title: Hormonal contraceptive use and discontinuation among HIV-infected women in Uganda and Zimbabwe.
abstract: BACKGROUND
  Hormonal contraception (HC) use by HIV-infected women has been identified by the World Health Organization as an important strategy for reducing vertical HIV transmission. Little is known about the factors associated with HC discontinuation among HIV-infected women.
  
  
  METHODS
  We analyzed data from a prospective study of HC use among 231 HIV-infected users with oral contraceptive (OC) or injectable depot medroxyprogesterone acetate (DMPA) in Uganda and Zimbabwe. We used Kaplan-Meier survival curves to estimate the median duration of OC and DMPA use and use of any highly effective contraceptive method. Cox proportional hazards models were used to investigate factors associated with HC discontinuation.
  
  
  RESULTS
  Median duration was 36 months [95% confidence interval (CI): 14 to 61] for OC use and 19 months (95% CI: 14 to 24) for DMPA use. Median duration of any highly effective method was 36 months (95% CI: 26 to N/A) for OC users and 22 months (95% CI: 14 to 38) for DMPA users. In multivariable analyses, living in Zimbabwe [hazard ratio (HR): 0.39; 95% CI: 0.18 to 0.83], no partner (HR: 7.18; 95% CI: 3.05 to 16.88), and cervical infection (HR: 1.99; 95% CI: 0.90 to 4.41) were associated with OC discontinuation. No partner (HR: 2.00; 95% CI: 1.12 to 3.58), nausea (HR: 1.84; 95% CI: 1.02 to 3.34), and excessive night sweats (HR: 1.80; 95% CI: 0.95 to 3.40) were associated with DMPA discontinuation.
  
  
  CONCLUSIONS
  Long-term use of HC methods is acceptable to HIV-infected women. Women discontinue for a variety of reasons, primarily unrelated to HIV. Alternative methods and ongoing contraceptive counseling is essential to reduce unplanned pregnancies and vertical HIV transmission.
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA. abengtso@live.unc.edu
authors.forename: Angela
authors.initials: A
authors.lastname: Bengtson
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kwok
authors.forename: Robert A
authors.initials: RA
authors.lastname: Salata
authors.forename: Josaphat
authors.initials: J
authors.lastname: Byamugisha
authors.forename: Tsungai
authors.initials: T
authors.lastname: Chipato
authors.forename: Sandra
authors.initials: S
authors.lastname: Rwambuya
authors.forename: Precious
authors.initials: P
authors.lastname: Moyo
authors.forename: Charles S
authors.initials: CS
authors.lastname: Morrison
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female / Q000009:adverse effects; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D007273:Injections, Intramuscular; D007398:Interpersonal Relations; D053208:Kaplan-Meier Estimate; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects; D015999:Multivariate Analysis; D009325:Nausea / Q000139:chemically induced; D016016:Proportional Hazards Models; D011446:Prospective Studies; D060737:Reproductive Tract Infections / Q000139:chemically induced; D013546:Sweating; D013997:Time Factors; D014454:Uganda; D055815:Young Adult; D015030:Zimbabwe
chemical_list: D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate