A comparative analysis of documented contraceptive use among women aged 18-30 living with and without HIV in Alabama.

OBJECTIVES: To compare contraception use in 18-30-year-old women living with and without HIV. We also explored factors associated with contraceptive use. STUDY DESIGN: We reviewed outpatient medical records for women living with HIV aged 18-30 years seen in one of two university-affiliated HIV-subspecialty clinics in Birmingham, Alabama, between July 2015 and June 2016. We selected an age-matched sample of women living without HIV seen in one of two university-affiliated non-HIV primary care clinics as the comparator group and focused our analysis on women with a documented discussion of contraception in clinic. For women with more than one clinic visit during the 1-year study period, the most recent visit was used for analysis. Multinominal and binary logistic regressions were used to identify factors associated with contraception use, and models were adjusted for HIV status. RESULTS: This study included 197 women (58 HIV-positive, 139 HIV-negative). Short-acting contraception methods were the most common methods used by women with (41.4%) and without HIV (47.5%, p=.43). Long-acting reversible contraception (LARC) use was 14% among women with HIV and 32% among women without HIV (p=.12). Contraception use predictors included HIV status, mental health comorbidities, obesity and number of pregnancies. CONCLUSION: Documented contraceptive method use among 18-30-year -old women seen in clinics in urban Alabama varied by HIV status. Women with HIV were less likely to use LARC methods compared to women without HIV. IMPLICATIONS: Future studies should focus on identifying factors that influence contraceptive choice and which methods are offered to young women in the South. Providers should document contraception discussions at each visit and remove any barriers to LARC provision.

Contraceptive adherence among women Veterans with mental illness and substance use disorder.

OBJECTIVE: Emerging data suggest that mental illness and substance use disorder (SUD) are important risk factors for inconsistent contraceptive use. We investigated whether mental illness without or with SUD is associated with contraceptive adherence and continuation of hormonal methods among women Veterans. STUDY DESIGN: We conducted a retrospective analysis of national Veteran's Administration data among women aged 18-45 with a hormonal contraceptive prescription (pill/patch/ring/injectable) during the first week of fiscal year 2013. We tested associations between mental illness diagnoses (depression, posttraumatic stress disorder, anxiety, bipolar disorder, schizophrenia, adjustment disorder) without or with SUD diagnoses (drug/alcohol abuse) and 12-month contraceptive adherence (number and length of gaps ≥7 days between refills and months of contraceptive coverage) using multivariable regression models. RESULTS: Among 9780 Veterans, 43.6% had mental illness alone, 9.4% comorbid mental illness and SUD, and 47.0% neither diagnosis. In adjusted analyses, compared to women with neither diagnosis, women with mental illness alone had a similar rate of gaps but increased odds of having gaps longer than 30 days [odds ratio (OR): 1.35, 95% confidence interval (CI): 1.10-1.52] and fewer months of contraceptive coverage (ß_coefficient: -0.39, 95% CI: -0.56 to -0.23). Women with mental illness and SUD experienced more gaps (incidence rate ratio: 1.12, 95% CI: 1.03-1.21), increased odds of gaps longer than 30 days (OR: 1.46, 95% CI: 1.10-1.79), fewer months of contraceptive coverage (ß_coefficient: -0.90, 95% CI: -1.20 to -0.62) and reduced odds of continuous 12-month coverage (adjusted OR: 0.76, 95% CI: 0.63-0.93). CONCLUSIONS: Mental illness, particularly with comorbid SUD, is associated with reduced contraceptive adherence and continuation among women Veterans. Women with these risk factors could potentially benefit from use of long-acting reversible methods. IMPLICATIONS: Women Veterans have a high burden of mental illness and SUD, which we found are associated with inconsistent contraceptive use. Efforts to improve adherence to hormonal contraceptives and to increase availability of long-acting reversible methods in this vulnerable population are warranted.

A review of the endometrial histologic effects of progestins and progesterone receptor modulators in reproductive age women.

This review compares the histologic changes that occur in the endometrium following ovulation and progesterone secretion with contraceptive progestins and progesterone receptor modulators (PRMs) that may be used as contraceptive agents in women. The morphologic endometrial changes vary by the progestin type, dosage and duration; are often subtle and difficult to interpret; and may also vary depending on whether or not estrogen is used. The prolonged use of ethinyl estradiol and a progestin as a combined oral contraceptive results in common endometrial histologic findings that include glandular and stromal atrophy and spiral arteriole underdevelopment. Intrauterine systems releasing levonorgestrel have similar changes that are related to the proximity of the device to the endometrium, while progestin-only implants result in atrophy with marked vascular changes characterized by underdevelopment of spiral arterioles and dilated, thin-walled vessels near the surface epithelium. Lower doses of levonorgestrel delivered by a vaginal ring allow ovulation, and the endometrial changes appear to reflect the impact of the endogenous hormones. PRMs have been investigated as potential female contraceptives. PRM-associated endometrial changes include an inactive endometrium with cystically dilated glands, lined by epithelium with increased apoptosis in a background of compact nondecidualized stroma. Histologic differences between PRMs appear to depend on the degree of progesterone receptor agonistic activity.

Contraceptive use in women enrolled into preventive HIV vaccine trials: experience from a phase I/II trial in East Africa.

