Does hormone therapy exacerbate other venous thromboembolism risk factors?

OBJECTIVE: Postmenopausal symptoms in women at higher risk for venous thromboembolism (VTE) due to comorbidities are often undertreated because of concerns that hormone therapy (HT) may increase VTE risk; however, it is unclear how much HT impacts risk of VTE when compared with other risk factors. METHODS: This is a case-control study in a commercial claims database from 2007 to 2019. Women aged 50 to 64 years (n = 223,949) were classified as cases if they had an International Classification of Diseases code indicating an acute VTE plus a filled prescription for an anticoagulant, placement of intravascular vena cava filter, or death within 30 days of diagnosis. Controls were matched 10:1 to each case by index date and age. Risk factors and comorbidities present within the year before index were examined. Exposure was defined as a HT prescription within 60 days before index. RESULTS: There were 20,359 VTE cases and 203,590 matched controls. A conditional logistic regression indicated that the greatest risks for VTE were from metastatic cancer (odds ratio [OR], 13.66; 95% CI, 12.64-14.75), hospitalization/surgery (OR, 8.51; 95% CI, 8.09-8.96), trauma (OR, 3.52; 95% CI, 3.32-3.73), comorbidity burden (OR, 3.51; 95% CI, 3.34-3.69), history of hypercoagulable condition (OR, 3.10; 95% CI, 2.87-3.36), and varicose veins (OR, 2.87; 95% CI, 2.56-3.22). Regarding hormone exposure, we observed ORs of 1.51 (95% CI, 1.43-1.60) for any recent hormone exposure; 1.13 (95% CI, 1.04-1.23; number needed to harm, 4,274) for unopposed estrogen menopausal HT; 1.23 (95% CI, 1.10-1.38; number needed to harm, 2,440) for combined menopausal HT; and 5.22 (95% CI, 4.67-5.84) for combined hormonal contraceptives compared with no recent HT exposure. CONCLUSIONS: Hormone therapy exposure did not appear to adversely influence other risk factors, and exposure generally played a minor role in VTE risk. Contraceptives, however, were a strong risk factor.

Psychosocial dimensions of access and their association with contraceptive use and intention to use.

BACKGROUND: Several studies suggest that psychosocial accessibility appears to be the key remaining hurdle to contraceptive use when issues of geographic and financial accessibility have been resolved. To date, the literature has considered various dimensions of psychosocial accessibility, which are not well measured by the two main sources of contraceptive data (DHS and PMA2020). In a previous paper, we have designed a framework that outlines four subdimensions of cognitive and psychosocial access and their theoretical relationship to contraceptive use and intention to use. This paper aims to study the associations between the four dimensions of access to contraception with the contraceptive use and intention to use. It also aims to explore the mediation effect of these four dimensions of access in the relationships between classical individual characteristics and contraceptive use and intention to use. METHODS: The data we used came from the 6th round of the PMA2020 survey in Burkina Faso in 2018-19. This survey included 2,763 households (98.4% response rate) and 3329 women (97.7% response rate). In addition to PMA's core questions, this survey collected data on psychosocial accessibility. Each group of questions was added to address one dimension. We use a multilevel generalized structural equation and mediation modeling to test the associations between psychosocial accessibility and contraceptive use while controlling for some individual and contextual characteristics. RESULTS: Approval, contraceptive knowledge, and agency were associated with contraceptive use, while fears of side effects were not. Approval and agency explain part of the effects of education and parity on contraceptive use. Exposure to family planning messages had a positive impact on women's contraceptive agency. CONCLUSION: FP messages can help enhance women's contraceptive agency, and then, contraceptive use, regardless of age and parity. The analysis highlights the mediator effects of contraceptive approval and agency on the association between parity and education with contraceptive use.

Characteristics Associated With Physician Bias in Contraceptive Recommendations.

