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Lebetkin E, Steiner MJ, Sonneveldt E, Selim A, Feyisetan B, Ndugga BM, Munthali AW, Malkin M, Jallow F. Couple-Years of Protection Indicator: New Global Guidance for Updating Existing Methods and Adding New Methods. Glob Health Sci Pract 2024; 12:e2300388. [PMID: 38589048 PMCID: PMC11057804 DOI: 10.9745/ghsp-d-23-00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Couple-years of protection (CYP) is an indicator that allows for monitoring and evaluating of family planning (FP) program performance through simple calculations. The CYP for each contraceptive method is calculated by multiplying the number of contraceptive commodity units distributed to clients over a 1-year period by a conversion factor that quantifies the duration of contraceptive protection provided per unit distributed. CYP calculations across methods were previously updated in 2000 and 2011, resulting in changes in methodology, factor inclusion, and specific methods. Since the 2011 update, changes and additions to the modern contraceptive method mix required new CYP conversion factors for 4 methods of contraception: Levoplant implant, progestin-only pills (POPs), Caya diaphragm, and the hormonal intrauterine device. METHODS We conducted literature reviews of both published and gray literature and consulted with experts to identify updated data on continuation rates, duration of efficacy, and method effectiveness for the 4 methods. New CYP conversion factors were calculated for the 4 methods either by using the same calculation used previously for the method considering new data or, for new methods, using calculations for similar methods. RESULTS New CYP conversion factors were assigned to the 4 methods of contraception covered in this update: Levoplant, 2.5 CYP per implant inserted; POPs, 0.0833 CYP per pack (i.e., 12 cycles per CYP); Caya diaphragm, 1 CYP per device, and hormonal intrauterine device, 4.8 CYP per device inserted. CONCLUSIONS CYP is an important indicator for FP programs. As new methods of contraception are developed and new evidence is generated for current methods, the indicator may need to be updated. A standard process for updating and documenting future CYP updates is recommended.
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Affiliation(s)
| | | | | | - Amani Selim
- Public Health Institute Contractors with USAID Global Health Training, Advisory and Support Contract, Washington, DC, USA
| | - Bamikale Feyisetan
- Public Health Institute Contractors with USAID Global Health Training, Advisory and Support Contract, Washington, DC, USA
| | - Baker Maggwa Ndugga
- Public Health Institute Contractors with USAID Global Health Training, Advisory and Support Contract, Washington, DC, USA
| | - A Wezi Munthali
- Public Health Institute Contractors with USAID Global Health Training, Advisory and Support Contract, Washington, DC, USA
| | | | - Fatou Jallow
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Deese J, Chen PL, Gao X, Heffron R, Hobbs M, Lapple D, Jaspan H, Miller A, Nair G, Onono M, Palanee-Phillips T, Reddy K, Steiner MJ. Post-randomization Differences in Condomless Vaginal Sex Among Women Randomized to Intramuscular Depot Medroxyprogesterone Acetate Injections, a Copper Intrauterine Device or a Levonorgestrel Implant in the ECHO Trial. AIDS Behav 2023; 27:978-983. [PMID: 36357806 PMCID: PMC9945058 DOI: 10.1007/s10461-022-03834-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/12/2022]
Abstract
The Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial found no substantial difference in HIV acquisition risk between women randomised to injectable intramuscular depot medroxyprogesterone acetate (DMPA-IM), copper intrauterine device (Cu-IUD) or the levonorgestrel (LNG) implant. We evaluated post-randomization sexual behavior using an objective marker of condomless vaginal sex in a subset of participants. We conducted a sub-study among 458 ECHO participants at three sites (Cape Town, Johannesburg, Kisumu) to evaluate the frequency of condomless vaginal sex, measured by prostate specific antigen (PSA) detection in vaginal swabs, collected at the month 6 and final visit and the concordance of self-reported condomless vaginal sex with PSA detection, by randomized arm. We compared PSA detection frequency and concordance of PSA and self-reported condomless vaginal sex, by randomized group using Cochran-Mantel-Haenszel tests and adjusted generalized logistic growth curve models. PSA was detected less frequently in the DMPA-IM (16%), compared to the Cu-IUD (21%) and LNG implant (24%) groups, although results were not statistically significant in the unadjusted model when accounting for pre-specified multiple-testing criteria. There were significant differences in PSA detection between the DMPA-IM and LNG-implant groups (odds ratio 0.61 (95% CI 0.40, 0.94) in the adjusted model. There was moderate discordance between self-reported condomless vaginal sex and detection of PSA that was similar across randomized groups. These data suggest that women randomized to Cu-IUD and LNG implant may have had condomless sex more frequently than women randomized to DMPA-IM. The discordance between detectable PSA and self-reported sexual behaviour has important implications for design of future HIV prevention studies.
