Abstract
Background
Women living with HIV (WLHIV) experience high rates of unmet contraceptive need and
unintended pregnancy. Contraceptive method-specific continuation rates and associated
factors are critical for guiding providers tasked with both reproductive health (RH)
and HIV care. We conducted this systematic review to determine whether contraceptive
continuation rates differ between WLHIV and uninfected women and, for WLHIV, whether
differences are impacted by method type, antiretroviral therapy use or other factors.
Methods
We searched Ovid MEDLINE, POPLINE and PubMed.gov for studies published between January 1, 2000, and August 31, 2016. Inclusion criteria
comprised prospective data of WLHIV, nonbarrier method continuation as an outcome
measure, and recorded method switching and/or discontinuation.
Results
Of 939 citations screened, 22 articles from 18 studies were eligible. For studies
with comparator groups, data quality was moderate overall based on Grading of Recommendations,
Assessment, Development and Evaluations and Newcastle–Ottawa Quality Assessment scales.
Of four studies comparing women by HIV serostatus, two showed higher rates of contraceptive
continuation among WLHIV versus uninfected women, while two others detected lower
continuation rates for the same comparison. Generally, baseline method continuation
exceeded 60% for studies with >12 months of follow-up. Studies providing contraception had higher continuation rates
than studies not providing contraception, while women allocated to contraceptive methods
in trials had similar continuation rates to those choosing contraceptive methods.
Across all studies, continuation rates differed by method and context, with the copper
intrauterine device showing greatest variability between sites (51%–91% continuation
rates at ≥12 months). Implant continuation rates were ≥86%, though use was low relative to other
methods and limited to few studes.
Conclusions
Contraceptive continuation among WLHIV differs by method and context. More longitudinal
studies with contraceptive continuation as a measured outcome following ≥12 months are needed to strengthen integration of RH and HIV care.
Keywords
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Article info
Publication history
Published online: February 09, 2018
Accepted:
February 3,
2018
Received in revised form:
January 29,
2018
Received:
June 12,
2017
Footnotes
☆Conflict of interest: The authors declare that there is no conflict of interest.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