OBJECTIVE: We aimed to examine associations between obstetrician-gynecologist (OBGYN) contraceptive recommendations and sociodemographic characteristics of patients and recommending physicians. METHODS: OBGYNs affiliated with residency programs across the United States were recruited via email to participate in an online exploratory survey depicting scenarios of reproductive-age women of differing race and socioeconomic status, all other factors identical, and were asked to provide contraceptive recommendations. The χ2 test, Fisher's exact tests, and logistic regression were used to analyze recommendation differences based on physician and patient characteristics. RESULTS: Of 172 physician respondents, large proportions self-identified as white (74%) and attending physicians (56%) from the Mid-Atlantic (42%). In multivariate logistic regression, self-administered methods (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.2-0.8) and condoms (OR, 0.5; 95% CI, 0.3-0.9) were recommended significantly less to Black high SES patients compared with white high SES patients. Non-white physicians recommended tubal ligation (OR, 0.7; 95% confidence interval [CI], 0.5-0.9) significantly less than white physicians, and recommended long-acting reversible contraception (OR, 3.3, CI 2.2-5.2) and condoms (OR, 1.4; 95% CI, 1.1-1.9) significantly more. Trainee physicians recommended self-administered methods (OR, 0.3; 95% CI, 0.2-0.4), condoms (OR, 0.2; 95% CI, 0.2-0.3), and tubal ligation (OR, 0.4; 95% CI, 0.3-0.6) significantly less than attending physicians. CONCLUSIONS: OBGYN contraceptive recommendations differed based on patients' perceived race and SES. Recommendations also differed based on race, training level, and geographic location of the recommending physician. Results suggest that physician bias contributes to contraceptive recommendations. OBGYNs should receive education about contraceptive coercion and patient-centered decision-making so that they provide high-quality counseling to all patients.

"It's already in your body and it's preventing": a qualitative study of African female adolescent's acceptability and preferences for proxy HIV prevention methods in Cape Town, South Africa.

BACKGROUND: Advances in biomedical HIV prevention will soon offer young women a choice of HIV prevention methods, including various pre-exposure prophylaxis (PrEP) modalities such as daily oral pills, dapivirine vaginal ring, and long-acting injectable agents. By understanding preferences for contraceptive methods, we may draw analogies for the HIV prevention needs of young women. The UChoose Study was an open-label randomised cross-over study designed to evaluate the acceptability and preference for several contraceptive options as a proxy for HIV prevention methods that use similar types of administration. The study enrolled healthy HIV uninfected young women aged 15 to 19 years. At enrolment, participants were randomly assigned to a contraceptive method for a period of 16 weeks in the form of monthly Nuvaring® (vaginal ring), daily combined oral contraceptive (daily pills), or bi-monthly injectable contraceptive (injectable). After 16 weeks, participants crossed over to another contraceptive method, and those who had received the injectable and the daily pills received the vaginal ring for another 16 weeks, whereas those who had received the vaginal ring were able to choose between the injectable and daily pills, to ensure that all participants tried the vaginal ring-the least familiar option to the study population. RESULTS: Thirty-three participants were purposively recruited to participate in seven focus group discussions (FGD) and completed a pre-survey for their assigned group. Our sample comprised 14 participants randomised to use of the vaginal ring and daily pills and 19 participants randomised to use of the vaginal ring and injectable. For most participants, their preferences for a prevention method were based primarily on their desire to avoid negative aspects of one method rather than their positive user experience with another method. Most participants expressed initial hesitancy for trying new contraception method products; however, a lack of familiarity was moderated by a strong interest in diverse user-controlled prevention methods. Participants valued methods that had infrequent dosing and simplified use requirements. The injection and vaginal ring were preferred over daily pills as a potential HIV prevention method. CONCLUSION: Expanding the availability of diverse products could provide adolescents with multiple choices in HIV prevention for the uninitiated. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02404038 ). Registered March 31, 2015-Registered.

Residential status and household wealth disparities in modern contraceptives use among women in Ghana: a cross-sectional analysis.

BACKGROUND: Modern contraceptive refers to "a product or medical procedure that interferes with reproduction from acts of sexual intercourse". The aim of this study was to assess the relationship between residential status and wealth quintile, and modern contraceptive use among women in Ghana. METHODS: We examined residential status and wealth quintile on contraceptive use analysing the 2006, 2011 and 2018 Multiple Indicator Cluster Surveys datasets. A sample of 30,665 women in their reproductive ages (15-49 years) were enrolled in the surveys across Ghana. STATA version 13 was used to process and analyse the data. It examined socioeconomic and demographic characteristics, assessed modern contraceptive use prevalence among women, and used logistic regression models to determine predictors. The results were presented in odds ratio and adjusted odds ratio with 95% confidence intervals. All statistical tests were measured with p < 0.05. RESULTS: In the three survey years, the highest prevalence of modern contraceptive usage was observed in 2011 (27.16%). The odds of using modern contraceptive increased by 19% in rural places (AOR = 1.19; 95% CI = 1.097-1.284) compared to urban places. The likelihood of women in second (AOR = 1.17; 95% CI = 1.065-1.289), middle (AOR = 1.24; 95% CI = 1.118-1.385), and fourth (AOR = 1.25; 95% CI = 1.113-1.403) wealth quintile using contraceptives increased compared to those of low wealth quintile. With the interactive terms, rural-second (AOR = 1.38; 95% CI = 1.042-1.830), rural-middle (AOR = 1.45; 95% CI = 1.084-1.933), rural-fourth (AOR = 1.52; 95% CI = 1.128-2.059), and rural-high (AOR = 1.42; 95% CI = 1.019-1.973) were more likely to use contraceptives compared to urban-low women. Despite lower odds, women of the age groups 20-24 (AOR = 2.33; 95% CI = 2.054-2.637), cohabitaing (AOR = 1.07; 95% CI = 0.981-1.173), secondary or higher education (AOR = 1.55; 95% CI = 1.385-1.736), Central (AOR = 1.48; 95% CI = 1.296-1.682) and Eastern (AOR = 1.48; 95% CI = 1.289-1.695) regions significantly predicted modern contraceptive use. CONCLUSION: Modern contraceptive use in Ghana is low. Women in rural-rich categories are more likely to use modern contraceptives. Background factors such as age, marital status, educational attainment, and previous child experiences predict modern contraceptive use. It is recommended for the intensification of contraceptive awareness and utilization for all reproductive age women, regardless of education, marriage, or wealth.