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Affiliation(s)
- Jennifer Deese
- Women's Global Health Imperative, Global Public Health Impact Center, RTI International, Research Triangle Park, USA.
- , Cary, USA.
- FHI 360, Durham, USA.
| | - Pai Lien Chen
- Biostatistics and Data Science, FHI 360, Durham, USA
| | - Xiaoming Gao
- Biostatistics and Data Science, FHI 360, Durham, USA
| | - Renee Heffron
- Department of Global Health and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Marcia Hobbs
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dana Lapple
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Gonasagrie Nair
- Centre for Medical Ethics and Law, Department of Medicine, University of Stellenbosch, Stellenbosch, South Africa
| | | | - Thesla Palanee-Phillips
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Krishnaveni Reddy
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
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Rademacher KH, Sripipatana T, Danna K, Sitrin D, Brunie A, Williams KM, Afolabi K, Rasoanirina F, Ramarao S, Pfitzer A, Cain D, Simon M, Menotti E, Hazelwood A, Nwala AA, Saidu Z, Chowdhury R, Taiwo A, Chidanyika A, Ndirangu G, Steiner MJ, Lepine MC, Homan R, Saad A, Vivalo J, Dorflinger LJ. What Have We Learned? Implementation of a Shared Learning Agenda and Access Strategy for the Hormonal Intrauterine Device. Glob Health Sci Pract 2022; 10:e2100789. [PMID: 36316136 PMCID: PMC9622288 DOI: 10.9745/ghsp-d-21-00789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/23/2022] [Indexed: 09/16/2023]
Abstract
In 2015, a global learning agenda for the hormonal intrauterine device (IUD) was developed with priority research questions regarding use of the method in low- and middle-income countries. In addition, members of the Hormonal IUD Access Group aligned on a strategy to expand access in the context of volunteerism and contraceptive method choice. This article synthesizes evidence generated since then and describes steps taken to address demand- and supply-side barriers to access. Findings demonstrated high continuation rates and satisfaction among hormonal IUD users that are comparable to other long-acting reversible contraceptives (LARCs). Across studies, a sizable number of users reported they would have chosen a short-acting method or no method at all if the hormonal IUD were not an option, which suggests that women did not see the hormonal IUD as interchangeable with other LARC options and thus it may fill an important niche in the market. With several countries now poised to scale up the method, resource mobilization will be key. On the demand side, investments in implementation research will be critical to understanding how best to launch and scale the method, while ensuring the sustainability of multiple quality-assured suppliers with affordable public-sector pricing will be necessary on the supply side.
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Affiliation(s)
| | | | - Kendal Danna
- Population Services International, Washington, DC, USA
| | | | | | | | - Kayode Afolabi
- Formerly of the Reproductive Health Division, Federal Ministry of Health, Abuja, Nigeria
| | | | | | | | - Devon Cain
- Clinton Health Access Initiative, Boston, MA, USA
| | - Morgan Simon
- Global Health Supply Chain Program-Procurement and Supply Management project, Washington, DC, USA
| | - Elaine Menotti
- United States Agency for International Development, Washington, DC, USA
| | - Anna Hazelwood
- Formerly of the Foreign, Commonwealth & Development Office; Now with Clinton Health Access Initiative, Monrovia, Liberia
| | | | - Zainab Saidu
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | - Anne Taiwo
- Marie Stopes International Nigeria, Abuja, Nigeria
| | | | | | | | | | | | - Abdulmumin Saad
- Formerly of United States Agency for International Development; Now with Bill & Melinda Gates Foundation, Washington, DC, USA
| | - John Vivalo
- United States Agency for International Development, Washington, DC, USA
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Deese J, Wang M, Lapple D, Nelson JAE, Kuerten B, Steiner MJ, Chen PL, Hobbs MM. What's Sex Got to Do With It? Understanding Potential Confounding and Exposure Misclassification in Mechanistic Sexually Transmitted Infection Research. J Infect Dis 2021; 224:137-140. [PMID: 33179029 DOI: 10.1093/infdis/jiaa705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/06/2020] [Indexed: 11/13/2022] Open
Abstract
We conducted a prospective study of 13 heterosexual couples to understand the impact of recent condomless vaginal sex on vaginal immune marker measurement and potential exposure misclassification due to the presence of semen. All immune markers were detectable in semen and concentrations of vaginal immune markers varied by sex recency.
