title: Contraception use and effectiveness among women in a trial of the diaphragm for HIV prevention.
abstract: BACKGROUND
  There is little data on contraceptive effectiveness or use patterns from sub-Saharan Africa.
  
  
  METHODS
  We analyzed data from women at risk of pregnancy (n=4905) in the Methods for Improving Reproductive Health in Africa trial of the diaphragm for HIV prevention. We described reported contraceptive method use and calculated rates of pregnancy by contraceptive method. We compared time to first pregnancy by study arm (condoms or condoms plus diaphragm), and estimated a Cox proportional hazards model to identify predictors of pregnancy.
  
  
  RESULTS
  Condoms (25.8%), injectables (25.4%) and OC (21.6%) were the most commonly used methods; long-acting method use was rare. During the trial, 51.6% of women used the same method, 27.4% switched to a more effective method and 20.9% switched to a less effective method; 21.4% of women became pregnant. Pregnancy rates by contraceptive group mirrored published estimates; frequency of study product use was not associated with pregnancy.
  
  
  CONCLUSIONS
  Long-acting methods of contraception should be made available in HIV prevention trials and to women in Southern Africa.
authors.affiliation: Ibis Reproductive Health, Cambridge, MA 02138, USA. kblanchard@ibisreproductivehealth.org
authors.forename: Kelly
authors.initials: K
authors.lastname: Blanchard
authors.forename: Alan
authors.initials: A
authors.lastname: Bostrom
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Montgomery
authors.forename: Ariane
authors.initials: A
authors.lastname: van der Straten
authors.forename: Naomi
authors.initials: N
authors.lastname: Lince
authors.forename: Guy
authors.initials: G
authors.lastname: de Bruyn
authors.forename: Dan
authors.initials: D
authors.lastname: Grossman
authors.forename: Tsungai
authors.initials: T
authors.lastname: Chipato
authors.forename: Gita
authors.initials: G
authors.lastname: Ramjee
authors.forename: Nancy
authors.initials: N
authors.lastname: Padian
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003270:Contraceptive Agents; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D008297:Male; D011247:Pregnancy; D018873:Pregnancy Rate; D013019:South Africa; D014622:Vaginal Creams, Foams, and Jellies; D015030:Zimbabwe
chemical_list: D003270:Contraceptive Agents; D014622:Vaginal Creams, Foams, and Jellies