Contraception and Abortion Care for People Living With HIV: A Clinical Guide for Reproductive Health Practitioners.

People capable of pregnancy are disproportionately affected by HIV. Family planning needs and services are often unmet in this population, and clinical care guidelines regarding contraceptive options and abortion care are not well elucidated. Individuals living with HIV often face unique barriers in accessing contraception and abortion services due to internalized stigma, medically complex care (eg, drug-drug interactions, adverse effects of antiretroviral therapy), and distrust of health care providers. There is also a lack of clarity among reproductive health, primary, and infectious disease care providers on best-practice contraceptive counseling and contraceptive care for individuals living with HIV, given limited opportunities to enhance expertise in reproductive infectious disease. In this review, we summarize existing and updated evidence and clinical considerations regarding contraceptive counseling and abortion care in this population.

Factors Affecting Recurrence of Idiopathic Granulomatous Mastitis: A Systematic Review.

Idiopathic granulomatous mastitis is a rare and benign disease that primarily affects young women of reproductive age. Various factors have been suggested as possible causes, including pregnancy, breastfeeding, history of taking birth control pills, hyperprolactinemia, smoking, and history of trauma. Due to unknown etiology, opinions on its treatment have varied, resulting in differing recurrence rates and side effects. Therefore, conducting a comprehensive systematic review and meta-analysis can aid in understanding the causes and recurrence of the disease, thereby assisting in the selection of effective treatment and improving the quality of life. A systematic literature review was conducted using predefined search terms to identify eligible studies related to risk factors and recurrence up to June 2022 from electronic databases. Data were extracted and subjected to meta-analysis when applicable. A total of 71 studies with 4735 patients were included. The mean age of the patients was 34.98 years, and the average mass size was 4.64 cm. About 3749 of these patients (79.17%) were Caucasian. Patients who mentioned a history of pregnancy were 92.65% with 76.57%, 22.7%, and 19.7% having a history of breastfeeding, taking contraceptive pills, and high prolactin levels, respectively. Around 5.6% of patients had previous trauma. The overall recurrence rate was 17.18%, with recurrence rates for treatments as follows: surgery (22.5%), immunosuppressive treatment (14.7%), combined treatment (14.9%), antibiotic treatment (6.74%), and observation (9.4%). Only antibiotic and expectant treatments had significant differences in recurrence rates compared to other treatments (p value = 0.023). In conclusion, factors such as Caucasian race, pregnancy and breastfeeding history, and use of contraceptive hormone are commonly associated with the disease recurrence. Treatment should be tailored based on symptom severity and patient preference, with surgery or immunosuppressive options for recurrence.

Contraceptive Adoption and Changes in Empowerment in Kenya, Nigeria, and Senegal.

Women's empowerment and contraceptive use are critical to achieving gender equality. The positive association between more empowered women and higher rates of contraceptive use has been well-established by cross-sectional research. However, there remains a gap in understanding the longitudinal relationship between contraceptive adoption and changes to women's empowerment. This study represents a novel approach to understanding the relationship between contraceptive adoption and women's empowerment longitudinally, at the individual level. To the authors' knowledge, this is the first attempt to measure the relationship between contraceptive adoption and women's empowerment using more than one wave of panel data. We leverage the longitudinal design of the Urban Reproductive Health Initiative data to code empowerment items by change over time (e.g., more empowered, no change, less empowered). We use sparse principal component analysis to establish empowerment change domains and calculate individual scores standardized by country-level averages. We estimate mixed effects models on these change domains, to investigate the link between contraceptive adoption and empowerment. We find common themes in empowerment across contexts-but contraceptive adoption has both positive and negative effects on those domains, and this varies across context. We discuss the need for cohort studies to examine this relationship.