BACKGROUND: HIV vaccine trials generally require that pregnant women are excluded from participation, and contraceptive methods must be used to prevent pregnancy during the trial. However, access to quality services and misconceptions associated with contraceptive methods may impact on their effective use in developing countries. We describe the pattern of contraceptive use in a multi-site phase I/IIa HIV Vaccine trial in East Africa (Uganda, Kenya and Tanzania) and factors that may have influenced their use during the trial. METHODS: Pregnancy prevention counseling was provided to female participants during informed consent process and at each study visit. Participants' methods of contraception used were documented. Methods of contraceptives were provided on site. Pregnancy testing was done at designated visits during the trial. Obstacles to contraceptive use were identified and addressed at each visit. RESULTS: Overall, 103 (31.8%) of a total of 324 enrolled volunteers were females. Female participants were generally young with a mean age of 29(+/-7.2), married (49.5%) and had less than high school education (62.1%). Hormonal contraceptives were the most common method of contraception (58.3%) followed by condom use (22.3%). The distribution of methods of contraception among the three sites was similar except for more condom use and less abstinence in Uganda. The majority of women (85.4%) reported to contraceptive use prior to screening. The reasons for not using contraception included access to quality services, insufficient knowledge of certain methods, and misconceptions. CONCLUSION: Although hormonal contraceptives were frequently used by females participating in the vaccine trial, misconceptions and their incorrect use might have led to inconsistent use resulting in undesired pregnancies. The study underscores the need for an integrated approach to pregnancy prevention counseling during HIV vaccine trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT00123968.

Usage of Long Acting Reversible Contraceptive Methods (LARC) in couples attending for vasectomy counselling.

OBJECTIVE: Vasectomy is a safe and effective method of permanent contraception. A proportion of men will regret the procedure and some may experience chronic testicular pain. National recommendations in the UK advocate that couples requesting sterilization should be counselled and given access to Long Acting Reversible Contraceptive (LARC) methods. This study aims to ascertain usage of LARC methods in couples attending for vasectomy counselling. METHOD: A case notes review of 200 consecutive couples attending for vasectomy counselling between January and May 2006. RESULTS: Most couples were using condoms for contraception (51%) prior to vasectomy counselling. Only 11% of couples were using a LARC and 25% of couples had ever used one. The copper intrauterine device was the most popular LARC with 16% having ever used it; hormonal LARCs were unpopular. Some couples (9.5%) expressed dissatisfaction with current methods and associated health risks. CONCLUSION: Usage of LARC methods was low but similar to that of the background population in the UK. Couples attending for vasectomy are seeking effective contraception but prefer non-hormonal methods. LARC uptake in the UK is poor; there is a need for wider education and awareness of all LARC methods including side effects and safety.

Coil or intrauterine device? Patient preferences for contraceptive terminology.

OBJECTIVE: To discover what terminology women prefer to use when referring to contraceptive methods and to investigate the understanding of and ideas associated with contraceptive names. DESIGN: A self-administered questionnaire was answered by 191 new patients at family planning clinics (FPCs). Women were asked if they understood the terms used by the fpa (Family Planning Association), if they knew of any alternatives and, if so, which they preferred. SETTING: Selected FPCs across the city of Manchester. RESULTS: Patients preferred to use familiar terms, e.g. pill, mini-pill, coil and morning-after pill. There was no difference in preference when the results were compared by age or educational level. A greater proportion of non-Caucasians than Caucasians preferred the precise (fpa) terms. Although precise terms were not widely known or understood, when used they were associated with more information than were the familiar terms. CONCLUSION: All FPC staff should evaluate the language used by individual patients and, where appropriate, introduce precise terminology to help patients to make informed, appropriate choices.

Status of certain additional over-the-counter drug category II and III active ingredients. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule stating that a certain ingredient in over-the-counter (OTC) drug products is not generally recognized as safe and effective or is misbranded. FDA is issuing this final rule after considering the reports and recommendations of various OTC drug advisory review panels and public comments on proposed agency regulations. This final rule addresses the ingredient octoxynol 9, considered in the rulemaking for OTC vaginal contraceptive drug products. Based on the failure of interested parties to submit new data or information to FDA under the proposed regulation, the agency has determined that the presence of this active ingredient in an OTC drug product would result in that drug product not being generally recognized as safe and effective for its intended use or would result in misbranding. This final rule is part of FDA's ongoing OTC drug product review.

Provider attitudes toward dispensing emergency contraception in Michigan's Title X programs.

PIP: In 1997, the US Department of Health and Human Services instructed all Title X delegate agencies to provide emergency contraceptive pills as part of their standard family planning services. The results of a survey conducted in the state of Michigan in October 1996, prior to this policy development, elucidate potential obstacles to implementation of this directive. Questionnaires were completed by the family planning coordinator of all 53 Michigan health departments and Planned Parenthood affiliates that receive Title X funding. At the time of the survey, only 32 programs were providing emergency contraception and 27 of these agencies were offering the method to no more than one woman per month. 75% of providers agreed that poor or underprivileged women would benefit from more widespread access to emergency contraception through Title X programs. Barriers to translating this commitment into practice included inadequate staffing, the logistics of scheduling emergency appointments, lack of federal service guidelines, few client requests, and reservations about the impact on sexual risk-taking and contraceptive practice. In several cases, the decision not to dispense emergency contraception was made by a medical doctor or health officer who viewed the method's medicolegal status as unclear or considered the associated political risk too great. The subsequent marketing of a product specifically designated for emergency contraception should alleviate provider concerns about the method's status. The logistic concerns suggest a need to consider provision of emergency pills to clients in advance of actual need.^ieng