title: Effects of initiating a contraceptive implant on subsequent condom use: A randomized controlled trial.
abstract: OBJECTIVE
  To evaluate whether initiation of a contraceptive implant, a method of long-acting reversible contraception, reduces condom use, as measured by a biomarker of recent semen exposure [prostate-specific antigen (PSA)].
  
  
  METHODS
  We conducted a randomized controlled clinical trial in which 414 Jamaican women at high risk for sexually transmitted infections (STIs) attending family planning clinics received the contraceptive implant at baseline ("immediate" insertion arm, N=208) or at the end ("delayed" insertion arm, N=206) of a 3-month study period. Participants were tested for PSA at baseline and two follow-up study visits and were asked about their sexual activity and condom use.
  
  
  RESULTS
  At baseline, 24.9% of women tested positive for PSA. At both follow-up visits, the prevalence of PSA detection did not significantly differ between the immediate versus delayed insertion arm [1-month: 26.1% vs. 20.2%, prevalence ratio (PR)=1.3, 95% confidence interval (CI)=0.9-1.9; 3-month: 25.6% vs. 23.1%, PR= 1.1, 95% CI=0.8-1.6]. The change in PSA positivity over the three study visits was not significantly larger in the immediate arm compared to the delayed arm (1-sided p-value of .15).
  
  
  CONCLUSIONS
  Contraceptive implants can be successfully introduced into a population at high risk of unintended pregnancy and STIs without a biologically detectable difference in unprotected sex in the short term. This information strengthens the evidence to support promotion of implants in such populations and can help refine counseling for promoting and maintaining use of condoms among women who choose to use implants.
  
  
  CONCLUSIONS
  Sex unprotected by a condom was not higher over 3 months in women receiving a contraceptive implant, compared with those not receiving the implant.
authors.affiliation: University Hospital of the West Indies, Kingston, Jamaica.
authors.forename: Carole
authors.initials: C
authors.lastname: Rattray
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wiener
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Legardy-Williams
authors.affiliation: Family Health International (FHI 360), Research Triangle Park, NC, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Costenbader
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Pazol
authors.affiliation: University Hospital of the West Indies, Kingston, Jamaica.
authors.forename: Natalie
authors.initials: N
authors.lastname: Medley-Singh
authors.affiliation: University Hospital of the West Indies, Kingston, Jamaica.
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Snead
authors.affiliation: Family Health International (FHI 360), Research Triangle Park, NC, USA.
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Steiner
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Warner
authors.affiliation: Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Gallo
authors.affiliation: Epidemiology Research and Training Unit, Ministry of Health, Kingston, Jamaica.
authors.forename: Tina
authors.initials: T
authors.lastname: Hylton-Kong
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: apk3@cdc.gov.
authors.forename: Athena P
authors.initials: AP
authors.lastname: Kourtis
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D015415:Biomarkers / Q000032:analysis; D017280:Condoms / Q000706:statistics & numerical data*; D003267:Contraception / Q000379:methods / Q000523:psychology*; D003268:Contraception Behavior / Q000523:psychology*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D004343:Drug Implants / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007563:Jamaica; D008297:Male; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D017430:Prostate-Specific Antigen / Q000032:analysis; D021841:Safe Sex / Q000523:psychology*; D012661:Semen; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D047568:Unsafe Sex / Q000523:psychology*; D014621:Vagina / Q000737:chemistry; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003271:Contraceptive Agents, Female; D004343:Drug Implants; D017430:Prostate-Specific Antigen
keywords: Condom use; Contraceptive implant; LARC; PSA; Randomized controlled trial