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Affiliation(s)
- Jennifer Deese
- Global Public Health Impact Center, RTI International, Research Triangle Park, North Carolina, USA
| | - Meng Wang
- Target PharmaSolutions, Durham, North Carolina, USA
| | - Dana Lapple
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Julie A E Nelson
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Markus J Steiner
- Product Development and Introduction, FHI 360, Durham, North Carolina, USA
| | | | - Marcia M Hobbs
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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5
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Abstract
Low contraceptive knowledge may limit contraception initiation or continuation and, consequently, could represent an important, modifiable cause of unintended pregnancy. The objective of this analysis was to identify correlates of knowledge among women at risk of unintended pregnancy. We analyzed data from a study of 222 young women attending a public clinic in Kingston in November 2018 to March 2019. We measured contraceptive knowledge with seven questions on method reversibility, ability to use covertly, contraindications, and side effects. We used multivariable linear regression to evaluate the correlates of summary knowledge scores and report beta coefficients, which represent differences in mean summary knowledge scores. The mean knowledge score was low (2.7; range = 0-7). Only 30.2% of the participants correctly identified intrauterine devices as more effective than oral contraception, male condoms, and withdrawal. Women who reported that their provider discussed contraception scored higher (adjusted ß = 0.37, p = 0.05) than those not reporting this. Women who perceived implants as very/mostly safe scored higher (adjusted ß = 0.45, p = 0.01) than those perceiving the device as mostly/very unsafe. Finally, compared to contraception non-users, women using less-effective contraception had a lower score (adjusted ß = -0.40, p = 0.04) while those using effective contraception did not differ in scores (ß = -0.30, p = 0.18). Overall, we found poor contraceptive knowledge among young women in Kingston. Providers appeared to hold an important role in women's understanding of contraception.
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Affiliation(s)
- Tina Hylton-Kong
- Jamaica Ministry of Health, Epidemiology Research and Training Unit (ERTU), Kingston, Jamaica
| | - Althea Bailey
- Department of Community Health and Psychiatry, The University of the West Indies at Mona, Mona, Jamaica
| | - Markus J Steiner
- Contraceptive Technology Innovation Division, FHI 360, Durham, North Carolina, USA
| | - Maria F Gallo
- College of Public Health, Division of Epidemiology, The Ohio State University, Columbus, Ohio, USA
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Hylton-Kong T, Steiner MJ, Bailey A, Palazzi M, Gallo MF. Debunking myths about contraceptive safety among women in Kingston, Jamaica: Pilot randomized controlled trial. Contraception 2021; 103:356-360. [PMID: 33428906 DOI: 10.1016/j.contraception.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES (1) To create a short motion graphic video to debias women, using evidence from cognitive psychology, of 2 common myths about safety of intrauterine devices (IUDs) and implants in Jamaica; and (2) to conduct a pilot study to evaluate video effectiveness. STUDY DESIGN We conducted a series of 3 focus group discussions among target users to inform the development process of the script, story, character, and look of the intervention video. We randomized young, female nonusers of long-acting contraception at risk of pregnancy at a public clinic in Kingston in 2018-2019 to watch either the intervention (n = 113) or control video (n = 112). We used logistical regression to evaluate perceptions of method safety, naturalness, and uptake after 3 months of follow up. RESULTS Almost all (n = 220; 97.8%) participants completed the 3-month interview. More women in the intervention arm perceived IUDs to be safe (59.1%) compared to the control arm (43.6%; p = 0.02). Perceived implant safety increased from enrollment to follow up in the intervention and control arms (10.9 and 2.7 percentage-point increases, respectively); however, the difference between arms at follow up was not statistically significant (p = 0.57). This appeared to be due to arm imbalances at enrollment. Study arms did not differ at follow up in perceived IUD naturalness (p = 0.36) or implant naturalness (p = 0.68). CONCLUSIONS Findings from a pilot study of a video intervention suggest that using debiasing strategies from cognitive psychology has the potential to address misconceptions about contraceptive safety. A larger trial with adequate power is warranted. IMPLICATIONS Evidence from a pilot randomized controlled trial suggested that use of debiasing strategies from cognitive psychology could be effective in correcting women's misconceptions about contraception safety and thus show promise for the design of future contraceptive promotion videos to increase uptake.
