Contraceptive use, prevalence and incidence of pregnancy and associated factors among women participating in a vaccine preparedness cohort study in Masaka, Uganda, a retrospective secondary analysis.
IF 3.6 2区 医学Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Sylvia Kusemererwa, Sheila Kansiime, Sarah Nakamanya, Elizabeth Mbabazi, Julie Fox, Sheena McCormack, Pontiano Kaleebu, Eugene Ruzagira
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引用次数: 0
Abstract
Background: HIV prevention trials usually require that women of childbearing potential use an effective method of contraception. This is because the effect of most investigational products on unborn babies is unknown. We assessed contraceptive use, prevalence and incidence of pregnancy and associated factors among women in a HIV vaccine preparedness study in Masaka, Uganda.
Methods: HIV sero-negative women (18-45 years) at high risk of HIV infection identified through HIV counselling and testing (HCT) were recruited between July 2018 and October 2022. Study procedures included collection of baseline socio-demographics and contraceptive use data, quarterly HCT, counselling on and provision of contraceptive methods onsite/through referral, and 6-monthly urine pregnancy tests. Multivariable Logistic and Poisson regression analyses were conducted to determine factors associated with contraceptive use, prevalence, and incidence of pregnancy.
Results: 652 (73%) of 891 women reported contraceptive use at baseline. Contraceptive use was higher in women who were in a relationship/married/cohabiting [adjusted odds ratio (aOR) = 1.60; 95% confidence interval (CI) 1.07-2.40] or divorced/separated/widowed [aOR = 1.86; 95% CI 1.24-2.79] versus those that were single, and among women reporting transactional sex [aOR = 2.10; 95% CI 1.16-3.80] versus those who did not. Baseline pregnancy prevalence was 4% (95% CI 3-6%) and lower in women who reported using long-acting contraceptive methods (aOR = 0.17; 95% CI 0.07-0.39) versus women who did not use these methods. A total of 65 pregnancies over 301.3 person-years of observation (PYO), an incidence rate of 21.6/100 (95% CI 16.9-27.5) PYO, higher among younger women (≤ 24 versus 25 + years, adjusted incidence rate ratio = 1.97; 95% CI 1.15-3.40).
Conclusion: We observed a high pregnancy incidence in this cohort. Innovative strategies that promote sustained and consistent use of highly effective contraceptive methods especially for young women will be critical to the success of HIV prevention trials in this and similar populations.
背景：艾滋病毒预防试验通常要求有生育潜力的妇女使用有效的避孕方法。这是因为大多数研究产品对未出生婴儿的影响是未知的。我们在乌干达马萨卡的一项HIV疫苗准备研究中评估了避孕药具的使用、流行率和怀孕发生率以及相关因素。方法：于2018年7月至2022年10月招募通过HIV咨询和检测（HCT）确定的HIV血清阴性高危女性（18-45岁）。研究程序包括收集基线社会人口统计和避孕药具使用数据，每季度进行一次HCT，在现场/通过转诊提供避孕方法咨询和提供，以及6个月进行尿液妊娠检查。进行多变量Logistic和泊松回归分析，以确定与避孕药具使用、流行率和妊娠发生率相关的因素。结果：891名妇女中有652名（73%）报告在基线时使用避孕药。处于恋爱关系/已婚/同居的女性使用避孕药具的比例较高[调整后优势比(aOR) = 1.60；95%可信区间（CI） 1.07-2.40]或离婚/分居/丧偶[aOR = 1.86；95% CI 1.24-2.79]与单身和报告交易性行为的女性相比[aOR = 2.10；（95% CI 1.16-3.80）。基线妊娠患病率为4% (95% CI 3-6%)，报告使用长效避孕方法的妇女的基线妊娠患病率更低(aOR = 0.17；95% CI 0.07-0.39)与不使用这些方法的妇女相比。共有65例妊娠超过301.3人-年（PYO）， PYO的发生率为21.6/100 (95% CI 16.9-27.5)，在年轻女性中较高(≤24岁vs > 25岁，调整后的发病率比= 1.97；95% ci 1.15-3.40)。结论：我们观察到该队列中妊娠发生率高。促进持续和一贯使用高效避孕方法的创新战略，特别是对年轻妇女的创新战略，对于在这一人群和类似人群中进行艾滋病毒预防试验取得成功至关重要。
期刊介绍：
Reproductive Health focuses on all aspects of human reproduction. The journal includes sections dedicated to adolescent health, female fertility and midwifery and all content is open access.
Reproductive health is defined as a state of physical, mental, and social well-being in all matters relating to the reproductive system, at all stages of life. Good reproductive health implies that people are able to have a satisfying and safe sex life, the capability to reproduce and the freedom to decide if, when, and how often to do so. Men and women should be informed about and have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care services that enable women to safely go through pregnancy and childbirth.
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