Trends and Determinants of Non-Utilization of Modern Contraception in Ekiti State, Nigeria: A Ten-Year Review.

BACKGROUND: An increase in correct usage of modern contraception is vital in reducing the maternal mortality ratio and Under-5 mortality, leading towards the achievement of Sustainable Development Goal 3. Our study examined the trends and factors affecting non-utilization of modern contraceptives over a 10-year period in Ekiti State, Nigeria. METHODOLOGY: This study used data from three consecutive National Demographic Health Surveys (NDHS) - 2008, 2013, and 2018 - with a weighted sample size of 1,357 women of reproductive age (15-49 years). Data on contraceptive use on these women, provided by the NDHS, were extracted and analysed using IBM SPSS version 25. The sample was weighted to adjust for disproportionate sampling and non-response. Pearson's chi-square and binary logistic regression were used to assess the factors associated with non-utilization of modern contraceptives. RESULTS AND FINDINGS: The mean age of the women was 30 years. Modern contraceptive use increased from 13.1% in 2008 to 23.0% in 2018, while unmet need for modern contraceptives decreased from 84.8% in 2008 to 75.4% in 2018. Identified predictors of non-utilization of modern contraceptive were age 20-24 years [aOR=0.33, 95%CI=0.19-0.59], 25-29 years [aOR=0.34, 95%CI=0.18-0.64], 30-34 years [aOR=0.46, 95%CI=0.22-0.94], 35-39 years [aOR=0.29, 95%CI=0.14-0.61] and 40-44 years [aOR=0.37, 95%CI=0.17-0.80] compared to age 15-19 years; living in urban areas [aOR=0.72, 95%CI=0.53-0.98] compared to in rural areas; higher level of education [aOR=0.46, 95%CI=0.21-0.98] compared to no education; and desire for more children [aOR=0.48, 95%CI=0.32-0.73] compared to not wanting more children. CONCLUSION: Although contraceptive usage increased over time, the factors associated with non-utilization were being an adolescent, living in a rural area, lower level of education, and desire for more children.

Feasibility and acceptability of virtual group contraceptive counseling prior to abortion care.

OBJECTIVES: This study aimed to evaluate the feasibility and acceptability of virtual group contraceptive counseling in the abortion care setting. STUDY DESIGN: Patients seeking abortion care at an urban university hospital were invited to participate in this cohort study. Prior to their clinical appointments, groups of two to six patients participated in 45-minute virtual contraceptive counseling visits facilitated by study staff. Contraceptive method use, effectiveness, and side effects were reviewed according to group interest. Participant satisfaction scores were collected immediately following the sessions. After their appointments, providers estimated the time spent on contraceptive counseling during the clinical visit. RESULTS: Of 195 patients approached, 86 (44%) were enrolled. Fifty-seven (66%) enrolled patients completed a session. The most common reason for declining enrollment was concern about the time commitment. Most (93%) participants reported being "satisfied" or "very satisfied" overall, and 96% would recommend group contraceptive counseling to a friend. Providers reported that compared to typical counseling, participants required a shorter amount of time during the clinical visit than nonparticipants (time spent <5 minutes: 74% vs 54%). CONCLUSIONS: Virtual group contraceptive counseling for patients seeking abortion was feasible and acceptable in this study. Group virtual visits may reduce provider time burden, add value when virtual care delivery is desired or required, and deserve further study. IMPLICATIONS: Family planning clinics can consider incorporating virtual group counseling as a person-centered and efficient approach to contraceptive counseling at the time of abortion care.

Association of State Funding for Comprehensive Reproductive Health Care With Use of Contraception Among Latina Patients and Non-Latina Patients in Oregon.

