-09. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Sharon A. Riddler http://orcid.org/0000-0002-2545-7037

Additional information

Funding

This work was supported by National Institute of Allergy and Infectious Diseases: [Grant Number UM1AI068615,UM1AI068633,UM1AI106707]; National Institute of Mental Health: [Grant Number 5T32MH80634-09,P30MH58107]; UCLA Clinical Translational Science Institute: [Grant Number UL1TR001881]; UCLA Center for AIDS Research: [Grant Number 5P30AI028697].