title: The impact of an IUD and implant intervention on dual method use among young women: Results from a cluster randomized trial.
abstract: Long-acting reversible contraceptives (LARCs) are highly effective at preventing pregnancy but do not protect against sexually transmitted infection (STI). Recent efforts to improve access to intrauterine devices (IUDs) and implants have raised concerns about STI prevention and reduced condom use, particularly among teenagers and young women. We evaluated whether a provider-targeted intervention to increase LARC access negatively impacted dual method use and STI incidence among an at-risk patient population. We conducted a cluster randomized trial in 40 reproductive health centers across the United States from May 2011 to May 2013. After training providers at 20 intervention sites, we recruited 1500 sexually-active women aged 18-25years who did not desire pregnancy and followed them for one year. We assessed intervention effects on dual method use, condom use and STI incidence, modeling dual method use with generalized estimating equations and STI incidence with Cox proportional hazard regression models, accounting for clustering. We found no differences between intervention and control groups in dual method use (14.3% vs. 14.4%, aOR 1.03, 95% CI 0.74-1.44) or condom use (30% vs. 31%, aOR 1.03, 95% CI 0.79-1.35) at last sex at one year. STI incidence was 16.5 per 100 person-years and did not differ between intervention and control groups (aHR 1.20, 95% CI 0.88-1.64). A provider training intervention to increase LARC access neither compromised condom use nor increased STI incidence among young women. Dual method use was very low overall, highlighting the need to bolster STI prevention efforts among adolescents and young women.
authors: Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States. Electronic address: alison.elayadi@ucsf.edu.
authors: Alison M
authors: AM
authors: El Ayadi
authors: Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States.
authors: Corinne H
authors: CH
authors: Rocca
authors: Planned Parenthood Federation of America, United States.
authors: Julia E
authors: JE
authors: Kohn
authors: University of California, Berkeley, United States.
authors: Denisse
authors: D
authors: Velazquez
authors: Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States.
authors: Maya
authors: M
authors: Blum
authors: Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States.
authors: Sara J
authors: SJ
authors: Newmann
authors: Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States.
authors: Cynthia C
authors: CC
authors: Harper
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003267:Contraception / Q000379:methods*; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D021841:Safe Sex; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D014481:United States
keywords: Condoms; Etonogestrel; Female adolescents; Female contraceptive devices; Intrauterine contraceptive devices; Sexually transmitted diseases