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Affiliation(s)
- Tina Hylton-Kong
- Epidemiology Research and Training Unit (ERTU), Kingston, Jamaica; The University of the West Indies at Mona, Department of Community Health and Psychiatry, Mona, Jamaica
| | - Markus J Steiner
- FHI 360, Product Development and Introduction Division, Durham, NC, United States
| | - Althea Bailey
- The University of the West Indies at Mona, Department of Community Health and Psychiatry, Mona, Jamaica
| | - Maria Palazzi
- The Ohio State University (OSU), College of Arts and Sciences, Department of Design, Columbus, OH, United States
| | - Maria F Gallo
- OSU, College of Public Health, Division of Epidemiology, Columbus, OH, United States.
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Fuchs R, Taylor D, Jenkins DW, Brache V, Luo D, Dorflinger LJ, Steiner MJ. Levonorgestrel release rates measured through analysis of two-rod contraceptive explants. Contracept X 2020; 2:100039. [PMID: 32995746 PMCID: PMC7509190 DOI: 10.1016/j.conx.2020.100039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/15/2022] Open
Abstract
Objective The objective was to characterize and compare in vivo rates of levonorgestrel (LNG) release from Sino-implant (II) and Jadelle® contraceptive implants. Study design 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. Results 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). Conclusions 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. Implications 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.
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Affiliation(s)
- Rachael Fuchs
- FHI 360, 359 Blackwell St. Suite 200, Durham, NC 27701, USA
| | - Douglas Taylor
- FHI 360, 359 Blackwell St. Suite 200, Durham, NC 27701, USA
| | | | - Vivian Brache
- Asociación Dominicana Pro Bienestar de la Familia, Inc. (PROFAMILIA), Santo Domingo, Dominican Republic
| | - Diane Luo
- FHI 360, 359 Blackwell St. Suite 200, Durham, NC 27701, USA
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Nanda K, Lebetkin E, Steiner MJ, Yacobson I, Dorflinger LJ. Contraception in the Era of COVID-19. Glob Health Sci Pract 2020; 8:166-168. [PMID: 32312738 PMCID: PMC7326510 DOI: 10.9745/ghsp-d-20-00119] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/03/2020] [Indexed: 11/15/2022]
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Meyer BD, Wang R, Steiner MJ, Preisser JS. The Effect of Physician Oral Health Services on Dental Use and Expenditures under General Anesthesia. JDR Clin Trans Res 2019; 5:146-155. [PMID: 31434532 DOI: 10.1177/2380084419870128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite early evidence touting the effectiveness of physician-provided oral health services (POHS), recent evidence suggests these services might have little impact on caries-related outcomes in children. General anesthesia (GA) is often used to treat early childhood caries and may be considered the most extreme utilization outcome. We sought to assess the impact of POHS utilization on dental GA utilization and expenditures. METHODS We used the Medicaid claims of a birth cohort of children born in 2008 in North Carolina (N = 32,558) to determine the impact of POHS on dental utilization and expenditures under GA for individual children. Children were followed until their eighth birthday. We analyzed the association of the number of prior POHS visits with visit-specific outcomes of dental treatment under GA using population-averaged models fit with generalized estimating equations with exchangeable working correlation structure. RESULTS Children with 2 or more previous POHS visits had reduced odds of GA (odds ratio [OR] = 0.93; confidence interval [CI], 0.87-0.99; P = 0.029) and expenditures ($114; CI,-$152.61 to -$75.19; P < 0.001) compared to those without physician-provided oral health visits, adjusting for age, sex, race/ethnicity, and geographic residence. Dental expenditures did not differ between POHS and non-POHS subjects at non-GA visits. CONCLUSIONS POHS decreased the odds of having dental GA treatment and dental expenditures at GA visits. The role of physicians in oral health care can reduce the impact on the most severe outcome-treatment under general anesthesia. KNOWLEDGE TRANSFER STATEMENT The results of this study have important financial implications for state Medicaid programs and disease management programs trying to mitigate the costs of treating early childhood caries under general anesthesia. Children who receive physician oral health care are less likely to use and more likely to save money on general anesthesia to complete dental treatment.
