Contraceptive adherence among HIV-infected women in Malawi: a randomized controlled trial of the copper intrauterine device and depot medroxyprogesterone acetate.
OBJECTIVE
To evaluate contraceptive adherence to the copper intrauterine device (Cu-IUD) and the injectable depot medroxyprogesterone acetate (DMPA) among women with HIV in Lilongwe, Malawi.


METHODS
We randomized 200 HIV-infected women on highly active antiretroviral therapy (HAART) to either the Cu-IUD or DMPA and followed these women prospectively, evaluating adherence and factors associated with nonadherence.


RESULTS
There was no difference in contraceptive adherence: 68% of Cu-IUD and 65% of DMPA users were adherent at 48 weeks. Receiving first-choice contraceptive was not associated with adherence. Women commonly cited partner's disapproval as an indication for discontinuation. Women who experienced heavy menstruation and first-time contraceptive users were more likely to be nonadherent. Among ongoing users at study conclusion, 95% were happy with their method, and 98% would recommend their method to a friend.


CONCLUSIONS
Contraceptive adherence between the Cu-IUD and DMPA was similar at 1 year. With similar adherence and similar high rates of satisfaction among users of both methods at 1 year, the Cu-IUD offers a hormone-free alternative to DMPA.


CONCLUSIONS
Adherence to the Cu-IUD and DMPA is similar at 1 year among HIV-infected women on HAART in a randomized controlled trial. Despite high method satisfaction, partner disapproval and heavy bleeding contribute to reduced adherence. Receiving a method that differs from participant's first-choice method did not influence adherence.
Emory University, Department of Gynecology and Obstetrics, Atlanta, GA, USA. Electronic address: lbhadda@emory.edu.
Lisa B
LB
Haddad
Carrie
C
Cwiak
Denise J
DJ
Jamieson
Caryl
C
Feldacker
Hannock
H
Tweya
Mina
M
Hosseinipour
Irving
I
Hoffman
Amy G
AG
Bryant
Gretchen S
GS
Stuart
Isaac
I
Noah
Linly
L
Mulundila
Bernadette
B
Samala
Patrick
P
Mayne
Sam
S
Phiri
D000328:Adult; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007435:Intrauterine Devices, Copper; D008295:Malawi; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000627:therapeutic use*; D010349:Patient Compliance
D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate
Adherence; Contraception; DMPA; Depot medroxyprogesterone acetate; HIV; IUD