Importance: There are well-documented racial and ethnic disparities in effective contraceptive use due to multiple factors. A key contributor may be differential insurance coverage and patient costs. The Oregon Reproductive Health Equity Act (RHEA), enacted in 2017, ensures full coverage of reproductive health care without cost sharing for all Oregonians with low income. Objective: To assess whether removing financial barriers to accessing contraceptive care is associated with an improvement in use of moderately and highly effective contraceptive methods among Latina women compared with non-Latina women. Design, Setting, and Participants: This cohort study included women aged 12 to 51 years who sought contraceptive care in the Oregon Health Authority Reproductive Health Program from April 2016 to March 2020. Patients using permanent contraception, those missing data on ethnicity, and non-Oregon residents were excluded. Data analysis was performed in January 2021. Exposures: Contraceptive care in the Reproductive Health Program after RHEA implementation. Main Outcomes and Measures: The main outcome was prevalence of use of moderately effective methods (contraceptive pills, patch, ring, or injection) or highly effective methods (long-acting reversible contraceptives) at the time of the contraceptive visit. Difference-in-differences analysis was used to compare moderately and highly effective contraception use between Latina and non-Latina patients. Secondary outcomes were proportions of adoption or continuation of moderately and highly effective methods, prevalence of highly effective methods, and adoption or continuation of highly effective methods. The unit of analysis was at the clinic visit level. Results: The study sample consisted of 295 604 evaluable clinic visits, in which 28.4% of individuals identified as Latina and 71.6% of individuals identified as non-Latina. The mean (SD) age was 25.5 (8.1) years. With difference-in-differences analysis, there was a significant adjusted 1.9 percentage point (95% CI, 0.2-3.6 percentage points) increase in prevalence of moderately or highly effective contraceptive methods for Latina patients compared with non-Latina patients. There were no significant differences for other outcomes of interest. Conclusions: This cohort study found that in Oregon, legislation removing financial barriers to accessing contraceptive care was associated with significant mitigation in disparate moderately and highly effective contraceptive method prevalence for Latina patients compared with non-Latina patients. The findings suggest that state funds successfully supplanted federal funds to enable continued robust comprehensive family planning services after withdrawal from Title X.

Contraceptive use Among Hispanic Women Living in Puerto Rico.

OBJECTIVE: To assess the contraceptive methods used by sexually active Hispanic women living in Puerto Rico. METHODS: From October 2016 through February 2018, 518 patients completed a self-administered questionnaire. The inclusion criteria were being over the age of 21 and having visited San Juan City Hospital or University District Hospital. The results were analyzed using descriptive statistics and a 2-sample t test, where P < .05 was considered significant. RESULTS: A total of 518 participants completed the questionnaire. Of the 518, 413 (81.0%) reported having used at least 1 form of contraception; 252 (49.4%) used OCPs, 305 (60.8%) used male condoms, 92 (33.8%) used the rhythm method, 83 (30.6%) undergone female sterilization, 98 (19.9%) used the withdrawal method, 92 (18.9%%) used an implant, 67 (13.5%) received progesterone injections, 41 (8.3%) used female condoms, 13 (4.9%) had partners who undergone male sterilization, 20 (4.1%) used the transdermal patch, 16 (3.2%) used a vaginal ring, and 26 (5.3%) used an intrauterine device. CONCLUSION: Of the 518 women, 24.2% used LARC, representing an increase in the usage by this population; this increase is likely linked to LARC's being easily accessible and free of charge. Public health interventions should be developed to increase knowledge about sexual health, educate about the effectiveness of different contraceptive methods and the prevention of sexually transmitted diseases, and reduce both the barriers to acquiring contraception and, thereby, the number of unintended pregnancies in this population.

Survey of colleges and schools of pharmacy to determine restrictions for teaching, research, and advocacy related to contraception.

INTRODUCTION: The pharmacist's role in reproductive health is evolving. Since 46 states allow providers to refuse to provide reproductive health services, it is important to consider whether learning is impacted by institution restrictions on contraception teaching, advocacy, and research. METHODS: An electronic survey was emailed to deans of all pharmacy schools on the American Association of Colleges of Pharmacy Institutional Membership list with a request to share with faculty teaching women's health content within their curriculum. The survey collected information about contraception teaching, research, and advocacy. RESULTS: Of 145 schools contacted, 39 (27%) provided complete responses. Of these, 22 (56%) were public, not religiously-affiliated, seven (18%) were private, not religiously-affiliated, six (15%) were private, currently religiously-affiliated, and four were (10%) private, historically religiously-affiliated. All respondents taught hormonal contraception in the required curriculum and 15 (39%) taught miscarriage management/abortifacients. None reported restrictions on contraception teaching or research. One respondent cited an advocacy restriction for contraception methods due to violation of the school's beliefs, and another cited an advocacy restriction for miscarriage management/abortifacients. Respondents noted students expressed ethical questions/concerns about refusing to dispense contraception (59%), dispensing certain contraceptives (54%), dispensing to minors (46%), and dispensing all contraceptives (21%). Additionally, respondents reported pharmacists/faculty expressed ethical questions/concerns about refusing to dispense contraception (31%), dispensing to minors (21%), dispensing certain contraceptives (15%), and all contraceptives (13%). CONCLUSIONS: Overall, respondents reported no restrictions in contraception teaching and scholarship and minimal advocacy restrictions. Faculty should consider ethical questions/concerns from students, faculty, and pharmacists when teaching this material.

