Initiating contraception in sexually transmitted disease clinic setting: a randomized trial.
OBJECTIVE
Our purpose was to determine the effectiveness of sexually transmitted disease (STD) clinic-initiated contraceptive care.


METHODS
Nonpregnant women (n=877) attending an urban STD clinic using either no contraception or only condoms were randomly assigned to either an intervention (n=437) or control group (n=440). Both groups received condoms with spermicide and a referral list of primary care providers (PCP) for ongoing reproductive health care, and the intervention group also received enhanced contraceptive counseling, initial provision of contraception, and facilitated referral to a PCP. Outcomes measured at 4-, 8-, and 12-month follow-up were transition to a PCP, effective contraceptive use (ECU), interval pregnancy, and STD.


RESULTS
The median time to PCP transition was 79 days for the intervention group versus 115 days for the control group (P=.007). Rates of ECU were higher for the intervention group than for control group at the 4-month visit (50% vs 22%, P<.0001) as well as the 8-month visit, although in the intervention group ECU diminished over the course of the study. During follow-up, pregnancy outcomes were documented for 229 women (26.1%), for an overall pregnancy rate of 38.2 per 100 person-years of follow-up. Of the 159 pregnancies defined by patient self-report, 153 (96.2%) were described as unintended and 32 (20%) resulted in a therapeutic abortion. The pregnancy rate was 15% lower in the intervention (105/437, 24.0%) than the control group (124/440, 28.2%) (P=.16), but this difference was not statistically significant.


CONCLUSIONS
The intervention helped women transition to a PCP and initiate ECU but did not significantly reduce the pregnancy rate. More intensive interventions are needed to prevent unintended pregnancy in this high-risk population.
Shlay
Judith C
JC
Department of Public Health, Denver Health and Hospital Authority, CO 80204, USA. jshay@DHHA.org
Mayhugh
Barbara
B
Foster
Mark
M
Maravi
Moises E
ME
Barón
Anna E
AE
Douglas
John M
JM
D000032:Abortion, Therapeutic / Q000706:statistics & numerical data; D000328:Adult; D000554:Ambulatory Care Facilities; D017280:Condoms; D003267:Contraception; D003376:Counseling; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011247:Pregnancy / Q000706:statistics & numerical data; D018873:Pregnancy Rate; D011320:Primary Health Care; D012017:Referral and Consultation; D012731:Sex Counseling; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D013089:Spermatocidal Agents; D014481:United States
D013089:Spermatocidal Agents