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Affiliation(s)
- B D Meyer
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R Wang
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M J Steiner
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lebetkin E, Gao X, Taylor D, Maldonado LY, Saad A, Steiner MJ, Dorflinger LJ, Nanda K, Mastro TD. Planning for Outcomes (P 4O) Modeling Tool: Estimating the Impact of Changing the Proportion of Injectable Progestins in the Contraceptive Method Mix. Glob Health Sci Pract 2019; 7:317-328. [PMID: 31189699 PMCID: PMC6641814 DOI: 10.9745/ghsp-d-19-00062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/07/2019] [Indexed: 12/20/2022]
Abstract
The interactive deterministic online modeling tool P4O allows users to estimate how changing the proportion of injectable progestins in the contraceptive method mix might affect HIV and maternal and child health outcomes. With careful consideration for women's individual choices, policy makers and program planners may use country-specific results to help inform programming and policy decisions. Background: Observational studies raise concern about a potential link between injectable progestin contraceptive use and HIV acquisition risk. This possible link is particularly relevant in sub-Saharan Africa where HIV risk is high and the method mix is skewed toward injectables. We developed the Planning for Outcomes (P4O) model (https://planning4outcomes.ctiexchange.org/) to predict changes in maternal and child health (MCH) and HIV outcomes that could occur if the proportion of injectables in the method mix is changed. Methods: P4O incorporates evidence-based assumptions to predict yearly changes in unintended pregnancies, morbidity/mortality, HIV infections (women and infants), and anticipated health care costs associated with changing the proportions of injectable users in 22 selected countries. Users of this model designate all countries or a subset and adjust inputs including percentage of injectable users who discontinue, percentage of discontinuers who begin use of an alternative method, hazard ratio for HIV infection with injectable use, method mix used by injectable discontinuers, annual probabilities of method-specific pregnancy and mother-to-child transmission of HIV, condom effectiveness against HIV, risk of HIV during pregnancy, and HIV incidence among women of reproductive age. Results: Illustrative results from all sub-Saharan African countries combined and from selected countries demonstrate the potential of P4O to inform program planning and procurement decisions. In countries with high use of long-acting reversible contraception, the removal of injectables from the method mix is associated with improvement in MCH and HIV indicators if most injectable users switch to more effective methods (e.g., implants). In countries with high use of short-acting methods (e.g., condoms), the model predicts mostly negative MCH outcomes. Conclusions: Policy makers and program planners may use P4O to inform programming and policy decisions. In all scenarios, programmatic preparation to accommodate changes to the contraceptive method mix, considerations of how the individual desires of women will be addressed, and potential burden of anticipated MCH-related costs warrant advanced consideration.
