Contraception Usage and Timing of Pregnancy among Pregnant Teenagers in Cape Town, South Africa

OBJECTIVE:

To evaluate knowledge and use of contraception among pregnant teenagers in the Cape Town metropolitan area.

METHODS:

A cross-sectional study enrolled women aged 16 to 19 years who were pregnant and attending prenatal clinics, and prenatal and labor wards at regional hospitals and midwife-run obstetric clinics in the Cape Town area between March 1, 2011 and September 30, 2011. Data were collected using an administered questionnaire.

RESULTS:

The study enrolled 314 participants. Of the participants, 240 (76.4%) felt their pregnancies had occurred at the "wrong time" but only 38 (12.1%) were using contraception at the time of conception. The form of contraception that participants most commonly had knowledge of was injectable hormonal contraception (274 [87.3%]). Contraception use was low, with 126 (40.1%) participants having never used contraception. The forms of contraception used most commonly were the male condom (106 [33.8%]) and injectable contraception (98 [31.2%]). The majority of participants found it easy to get contraception (192 [61.1%]) and felt that information regarding contraception was readily available (233 [74.2%]).

CONCLUSION:

Contraception use is suboptimal but this may not simply be a reflection of ineffective family-planning services. Further research is needed to fully explain the lack of contraceptive use in this population.

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By:  Vollmer LR1, van der Spuy ZM2.

• 1Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa. Electronic address: lindivollmer@hotmail.com.
• 2Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa. 
• Int J Gynaecol Obstet. 2016 Jan 28. pii: S0020-7292(16)00039-4. doi: 10.1016/j.ijgo.2015.10.011. 

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Oral & Injectable Contraceptive Use & HIV Acquisition Risk among Women in 4 African Countries: A Secondary Analysis of Data from a Microbicide Trial

To assess the effect of oral and injectable contraceptive use compared to non-hormonal contraceptive use on HIV acquisition among Southern African women enrolled in a microbicide trial.

Prospective cohort study using data from women enrolled in HIV Prevention Trials Network (HPTN) protocol 035. At each quarterly visit, participants were interviewed about self-reported contraceptive use and sexual behaviors and underwent HIV testing. Cox proportional hazards regression was used to assess the effect of injectable and oral hormonal contraceptive use on HIV acquisition.

The analysis included 2,830 participants, of whom 106 became HIV infected (4.07 per 100 person-years.) At baseline, 1,546 (51%) participants reported using injectable contraceptives and 595 (21%) reported using oral contraceptives. HIV incidence among injectable, oral and non-hormonal contraceptive method users was: 4.72, 2.68 and 3.83 per 100 person-years, respectively. Injectable contraceptive use was associated with a non-statistically significant increased risk of HIV acquisition (adjusted hazard ratio [aHR]=1.17; 95% confidence interval [CI] 0.70, 1.96), while oral contraceptive use was associated with a non-statistically significant decreased risk of HIV acquisition (aHR=0.76; 95% CI 0.37,1.55).

In this secondary analysis of randomized trial data, a marginal, but non-statistically significant, increase in HIV risk among women using injectable hormonal contraceptives was observed. No increased HIV risk was observed among women using oral contraceptives. Our findings support the World Health Organization's recommendation that women at high risk for acquiring HIV, including those using progestogen-only injectable contraception, should be strongly advised to always use condoms and other HIV prevention measures.

Among Southern African women participating in an HIV prevention trial, women using injectable hormonal contraceptives had a modest increased risk of HIV acquisition, however this association was not statistically significant. Continued research on the relationship between widely used hormonal contraceptive methods and HIV acquisition is essential.

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By: Balkus JE1, Brown ER2, Hillier SL3, Coletti A4, Ramjee G5, Mgodi N6, Makanani B7, Reid C8, Martinson F9, Soto-Torres L10, Abdool Karim SS11, Chirenje ZM6.

¹Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. Electronic address: jbalkus@fhcrc.org.

²Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.

³University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences and the Magee-Women's Research Institute, Pittsburgh, PA, USA.

⁴FHI360, Durham, NC, USA.

⁵HIV Prevention Research Unit, South Africa Medical Research Council, Durban, South Africa.

⁶University of Zimbabwe - University of California San Francisco Research Program, Harare, Zimbabwe.

⁷College of Medicine, University of Malawi, Blantyre, Malawi.

⁸Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.

⁹University of North Carolina Project, Kamuzu Central Hospital, Lilongwe, Malawi.

¹⁰National Institutes of Health, Bethesda, MD, USA.

¹¹Centre for the AIDS Program of Research in South Africa, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, South Africa; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.

 

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Use of Injectable Hormonal Contraception & Women's Risk of Herpes Simplex Virus Type 2 Acquisition: A Prospective Study of Couples in Rakai, Uganda

HIV-negative and HSV2-negative women aged 15-49 years whose HIV-negative male partners were concurrently enrolled in a randomised trial of male circumcision in Rakai, Uganda. We excluded women if either they or their male partners HIV seroconverted. The primary outcome was HSV2 seroconversion, assessed annually. The male circumcision trial was registered with ClinicalTrials.gov, number NCT00425984.

:

We noted HSV2 seroconversions in 70 (10%) women. Incidence was 13·5 per 100 person-years in women consistently using depo-medroxyprogesterone acetate (DMPA) (nine incident infections per 66·5 person-years), 4·3 per 100 person-years in pregnant women who were not using hormonal contraception (18 incident infections per 423·5 person-years), and 6·6 per 100 person-years in women who were neither pregnant nor using hormonal contraception (35 incident infections per 529·5 person-years). Women consistently using DMPA had an adjusted hazard ratio for HSV2 seroconversion of 2·26 (95% CI 1·09-4·69; p=0·029) compared with women who were neither pregnant nor using hormonal contraception. Of 132 women with HSV2-seropositive partners, seroconversion was 36·4 per 100 person-years in consistent DMPA users (four incident infections per 11 person-years) and 10·7 per 100 person-years in women who were neither pregnant nor using hormonal contraception (11 incident infections per 103 person-years; adjusted hazard ratio 6·23, 95% CI 1·49-26·3; p=0·012).

Consistent DMPA use might increase risk of HSV2 seroconversion; however, study power was low. These findings should be assessed in larger populations with more frequent follow-up than in this study, and other contraceptive methods should also be assessed. Access to a wide range of highly effective contraceptive methods is needed for women, particularly in sub-Saharan Africa.

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By: Grabowski MK1, Gray RH2, Makumbi F3, Kagaayi J3, Redd AD4, Kigozi G3, Reynolds SJ5, Nalugoda F3, Lutalo T3, Wawer MJ2, Serwadda D6, Quinn TC7,Tobian AA8.

• 1Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
• 2Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Rakai Health Sciences Program, Entebbe, Uganda.
• 3Rakai Health Sciences Program, Entebbe, Uganda.
• 4Division of Intramural Research, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA.
• 5Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Rakai Health Sciences Program, Entebbe, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA.
• 6Rakai Health Sciences Program, Entebbe, Uganda; School of Public Health, Makerere University, Kampala, Uganda.
• 7Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA.
• 8Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Rakai Health Sciences Program, Entebbe, Uganda.