Contraception: X最新文献

{"title":"A risk scoring tool for predicting Kenyan women at high risk of contraceptive discontinuation","authors":"Claire W. Rothschild ,&nbsp;Barbra A. Richardson ,&nbsp;Brandon L. Guthrie ,&nbsp;Peninah Kithao ,&nbsp;Tom Omurwa ,&nbsp;James Mukabi ,&nbsp;Erica M Lokken ,&nbsp;Grace John-Stewart ,&nbsp;Jennifer A. Unger ,&nbsp;John Kinuthia ,&nbsp;Alison L. Drake","doi":"10.1016/j.conx.2020.100045","DOIUrl":"10.1016/j.conx.2020.100045","url":null,"abstract":"<div><h3>Objective</h3><p>We developed and validated a pragmatic risk assessment tool for identifying contraceptive discontinuation among Kenyan women who do not desire pregnancy.</p></div><div><h3>Study design</h3><p>Within a prospective cohort of contraceptive users, participants were randomly allocated to derivation (<em>n</em> = 558) and validation (<em>n</em> = 186) cohorts. Risk scores were developed by selecting the Cox proportional hazards model with the minimum Akaike information criterion. Predictive performance was evaluated using time-dependent receiver operating characteristic curves and area under the curve (AUC).</p></div><div><h3>Results</h3><p>The overall contraceptive discontinuation rate was 36.9 per 100 woman-years (95% confidence interval [CI] 30.3–44.9). The predictors of discontinuation selected for the risk score included use of a short-term method or copper intrauterine device (vs. injectable or implant), method continuation or switch (vs. initiation), &lt;<!--> <!-->9 years of completed education, not having a child aged &lt;<!--> <!-->6 months, and having no spouse or a spouse supportive of family planning (vs. having a spouse who has unsupportive or uncertain attitudes towards family planning). AUC at 24 weeks was 0.76 (95% CI 0.64–0.87) with 70.0% sensitivity and 78.6% specificity at the optimal cut point in the derivation cohort. Discontinuation was 3.8-fold higher among high- vs. low-risk women (95% CI 2.33–6.30). AUC was 0.68 (95% CI 0.47–0.90) in the validation cohort. A simplified score comprising routinely collected variables demonstrated similar performance (derivation-AUC: 0.73 [95% CI 0.60–0.85]; validation-AUC: 0.73 [95% CI 0.51–0.94]). Positive predictive value in the derivation cohort was 31.4% for the full and 28.1% for the simplified score.</p></div><div><h3>Conclusions</h3><p>The risk scores demonstrated moderate predictive ability but identified large proportions of women as high risk. Future research is needed to improve sensitivity and specificity of a clinical tool to identify women at high risk for experiencing method-related challenges.</p></div><div><h3>Implications</h3><p>Contraceptive discontinuation is a major driver of unmet contraceptive need globally. Few tools exist for identifying women who may benefit most from additional support in order to meet their contraceptive needs and preferences. This study developed and assessed the validity of a provider-focused risk prediction tool for contraceptive discontinuation among Kenyan women using modern contraception. High rates of early discontinuation observed in this study emphasize the necessity of investing in efforts to develop new contraceptive technologies and stronger delivery systems to better align with women's needs and preferences for voluntary family planning.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100045"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38351938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of efavirenz on levonorgestrel concentrations among Malawian levonorgestrel implant users for up to 30 months of concomitant use: a subanalysis of a randomized clinical trial","authors":"Jennifer H. Tang ,&nbsp;Nicole L. Davis ,&nbsp;Amanda H. Corbett ,&nbsp;Lameck Chinula ,&nbsp;Mackenzie L. Cottrell ,&nbsp;Yasaman Zia ,&nbsp;Gerald Tegha ,&nbsp;Frank Z. Stanczyk ,&nbsp;Stacey Hurst ,&nbsp;Mina C. Hosseinipour ,&nbsp;Lisa B. Haddad ,&nbsp;Athena P. Kourtis","doi":"10.1016/j.conx.2020.100027","DOIUrl":"10.1016/j.conx.2020.100027","url":null,"abstract":"<div><h3>Objectives</h3><p>Our primary objective was to compare geometric mean levonorgestrel concentrations between levonorgestrel implant users who were or were not taking the antiretroviral efavirenz, for up to 30 months after implant initiation. Our secondary objective was to evaluate the pregnancy rate among levonorgestrel implant users on efavirenz.</p></div><div><h3>Study design</h3><p>We performed a subanalysis of 42 Malawian women randomized to initiate the levonorgestrel implant as part of a parent randomized clinical trial. Our subset included 30 HIV-infected women taking efavirenz and 12 HIV-uninfected women not taking efavirenz. They underwent urine pregnancy testing every 3 months and serum levonorgestrel testing at day 3 and months 1, 3, 6, 12, 18, 24, 27 and 30 after implant initiation. Geometric mean levonorgestrel concentrations were calculated for efavirenz users and non-efavirenz users at each time point.