Determinants and prevalence of modern contraceptive use among sexually active female youth in the Berekum East Municipality, Ghana.

INTRODUCTION: Contraceptive use among sexually active women in Ghana remains low despite the efforts by the Ghana Health Service. This development has negative consequences on reproductive health care, particularly among adolescents. This study assessed the prevalence and factors influencing contraceptive use among sexually active young women in the Berekum Municipality, Ghana. METHOD: A community-based cross-sectional analytical study was carried out in Berekum East Municipality among young women between the ages of 15 to 24 years. Using a probabilistic sampling technique, we recruited 277 young women from the four selected communities in the Berekum Municipality based on data available from the Municipal Health Administration. We applied a univariate and multivariate logistic regression analysis to test the associations between the dependent and independent variables at a 95% Confidence interval (CI) and 5% significance (p value = 0.005). RESULTS: The modern contraceptive prevalence rate among the study participants was 211 (76%). Contraceptives ever used were emergency contraceptive pills 88 (41.7%) condoms 84 (39.8%), injectables 80 (37.9%) and the rest used the Calendar method 16 (7.58%), withdrawal 15 (7.11%), and implants 11 (5.21%). In the adjusted multivariate logistic regression, Age (AOR = 2.93; 95% CI; 1.29-7.50) p = 0.023, marital status (AOR = 0.08; 95%CI; 0.01-0.91) p = 0.041 and religion (AOR = 0.17; 95% CI; 0.05-0.64) p = 0.009 were significantly associated with contraceptive use. Other determinants such as hearing about contraceptives (AOR = 9.44; 95%CI; 1.95-45.77) p = 0.005, partner opposition (AOR = 33.61; 95%CI; 1.15-985.39) p = 0.041, side effects (AOR = 4.86; 95%CI; 1.83-12.91) p = 0.001, lack of knowledge (AOR = 5.41; 95%CI; 1.15-25.42) p = 0.032, and respondents receiving counselling on family planning were significantly associated with contraceptive use (AOR = 4.02; 95% CI;1.29-12.42), p = 0.016. CONCLUSION: Contraceptive use among sexually active women in the Berekum Municipality is higher than the national conceptive prevalence rate. However, factors such as knowledge about the side effects of contraceptive influences contraceptive use among women. Healthcare providers must explore avenues to enhance partner involvement, intensify health education and detailed counselling about contraceptive use to address misconceptions and myths surrounding the side effects of contraceptives.

How do Specialists Address Contraceptive Care Compared to General Practitioners in a Federally Qualified Health Center in Maryland.

OBJECTIVES: To determine associations between primary provider specialty and the contraceptive care that patients receive in a Federally Qualified Health Center setting in Maryland. METHODS: A study of reproductive-age patients and their providers was performed from January 2018 to December 2021. A pooled crosssectional survey of electronic medical record data for 44 127 encounters of 22 828 patients was performed to calculate the odds of contraceptive care being addressed by patients who had General Practitioner, OB/GYN, pediatrician, or infectious disease (ID) specialists as their primary providers. RESULTS: In 19 041 encounters (43%), contraception was addressed through either counseling alone, documentation of a contraceptive prescription, or long-acting reversible contraceptive (LARC) placement procedure. After adjusting for insurance status and race/ethnicity, the odds ratio (OR) of contraceptive care delivery was statistically significantly higher for OB/GYN providers compared to General Practitioners-OR 2.42 (CI 2.29-2.53) and statistically significantly lower for ID providers-OR 0.69 (CI 0.61-0.79). There was a non-statistically significant difference for Pediatricians-OR 0.88 (CI 0.77-1.01). CONCLUSION: The provision of contraceptive care, a critical aspect of comprehensive primary care delivered in an FQHC setting, varies by provider specialty, and may be negatively influenced by Ryan White funding related structures. There is a need to intentionally design robust referral and tracking systems to ensure contraceptive care is equitably accessible to all, regardless of assigned primary care provider specialty or HIV status.

Contraceptive dynamics among women with disabilities in low- and middle-income countries: a scoping review protocol.

