title: Impact of long-term contraceptive promotion on incident pregnancy: a randomized controlled trial among HIV-positive couples in Lusaka, Zambia.
abstract: OBJECTIVE
  To evaluate the impact of family planning promotion on incident pregnancy in a combined effort to address Prongs 1 and 2 of prevention of mother-to-child transmission of HIV.
  
  
  METHODS
  We conducted a factorial randomized controlled trial of 2 video-based interventions.
  
  
  METHODS
  "Methods" and "Motivational" messages promoted long-term contraceptive use among 1060 couples with HIV in Lusaka, Zambia.
  
  
  RESULTS
  Among couples not using contraception before randomization (n = 782), the video interventions had no impact on incident pregnancy. Among baseline contraceptive users, viewing the "Methods video" which focused on the intrauterine device and contraceptive implant was associated with a significantly lower pregnancy incidence [hazard ratio (HR) = 0.38; 95% confidence interval (CI): 0.19 to 0.75] relative to those viewing control and/or motivational videos. The effect was strongest in concordant positive couples (HR = 0.22; 95% CI: 0.08 to 0.58) and couples with HIV-positive women (HR = 0.23; 95% CI: 0.09 to 0.55).
  
  
  CONCLUSIONS
  The "Methods video" intervention was previously shown to increase uptake of long-acting contraception and to prompt a shift from daily oral contraceptives to quarterly injectables and long-acting methods such as the intrauterine device and implant. Follow-up confirms sustained intervention impact on pregnancy incidence among baseline contraceptive users, in particular couples with HIV-positive women. Further work is needed to identify effective interventions to promote long-acting contraception among couples who have not yet adopted modern methods.
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA 30322, USA. kmwall@emory.edu
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Wall
authors.forename: Bellington
authors.initials: B
authors.lastname: Vwalika
authors.forename: Lisa
authors.initials: L
authors.lastname: Haddad
authors.forename: Naw H
authors.initials: NH
authors.lastname: Khu
authors.forename: Cheswa
authors.initials: C
authors.lastname: Vwalika
authors.forename: William
authors.initials: W
authors.lastname: Kilembe
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Rob
authors.initials: R
authors.lastname: Stephenson
authors.forename: David
authors.initials: D
authors.lastname: Kleinbaum
authors.forename: Azhar
authors.initials: A
authors.lastname: Nizam
authors.forename: Ilene
authors.initials: I
authors.lastname: Brill
authors.forename: Amanda
authors.initials: A
authors.lastname: Tichacek
authors.forename: Susan
authors.initials: S
authors.lastname: Allen
mesh_terms: D000328:Adult; D003267:Contraception / Q000379:methods*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003376:Counseling / Q000379:methods*; D005191:Family Characteristics; D005193:Family Planning Services; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D011247:Pregnancy; D012736:Sex Education; D016896:Treatment Outcome; D014743:Videotape Recording / Q000379:methods; D015024:Zambia / Q000453:epidemiology