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Randomized Controlled Trial
. 2013 May 1;63(1):86-95.
doi: 10.1097/QAI.0b013e31827ee19c.

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

Kristin M Wall  1 , Bellington Vwalika, Lisa Haddad, Naw H Khu, Cheswa Vwalika, William Kilembe, Elwyn Chomba, Rob Stephenson, David Kleinbaum, Azhar Nizam, Ilene Brill, Amanda Tichacek, Susan Allen
Affiliations
Randomized Controlled Trial

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

Kristin M Wall et al. J Acquir Immune Defic Syndr. .

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 2 video-based interventions.

Methods: "Methods" and "Motivational" messages promoted long-term contraceptive use among 1060 couples with HIV in Lusaka, Zambia.

Results: Among couples not using contraception before randomization (n = 782), the video interventions had no impact on incident pregnancy. Among baseline contraceptive users, viewing the "Methods video" which focused on the intrauterine device and contraceptive implant was associated with a significantly lower pregnancy incidence [hazard ratio (HR) = 0.38; 95% confidence interval (CI): 0.19 to 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 to 0.58) and couples with HIV-positive women (HR = 0.23; 95% CI: 0.09 to 0.55).

Conclusions: The "Methods video" intervention was previously shown to increase uptake of long-acting contraception and to prompt a shift from daily oral contraceptives to quarterly injectables and long-acting methods such as the intrauterine device 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.

Trial registration: ClinicalTrials.gov NCT00067522.

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Conflict of interest statement

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

Figures

Figure 1
Figure 1
Participant flow diagram (adapted from the CONSORT 2010 Flow Diagram)
Figure 2
Figure 2
Product-limit survival estimates among couples in which the woman partner was using a method at baseline
Figure 2
Figure 2
Product-limit survival estimates among couples in which the woman partner was using a method at baseline
See this image and copyright information in PMC

References

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