</p></div><div><h3>Results</h3><p>The geometric mean levonorgestrel concentrations were lower for efavirenz users than non-efavirenz users at every time point; the geometric mean ratio for efavirenz users:non-efavirenz users ranged from 0.60 [90% confidence interval (CI) 0.46–0.79] at 1 month to 0.27 (90% CI 0.12–0.61) at 30 months after implant insertion. No pregnancies occurred over 60 woman-years of concomitant levonorgestrel implant and efavirenz use, although 11 women had levonorgestrel concentrations &lt;<!--> <!-->180 pg/mL (the previously suggested minimum threshold concentration for efficacy).</p></div><div><h3>Conclusions</h3><p>Efavirenz users had lower levonorgestrel concentrations than non-efavirenz users, and one third of our concomitant efavirenz and levonorgestrel implant users had concentrations &lt;<!--> <!-->180 pg/mL. Continued evaluation of the contraceptive efficacy of the levonorgestrel implant may be needed for efavirenz users.</p></div><div><h3>Implications</h3><p>Among 42 Malawian women using the levonorgestrel implant for contraception, women who were taking the antiretroviral efavirenz had lower serum levonorgestrel concentrations than women who were not taking efavirenz. However, none of the women who were taking efavirenz became pregnant over 60 women-years of follow-up.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100027"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38751899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of harassment and empowerment after sharing personal abortion stories publicly","authors":"Katie Woodruff,&nbsp;Rosalyn Schroeder,&nbsp;Stephanie Herold,&nbsp;Sarah C.M. Roberts,&nbsp;Nancy F. Berglas","doi":"10.1016/j.conx.2020.100021","DOIUrl":"10.1016/j.conx.2020.100021","url":null,"abstract":"<div><h3>Objective</h3><p>In recent years, in an attempt to counter stigma and increase empathy, public education campaigns have encouraged people to share their personal abortion stories. This exploratory study sought to document negative and positive experiences of those who have shared their abortion stories publicly.</p></div><div><h3>Study design</h3><p>We conducted an anonymous online survey of people who have shared their abortion story publicly (<em>N</em> = 88), recruited via partners affiliated with two abortion story-sharing campaigns. The survey asked about the context in which respondents shared their abortion story, any negative and positive experiences online and in “real life” as a result of story sharing, and any problems or benefits resulting from these experiences. We analyzed survey data using descriptive statistics, bivariate analyses and categorizing responses to open-ended questions.</p></div><div><h3>Results</h3><p>Sixty percent of respondents reported experiencing harassment and other negative incidents after sharing their story publicly. These experiences contributed to emotional stress, problems with loved ones and difficulties at work and/or school. These harms were reported even by many respondents who used only a first name or alias when sharing their story. Despite this, positive experiences as a result of story sharing were reported by four out of five respondents and motivated many to continue sharing their story.</p></div><div><h3>Conclusions</h3><p>This exploratory study indicates that many people who share their abortion story publicly find it to be an empowering, rewarding experience. Yet they also experience harassment and threats at high rates. Future research should explore both positive and negative experiences in more depth.</p></div><div><h3>Implications</h3><p>Sharing one's personal abortion story as part of a public education campaign can be a positive, empowering experience. Nevertheless, policymakers, journalists and reproductive health advocates should recognize the potential harms experienced by people who share their abortion story publicly and consider measures to support these individuals.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100021"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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","authors":"Maricianah Onono ,&nbsp;Kavita Nanda ,&nbsp;Kate B. Heller ,&nbsp;Doug Taylor ,&nbsp;Irina Yacobson ,&nbsp;Renee Heffron ,&nbsp;Margaret Phiri Kasaro ,&nbsp;Cheryl E. Louw ,&nbsp;Zelda Nhlabasti ,&nbsp;Thesla Palanee-Phillips ,&nbsp;Jenni Smit ,&nbsp;Imelda Wakhungu ,&nbsp;Peter B. Gichangi ,&nbsp;Nelly R. Mugo ,&nbsp;Charles Morrison ,&nbsp;Jared M. Baeten ,&nbsp;for the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial Consortium","doi":"10.1016/j.conx.2020.100026","DOIUrl":"10.1016/j.conx.2020.100026","url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Study design</h3><p>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.</p></div><div><h3>Results</h3><p>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).