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Comparison of pregnancy incidence among African women in a randomized trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) or a levonorgestrel (LNG) implant for contraception.
Contracept X. 2020; 2:100026.CX

Abstract

Objective

The objective was to address bias in contraception efficacy studies through a randomized study trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) and a levonorgestrel (LNG) implant.

Study design

We analyzed data from the Evidence for Contraceptive Options and HIV Outcomes Trial, which assessed HIV incidence among 7829 women from 12 sites in eSwatini, Kenya, South Africa and Zambia seeking effective contraception and who consented to be randomized to DMPA-IM, copper IUD or LNG implant. We used Cox proportional hazards regression adjusted for condom use to compare pregnancy incidence during both perfect and typical (i.e., allowing temporary interruptions) use.

Results

A total of 7710 women contributed to this analysis. Seventy pregnancies occurred during perfect and 85 during typical use. There was no statistically significant difference in perfect use pregnancy incidence among the methods: 0.61 per 100 woman-years for DMPA-IM [95% confidence interval (CI) 0.36-0.96], 1.06 for copper IUD (95% CI 0.72-1.50) and 0.63 for LNG implants (95% CI 0.39-0.96). Typical use pregnancy rates were also largely similar: 0.87 per 100 woman-years for DMPA-IM (95% CI 0.58-1.25), 1.11 for copper IUD (95% CI 0.77-1.54) and 0.63 for LNG implants (95% CI 0.39-0.96).

Conclusions

In this randomized trial of highly effective contraceptive methods among African women, both perfect and typical use resulted in low pregnancy rates. Our findings provide strong justification for improving access to a broader range of longer-acting contraceptive options including LNG implants and copper IUD for African women.

Implications statement

Data from this study support recommendations to providers, policy makers and patients that all of these methods provide safe and highly effective contraception for African women.

Authors+Show Affiliations

Kenya Medical Research Institute Center for Microbiology Research, P.O. Box 19464-00202, Nairobi, Kenya.FHI 360, Durham, USA.University of Washington, Seattle, USA.FHI 360, Durham, USA.FHI 360, Durham, USA.University of Washington, Seattle, USA.UNC Global Projects Zambia & University of North Carolina at Chapel Hill, Zambia.Madibeng Centre for Research, Brits, South Africa. Department of Family Medicine, University of Pretoria, Pretoria, South Africa.Family Life Association of eSwatini & ICAP at Columbia University, eSwatini.Wits Reproductive Health and HIV Institute, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, South Africa.University of the Witwatersrand, Durban, South Africa.Kenya Medical Research Institute Center for Microbiology Research, P.O. Box 19464-00202, Nairobi, Kenya.International Center for Reproductive Health, Kenya. Technical University of Mombasa, Mombasa, Kenya.Kenya Medical Research Institute Center for Microbiology Research, P.O. Box 19464-00202, Nairobi, Kenya. University of Washington, Seattle, USA.FHI 360, Durham, USA.University of Washington, Seattle, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32577615

Citation

Onono, Maricianah, et al. "Comparison of Pregnancy Incidence Among African Women in a Randomized Trial of Intramuscular Depot Medroxyprogesterone Acetate (DMPA-IM), a Copper Intrauterine Device (IUDs) or a Levonorgestrel (LNG) Implant for Contraception." Contraception: X, vol. 2, 2020, p. 100026.
Onono M, Nanda K, Heller KB, et al. Comparison of pregnancy incidence among African women in a randomized trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) or a levonorgestrel (LNG) implant for contraception. Contracept X. 2020;2:100026.
Onono, M., Nanda, K., Heller, K. B., Taylor, D., Yacobson, I., Heffron, R., Kasaro, M. P., Louw, C. E., Nhlabasti, Z., Palanee-Phillips, T., Smit, J., Wakhungu, I., Gichangi, P. B., Mugo, N. R., Morrison, C., & Baeten, J. M. (2020). Comparison of pregnancy incidence among African women in a randomized trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) or a levonorgestrel (LNG) implant for contraception. Contraception: X, 2, 100026. https://doi.org/10.1016/j.conx.2020.100026
Onono M, et al. Comparison of Pregnancy Incidence Among African Women in a Randomized Trial of Intramuscular Depot Medroxyprogesterone Acetate (DMPA-IM), a Copper Intrauterine Device (IUDs) or a Levonorgestrel (LNG) Implant for Contraception. Contracept X. 2020;2:100026. PubMed PMID: 32577615.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of pregnancy incidence among African women in a randomized trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) or a levonorgestrel (LNG) implant for contraception. AU - Onono,Maricianah, AU - Nanda,Kavita, AU - Heller,Kate B, AU - Taylor,Doug, AU - Yacobson,Irina, AU - Heffron,Renee, AU - Kasaro,Margaret Phiri, AU - Louw,Cheryl E, AU - Nhlabasti,Zelda, AU - Palanee-Phillips,Thesla, AU - Smit,Jenni, AU - Wakhungu,Imelda, AU - Gichangi,Peter B, AU - Mugo,Nelly R, AU - Morrison,Charles, AU - Baeten,Jared M, AU - ,, Y1 - 2020/05/28/ PY - 2020/03/25/received PY - 2020/05/14/revised PY - 2020/05/17/accepted PY - 2020/6/25/entrez PY - 2020/6/25/pubmed PY - 2020/6/25/medline KW - Africa KW - Copper intrauterine device KW - Hormonal contraception KW - Implants KW - Injectables KW - Pregnancy incidence SP - 100026 EP - 100026 JF - Contraception: X JO - Contracept X VL - 2 N2 - Objective: The objective was to address bias in contraception efficacy studies through a randomized study trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) and a levonorgestrel (LNG) implant. Study design: We analyzed data from the Evidence for Contraceptive Options and HIV Outcomes Trial, which assessed HIV incidence among 7829 women from 12 sites in eSwatini, Kenya, South Africa and Zambia seeking effective contraception and who consented to be randomized to DMPA-IM, copper IUD or LNG implant. We used Cox proportional hazards regression adjusted for condom use to compare pregnancy incidence during both perfect and typical (i.e., allowing temporary interruptions) use. Results: A total of 7710 women contributed to this analysis. Seventy pregnancies occurred during perfect and 85 during typical use. There was no statistically significant difference in perfect use pregnancy incidence among the methods: 0.61 per 100 woman-years for DMPA-IM [95% confidence interval (CI) 0.36-0.96], 1.06 for copper IUD (95% CI 0.72-1.50) and 0.63 for LNG implants (95% CI 0.39-0.96). Typical use pregnancy rates were also largely similar: 0.87 per 100 woman-years for DMPA-IM (95% CI 0.58-1.25), 1.11 for copper IUD (95% CI 0.77-1.54) and 0.63 for LNG implants (95% CI 0.39-0.96). Conclusions: In this randomized trial of highly effective contraceptive methods among African women, both perfect and typical use resulted in low pregnancy rates. Our findings provide strong justification for improving access to a broader range of longer-acting contraceptive options including LNG implants and copper IUD for African women. Implications statement: Data from this study support recommendations to providers, policy makers and patients that all of these methods provide safe and highly effective contraception for African women. SN - 2590-1516 UR - https://www.unboundmedicine.com/medline/citation/32577615/Comparison_of_pregnancy_incidence_among_African_women_in_a_randomized_trial_of_intramuscular_depot_medroxyprogesterone_acetate__DMPA_IM__a_copper_intrauterine_device__IUDs__or_a_levonorgestrel__LNG__implant_for_contraception_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2590-1516(20)30009-5 DB - PRIME DP - Unbound Medicine ER -
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