INTRODUCTION: Contraceptive dynamics is the use of contraception, unmet need, discontinuation, and/or switching of contraception. Women with disabilities (WWDs) in low- and middle-income countries (LMICs) face a common problem: a low prevalence of contraceptive usage and a high unmet need. Even though certain studies have been conducted in high-income countries, research is scarce on the degree of contraceptive method mix, unmet needs, contraception discontinuation, and switching among WWDs in LMICs. As a result, the scoping review's goal is to investigate, map available evidence, and identify knowledge gaps on contraceptive dynamics within LMICs WWDs. METHODS: The scoping review is guided by the six-stage Arksey and O'Malley methodology framework. Published articles will be retrieved from databases such as PubMed (MEDLINE), the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Global Health. Grey literature databases will be searched using electronic search engines such as Google Scholar, Google, OpenGrey, and Worldcat. In addition, a manual search of reference lists from recognized studies will be conducted, as well as a hand search of the literature. Any type of study design (e.g., randomized controlled trials, quasi-experimental studies, prospective and retrospective cohort studies, case-control or nested case-control studies, qualitative, cross-sectional studies) will be included in this scoping review. There will be no restrictions on publication year. Two independent reviewers will screen relevant publications, and data will be charted accordingly. The Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guidelines will be used to report all parts of the protocol and scoping review. DISCUSSION: When compared to non-disabled women, WWDs had a lower prevalence of contraceptive usage and a higher unmet need in LMICs. Despite these facts, they are the most marginalized people on the planet. This is, therefore, critical to map available evidence and identify knowledge gaps on contraceptive dynamics. As a result, the findings of this scoping review will be significant in terms of the contraceptive dynamic among WWDs in LMICs. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework (OSF), with registration number; DOI/10.17605/OSF.IO/XCKPT.

Assessment of the Risk Evaluation and Mitigation Strategy (REMS) for Phentermine-Topiramate to Prevent Exposure During Pregnancy.

BACKGROUND: The U.S. Food and Drug Administration approved phentermine-topiramate for obesity in 2012 and required a Risk Evaluation and Mitigation Strategy (REMS) to prevent prenatal exposure. No such requirement was introduced for topiramate. OBJECTIVE: To evaluate the rate of prenatal exposure, contraceptive use, and pregnancy testing among patients with phentermine-topiramate compared with topiramate or other antiobesity medications (AOMs). DESIGN: Retrospective cohort study. SETTING: Nationwide health insurance claims database. PARTICIPANTS: Females aged 12 to 55 years with no infertility diagnosis or sterilization procedure. Patients with other indications for topiramate were excluded to identify a cohort that was likely treated for obesity. MEASUREMENTS: Patients initiated use of phentermine-topiramate, topiramate, or an AOM (liraglutide, lorcaserin, or bupropion-naltrexone). Pregnancy at treatment initiation, conception during treatment, contraceptive use, and pregnancy testing outcomes were ascertained. Measurable confounders were adjusted for, and extensive sensitivity analyses were done. RESULTS: A total of 156 280 treatment episodes were observed. Adjusted prevalence of pregnancy at treatment initiation was 0.9 versus 1.6 per 1000 episodes (prevalence ratio, 0.54 [95% CI, 0.31 to 0.95]) for phentermine-topiramate versus topiramate. The incidence rate of conception during treatment was 9.1 versus 15.0 per 1000 person-years (rate ratio, 0.61 [CI, 0.40 to 0.91]) for phentermine-topiramate versus topiramate. Both outcomes were similarly lower for phentermine-topiramate compared with AOM. Prenatal exposure was marginally lower in topiramate users compared with AOM users. Approximately 20% of patients in all cohorts had at least 50% of treatment days covered by contraceptives. Few patients had pregnancy tests before treatment (≤5%), but this was more common among phentermine-topiramate users. LIMITATIONS: Outcome misclassification; unmeasured confounding due to lack of prescriber data to account for possible clustering and spillover effects. CONCLUSION: Prenatal exposure seemed to be significantly lower among phentermine-topiramate users under the REMS. Pregnancy testing and contraceptive use appeared to be inadequate for all groups, which deserves attention to prevent the remaining potential exposures. PRIMARY FUNDING SOURCE: None.

Influence of Hormonal Contraceptive Use and HIV on Cervicovaginal Cytokines and Microbiota in Malawi.

