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Author Notes:

Corresponding Author: Kristin M Wall, Department of Epidemiology, School of Public Health, Emory University, 1518 Clifton Road NE, 3rd Floor, Atlanta, GA 30322, Phone: (512) 785-4779, kmwall@emory.edu

We would like to acknowledge and thank the study participants, staff, interns, and Project Management Group members of the Zambia-Emory HIV Research Project in Lusaka, Zambia.

We also thank Michelle Kautzman MD MPH, Laurie Fuller RN MPH, Fong Liu MD MPH, Erin Shutes MPH, Lisa Jones RN MPH, and Tyronza Sharkey MPH for their contributions to study implementation.

Meetings at which parts of the data were presented: Wall KM, Bellington V, Haddad L, Htee Khu N, Vwalika C, Kilembe W, Chomba E, Stephenson R, Kleinbaum D, Nizam A, Brill I, Tichacek A, Allen S. Effect of an intervention to promote contraceptive uptake on incident pregnancy: a randomized controlled trial among HIV positive couples in Zambia. Abstract submission number 247684. AIDS Vaccine 2012. Boston, MA, Sept 2012.

The authors have no conflicts of interest, including relevant financial interests, activities, relationships, and affiliations.

Subjects:

Research Funding:

National Institutes of Child Health and Development [NICHD RO1 HD40125]

National Institute of Mental Health [NIMH R01 66767]

AIDS International Training and Research Program Fogarty International Center [D43 TW001042]; the Emory Center for AIDS Research [P30 AI050409]

National Institute of Allergy and Infectious Diseases [NIAID R01 AI51231]

International AIDS Vaccine Initiative

Keywords:

  • Couples’ voluntary HIV counseling and testing
  • family planning
  • long-term contraception
  • randomized controlled trial
  • Zambia

Impact of long-term contraceptive promotion on incident pregnancy: a randomized controlled trial among HIV positive couples in Lusaka, Zambia

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Journal Title:

Journal of Acquired Immune Deficiency Syndromes

Volume:

Volume 63, Number 1

Publisher:

, Pages 86-95

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objectives To evaluate the impact of family planning promotion on incident pregnancy in a combined effort to address Prongs 1 and 2 of Prevention of Mother-to-Child Transmission of HIV. Design We conducted a factorial randomized controlled trial of two video-based interventions. Methods “Methods-focused” and “Motivational” messages promoted long-term contraceptive use among 1060 couples with HIV in Lusaka, Zambia. Results Among couples not using contraception prior to randomization (N=782), the video interventions had no impact on incident pregnancy. Among baseline contraceptive users, viewing the “Methods” video which focused on the IUD and contraceptive implant was associated with a significantly lower pregnancy incidence (HR=0.38; 95%CI:0.19–0.75) relative to those viewing control and/or motivational videos. The effect was strongest in concordant positive couples (HR=0.22; 95%CI:0.08–0.58) and couples with HIV+ women (HR=0.23; 95%CI:0.09–0.55). Conclusions The “Methods video” intervention was previously shown to increase uptake of longer-acting contraception and to prompt a shift from daily oral contraceptives to quarterly injectables and long-acting methods such as the IUD and implant. Follow-up confirms sustained intervention impact on pregnancy incidence among baseline contraceptive users, in particular couples with HIV positive women. Further work is needed to identify effective interventions to promote long-acting contraception among couples who have not yet adopted modern methods.

Copyright information:

© 2013, (C) 2013 Lippincott Williams

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