</p></div><div><h3>Conclusions</h3><p>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.</p></div><div><h3>Implications statement</h3><p>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.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100026"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38077735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the extent of contraceptive non-use among women at risk of unintended pregnancy, National Survey of Family Growth 2011–2017","authors":"Brittni N. Frederiksen ,&nbsp;Katherine Ahrens","doi":"10.1016/j.conx.2020.100033","DOIUrl":"10.1016/j.conx.2020.100033","url":null,"abstract":"<div><h3>Objective</h3><p>To describe characteristics of U.S. contraceptive non-users to inform tailored contraceptive access initiatives.</p></div><div><h3>Study design</h3><p>We used National Survey of Family Growth data from 2011 to 2017 to identify characteristics of contraceptive non-users compared to other women ages 15–44 at risk for unintended pregnancy. We also examined reasons for not using contraception by when non-users expected their next birth. We calculated unadjusted and adjusted prevalence ratios using two definitions of contraceptive non-use: (1) contraceptive non-use during the interview month, and (2) a more refined definition based on contraception use during the most recent month of sexual intercourse and expectation of timing of next birth. We considered p-values &lt;<!--> <!-->0.05 statistically significant.</p></div><div><h3>Results</h3><p>Approximately 20% (<em>n</em> <!-->=<!--> <!-->2844) of 12,071 women at risk of unintended pregnancy were classified as standard contraceptive non-users. After adjusting for all other variables, non-users were more likely to be low-income, uninsured, never married, expect a birth within 2 years, and have zero or one parity. The top reasons for contraceptive non-use were not minding if they got pregnant (22.6%), worried about contraceptive side effects (21.0%), and not thinking they could get pregnant (17.6%). After applying the more refined non-user definition, we identified 5.7% (<em>n</em> <!-->=<!--> <!-->721) of women as non-users; expecting a birth within 2–5 years and having a parity of one were associated with non-use after adjustment of all other factors.</p></div><div><h3>Conclusion</h3><p>Our more refined definition of non-users could be used in future studies examining the causes of unintended pregnancy and to inform programmatic interventions to reduce unintended pregnancy.</p></div><div><h3>Implications</h3><p>Describing contraceptive non-users and reasons for contraceptive non-use could help us better understand reasons for unintended pregnancy and inform tailored contraceptive access initiatives.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100033"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38234074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-of-pocket spending for oral contraceptives among women with private insurance coverage after the Affordable Care Act","authors":"Brittni Frederiksen ,&nbsp;Matthew Rae ,&nbsp;Alina Salganicoff","doi":"10.1016/j.conx.2020.100036","DOIUrl":"10.1016/j.conx.2020.100036","url":null,"abstract":"<div><h3>Objectives</h3><p>We aimed to identify which types and brands of oral contraceptive pills have the largest shares of oral contraceptive users in large employer plans with out-of-pocket spending and which oral contraceptives have the highest average annual out-of-pocket costs.</p></div><div><h3>Study design</h3><p>We analyzed a sample of medical claims obtained from the 2003–2018 IBM MarketScan Commercial Claims and Encounters Database (MarketScan), which is a database with claims information provided by large employer plans. We only included claims for women between the ages of 15 and 44 years who were enrolled in a plan for more than half a year as covered workers or dependents. To calculate out-of-pocket spending, we summed copayments, coinsurance and deductibles for the oral contraceptive prescriptions.</p></div><div><h3>Results</h3><p>We found that 10% of oral contraceptive users in large employer plans still had out-of-pocket costs in 2018. Oral contraceptives with the largest share of users with annual out-of-pocket spending are brand-name contraceptives with generic alternatives. The three contraceptives with the highest average annual out-of-pocket spending were brand-name contraceptives without generic alternatives. Three of the 10 contraceptives with the largest shares of users who have annual out-of-pocket spending and 3 of the 10 contraceptives with the highest average annual out-of-pocket spending contain iron.</p></div><div><h3>Conclusions</h3><p>Women with health insurance are still paying out of pocket for oral contraception, and future research should investigate which health plans have fewer fully covered contraceptives and effective modes of educating providers and patients about how to maximize the no-cost coverage benefit that has been extended to women.