Important questions remain on how hormonal contraceptives alter the local immune environment and the microbiota in the female genital tract and how such effects may impact susceptibility to HIV infection. We leveraged samples from a previously conducted clinical trial of Malawian women with (n = 73) and without (n = 24) HIV infection randomized to depot medroxyprogesterone acetate (DMPA) or the levonogestrel implant in equal numbers within each group and determined the effects of these hormonal contraceptives (HCs) on the vaginal immune milieu and the composition of the vaginal microbiota. Longitudinal data for soluble immune mediators, measured by multiplex bead arrays and enzyme-linked immunosorbent assays (ELISAs), and vaginal microbiota, assessed by 16S rRNA gene amplicon, were collected prior to and over a period of 180 days post-HC initiation. DMPA and levonogestrel had only minimal effects on the vaginal immune milieu and microbiota. In women with HIV, with the caveat of a small sample size, there was an association between the median log10 change in the interleukin-12 (IL-12)/IL-10 ratio in vaginal fluid at day 180 post-HC compared to baseline when these women were classified as having a community state type (CST) IV vaginal microbiota and were randomized to DMPA. Long-lasting alterations in soluble immune markers or shifts in microbiota composition were not observed. Furthermore, women with HIV did not exhibit increased viral shedding in the genital tract after HC initiation. Consistent with the results of the ECHO (Evidence for Contraceptive Options and HIV Outcomes) trial, our data imply that the progestin-based HC DMPA and levonorgestrel are associated with minimal risk for women with HIV. (This study has been registered at ClinicalTrials.gov under registration no. NCT02103660). IMPORTANCE The results of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial, the first large randomized controlled clinical trial comparing the HIV acquisition risk of women receiving DMPA, the levonorgestrel (LNG) implant, or the copper intrauterine device (IUD), did not reveal an increased risk of HIV acquisition for women on any of these three contraceptives. Our study results confirm that the two different progestin-based hormonal contraceptives DMPA and levonogestrel will not increase the risk for HIV infection. Furthermore, DMPA and levonogestrel have only minimal effects on the immune milieu and the microbiota in the vaginal tract, attesting to the safety of these hormonal contraceptives.

Contraceptive methods in adolescence: a narrative review of guidelines.

PURPOSE: Adolescent pregnancy, while recently in decline, remains a matter in need of addressing. Education and counselling are deemed crucial and this review aims at comparing published contraceptive guidelines, thus resolving any surrounding misconceptions. MATERIALS AND METHODS: Recently published contraception guidelines regarding adolescent pregnancy were retrieved. In particular, guidelines and recommendations from ACOG, RCOG, SOCG, AAP, CPS, NICE, CDC, and WHO were compared and reviewed based on each guideline's method of reporting. RESULTS: Three categories of contraceptive methods are available for adolescents and recommendations on their initiation should be made based on their efficacy, according to all guidelines. Therefore, long acting reversible contraceptives (LARCs) should be highly recommended as the most effective method (typical use failure rate: 0.05%), followed by short-acting hormonal contraceptives (typical use failure rate: 3-9%). The third contraceptive option includes contraceptives used in the moment of intercourse and displays the lowest effectiveness (typical use failure rate: 12-25%), mostly due to its dependence on personal consistency, however offers protection against STI transmission. CONCLUSION: Adolescents should be encouraged to initiate contraception, with LARCs being the primary choice followed by short-acting hormonal contraception. However, regardless of the chosen effective contraceptive method, the use of condom is necessary for STI prevention.

Adolescent pregnancy, while recently in decline, remains a matter in need of addressing. The use of contraceptive methods such as LARCs and short-acting hormonal contraceptives should be encouraged and suggested based on effectiveness with the addition of condom for STI prevention.

Non-use of modern contraceptives among women in humanitarian contexts: evidence from a qualitative study in Akwa Ibom State, Nigeria.

The continuing conflict situation in Nigeria have created over 2 million displaced persons. In 2019, women and children accounted for about 80% of the internally displaced population in the country. Displacement increases the need for reproductive health services. This study explored the reasons for non-use of modern contraceptives among forcibly displaced Bakassi women in Akwa Ibom State, southern Nigeria. Focus group discussions were used to collect data from a convenience sample of 40 women of reproductive age (15-49 years) in two makeshift resettlement camps in the region in January and February 2020. Data were analysed using a qualitative inductive approach, with thematic organization and analysis of the transcribed responses from the focus group discussions. The findings revealed that many of the women were not using modern contraceptives at the time of the study, and the major reasons they gave for non-use were misconceptions, costs, religious beliefs, desire for more children and the inaccessibility and unavailability of contraceptive services. The use of family planning services can be a life-saving intervention in unstable, crisis environments. Programme implementation to address non-use of contraceptive services among women in crisis contexts should target social norm change, reproductive health education, empowerment programmes and health service provision.