</p></div><div><h3>Implications</h3><p>The Affordable Care Act eliminated out-of-pockets costs for contraception for most insured women. However, some women still pay out of pocket for certain oral contraceptive brands and types that may have covered alternatives. Providers and patients could benefit from more education on how to maximize the no-cost coverage benefit extended to women.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100036"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38343921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Google Ads to recruit and retain a cohort considering abortion in the United States","authors":"Ushma D. Upadhyay ,&nbsp;Iris J. Jovel ,&nbsp;Kevin D. McCuaig ,&nbsp;Alice F. Cartwright","doi":"10.1016/j.conx.2019.100017","DOIUrl":"10.1016/j.conx.2019.100017","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to develop and test the feasibility of a methodology to recruit and retain individuals in the United States (US) who were considering abortion at the point of searching for an abortion clinic.</p></div><div><h3>Study design</h3><p>We conducted the Google Ads Abortion Access Study, a national cohort study using a novel recruitment method — recruiting people searching for abortion care on Google. Advertisements for the study were displayed in search results. Users who clicked on the advertisement were directed to a landing page explaining the study and then to a screening form. Participants were eligible if they reported being pregnant and considering abortion. They completed an online baseline survey and 4 weeks later were invited by email or text message to complete a follow-up survey.</p></div><div><h3>Results</h3><p>Over the course of 8 months, we recruited a racially/ethnically and geographically diverse cohort considering an abortion using Google Ads. After removing fraudulent cases, we recruited 1706 respondents, and among these, 1464 (86%) provided contact information for follow-up. Among those providing contact information, 1005 completed the follow-up survey, resulting in a 69% follow-up rate. Older age, white race, higher education, difficulty meeting basic needs, being not religious/spiritual and having no previous births were associated with higher follow-up. Total cost of the ads was $31.99 per completed baseline + follow-up survey.</p></div><div><h3>Conclusion</h3><p>Researchers can use online advertising to successfully recruit populations early in their abortion-seeking process to understand the barriers they face and how to improve abortion access. Disadvantages include high cost and a small potential for fraudulent data.</p></div><div><h3>Implications</h3><p>Google Ads is a feasible tool to recruit and follow a diverse sample of individuals who are considering abortion for studies investigating the barriers they face in obtaining a wanted abortion.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100017"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2019.100017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transgender abortion patients and the provision of transgender-specific care at non-hospital facilities that provide abortions","authors":"Rachel K. Jones ,&nbsp;Elizabeth Witwer ,&nbsp;Jenna Jerman","doi":"10.1016/j.conx.2020.100019","DOIUrl":"10.1016/j.conx.2020.100019","url":null,"abstract":"<div><h3>Objective</h3><p>To estimate the number of transgender and gender non-binary (TGNB) individuals who obtained abortions in the United States and the extent to which abortion facilities offer transgender-specific health services.</p></div><div><h3>Study design</h3><p>We collected survey data from all known health care facilities that provided abortions in 2017. For the first time, the questionnaire included items about TGNB abortion patients and services.</p></div><div><h3>Results</h3><p>We estimate that 462 to 530 TGNB individuals obtained abortions in 2017 and that 23% of clinics provide transgender-specific care.</p></div><div><h3>Conclusion</h3><p>Several hundred abortions were provided to TGNB individuals in 2017, primarily at facilities that did not provide transgender-specific health services.</p></div><div><h3>Implications</h3><p>Findings from this study support efforts to implement and expand gender-inclusive and affirming care at health care facilities that provide abortion.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100019"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing telemedicine to in-clinic medication abortions induced with mifepristone and misoprostol","authors":"Ellen R Wiebe ,&nbsp;Mackenzie Campbell ,&nbsp;Harani Ramasamy ,&nbsp;Michaela Kelly","doi":"10.1016/j.conx.2020.100023","DOIUrl":"10.1016/j.conx.2020.100023","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to compare the practical aspects of providing medication abortions through telemedicine and in-person clinic visits so that clinics can use this information when planning to add this service.</p></div><div><h3>Study design</h3><p>We conducted a comparative retrospective chart review comparing telemedicine medication abortions to a control group matched for date seen. We extracted and compared demographics, use of dating ultrasound, outcomes and unscheduled visits or communications with staff and physicians.</p></div><div><h3>Results</h3><p>During the study period, we provided 4340 medication abortions, of which 182 (4.2%) were provided through by telemedicine; 199 patients met the criteria to be in the control group. The mean age was 28.7 years for telemedicine patients and 28.1 years for in-person patients (p = .38). The mean gestational ages were also similar, 48.2 days for telemedicine patients and 46.5 days for in-person patients (p = .03). Only 33 (18.1%) of telemedicine patients had dating ultrasounds compared to 199 (100%) of in-clinic patients (p &lt; .001). The proportions of documented completed abortions (164/182, 90.1% and 179/199, 89.9%, p = .76) were similar, as were the proportions of aspirations for completion (6/182, 3.3% and 9/199, 4.5%, p = .54) and the proportions lost to follow-up (5.5% and 6.6%, p = .66). There were 10 complications in each group (5.5% of telemedicine patients and 5.0% of in-clinic patients) (p &gt; 0.5). Unscheduled communications with office assistants were greater in the telemedicine patients than the in-person patients (84/182, 46.2% vs. 43/199, 21.6% in-person, p &lt; .001).</p></div><div><h3>Conclusion</h3><p>We found that telemedicine patients required more unscheduled communications and received ultrasounds far less often compared to in-clinic patients.</p></div><div><h3>Implications</h3><p>We could provide telemedicine without the need for ultrasound to most women. Larger studies without routine ultrasound use are needed to validate our findings. Unscheduled communication with clinic staff was more frequent with telemedicine medication abortion patients. This information may help clinics when planning to add this service.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100023"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Levonorgestrel release rates measured through analysis of two-rod contraceptive explants","authors":"Rachael Fuchs ,&nbsp;Douglas Taylor ,&nbsp;David W. Jenkins ,&nbsp;Vivian Brache ,&nbsp;Diane Luo ,&nbsp;Laneta J. Dorflinger ,&nbsp;Markus J. Steiner","doi":"10.1016/j.conx.2020.100039","DOIUrl":"10.1016/j.conx.2020.100039","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to characterize and compare in vivo rates of levonorgestrel (LNG) release from Sino-implant (II) and Jadelle® contraceptive implants.</p></div><div><h3>Study design</h3><p>We sampled 48 Sino-implant (II) and 49 Jadelle® explant sets for residual LNG content from participants treated for up to 51 months in a randomized contraceptive efficacy trial in the Dominican Republic (DR). Additional Sino-implant (II) explants were obtained from 8 women who became pregnant in the DR trial and 10 who contributed 3 to 5 years of use in a cohort study in China. Baseline LNG loads were estimated from five unused implant sets per device type. Release profiles were estimated using mixture models that captured initial burst fractions and compared with efficacy and pharmacokinetics data from the DR trial.</p></div><div><h3>Results</h3><p>Estimated baseline LNG loads for Sino-implant (II) and Jadelle® were 142.8 mg and 150.5 mg, respectively (vs. the labeled 150 mg). There was an initial burst release of drug (5.6% and 7.9%, respectively) followed by an exponential decrease in LNG content evident for each device. Release rates were significantly lower for Sino-implant (II) throughout the treatment period, with estimated rates after 3 years of 24.2 mcg/day and 29.0 mcg/day for Sino-implant (II) and Jadelle®, respectively. The estimated Sino-implant (II) rate after 3 years was similar to the predicted rate after 5 years (23.6 mcg/day) for Jadelle® (rate ratio: 1.03; 95% confidence interval: 0.92–1.13).</p></div><div><h3>Conclusions</h3><p>Sino-implant (II) LNG release rates were significantly lower than Jadelle® with Sino-implant (II) rates through year 3 comparable to Jadelle® rates through year 5. These results reinforce the 3-year duration of action for which Sino-implant (II) was prequalified by the World Health Organization.</p></div><div><h3>Implications</h3><p>This analysis confirms the WHO prequalification of Sino-implant (II) for 3 years of use and supports different durations of action for Jadelle® and Sino-implant (II). It provides additional evidence that this approach can complement efficacy trials in determining duration of action of hormonal contraceptives in general.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100039"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38439172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}