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Affiliation(s)
| | | | | | | | - Abdulmumin Saad
- United States Agency for International Development, Washington, DC, USA
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Steiner MJ, Brache V, Taylor D, Callahan R, Halpern V, Jorge A, Wevill S, Sergison J, Venkatasubramanian L, Dorflinger L. Randomized trial to evaluate contraceptive efficacy, safety and acceptability of a two-rod contraceptive implant over 4 years in the Dominican Republic. Contracept X 2019; 1:100006. [PMID: 32494772 PMCID: PMC7252426 DOI: 10.1016/j.conx.2019.100006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 11/26/2022] Open
Abstract
Objective Sino-implant (II) is a contraceptive implant that had a commodity price one-third of the competing products a decade ago. To make Sino-implant (II) more widely available, we conducted a trial to collect safety and efficacy data required for World Health Organization (WHO) prequalification, a quality standard allowing global donors to procure a pharmaceutical product. Study design This was a randomized controlled trial allocating 650 participants to either Sino-implant (II) or Jadelle®. Participants were seen at 1 and 6 months, and then semiannually. The primary efficacy measure was the pregnancy Pearl Index [number of pregnancies per 100 women-years (WY) of follow-up] in the Sino-implant (II) group during up to 4 years of implant use. Results For the primary outcome, Sino-implant (II) had a 4-year Pearl Index of 0.74 (95% confidence interval, 0.36-1.37) compared to 0.00 (95% confidence interval, 0.00-1.04) for Jadelle®. The Sino-implant (II) pregnancy rate was significantly higher in the fourth year (3.54 per 100 WY) than in the first 3 years combined (0.18 per 100 WY; p <.001). Total levonorgestrel concentrations were equivalent between groups at month 12, but were 19%, 22% and 32% lower in the Sino-implant (II) group at months 24, 36 and 48, respectively (p <.001 at each time point). Safety and acceptability of the two products were similar, while providers documented significantly higher breakage rates during removal of Sino-implant (II) (16.3% vs. 3.1%; p <.001). Conclusion Based on these results, WHO prequalified Sino-Implant (II) with a 3-year use label in June 2017, 2 years shorter than the 5-year duration of Jadelle®. Implications WHO prequalification allows global donors to procure Sino-implant (II), which means women in many low resource countries will have greater access to highly effective and acceptable contraceptive implants. Our study noted important clinical differences, including shorter duration of high effectiveness with Sino-implant (II) when compared to the other available two-rod system, Jadelle®. Introduction strategies should include appropriate training on these differences.
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Affiliation(s)
- M J Steiner
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - V Brache
- Asociación Dominicana Pro Bienestar de la Familia, Inc. (PROFAMILIA), Santo Domingo, Dominican Republic
| | - D Taylor
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - R Callahan
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - V Halpern
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - A Jorge
- Asociación Dominicana Pro Bienestar de la Familia, Inc. (PROFAMILIA), Santo Domingo, Dominican Republic
| | - S Wevill
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - J Sergison
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - L Venkatasubramanian
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - L Dorflinger
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
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Gallo MF, Nguyen N, Nguyen C, Steiner MJ. Knowledge of contraceptive effectiveness and method use among women in Hanoi, Vietnam. Contracept X 2019; 1:100009. [PMID: 32494774 PMCID: PMC7252424 DOI: 10.1016/j.conx.2019.100009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 12/15/2022] Open
Abstract
Objective To evaluate the association between contraceptive knowledge and type of method used. Methods We analyzed data from a cross-sectional study of sexually active women in Hanoi, Vietnam, not desiring pregnancy. We used linear and logistic regression to evaluate contraceptive knowledge of users of the intrauterine device (IUD), combination oral contraception (COC) and male condoms. We measured contraceptive knowledge with seven questions on relative effectiveness of methods, reversibility, covert use, contraindications and side effects. Results Respondents used IUD (n = 128), COC (n = 126) or condoms (n = 167). Summary knowledge scores did not differ by current type of method used. Only one knowledge domain, contraceptive effectiveness, varied by method. Compared to condom users, IUD users had higher odds of correctly identifying the IUD as more effective than COC, condoms and withdrawal (adjusted odds ratio [aOR], 4.8; 95% confidence interval [CI], 2.7–8.3). Higher proportions of condom users (49.7%) mistakenly identified condoms as the most effective of listed methods compared to IUD (20.3%) and COC users (23.0%). On the other hand, IUD and COC users had lower odds (aOR, 0.5; 95% CI, 0.2–1.0 and aOR, 0.3; 95% CI, 0.1–0.6, respectively) of identifying consistent condom use as better for pregnancy prevention than other practices (e.g., withdrawal and postcoital douching). Conclusions IUD users more often recognized that the IUD is highly effective while condom users appeared to overestimate condom effectiveness. Contraceptive counseling should ensure that women understand the relative effectiveness of methods. We found no evidence that other types of contraceptive knowledge differed by type of method used. Implications Knowledge of contraceptive effectiveness was the sole difference detected in contraceptive knowledge between women in Hanoi, Vietnam, using the IUD, COC or male condoms.
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Affiliation(s)
- Maria F Gallo
- The Ohio State University, College of Public Health, Division of Epidemiology, Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Nghia Nguyen
- Department of Obstetrics and Gynecology, Vinmec International Hospital, 458 Minh Khai, Hanoi, Vietnam
| | - Chuong Nguyen
- Department of Research and Training, Hanoi Obstetrics and Gynecology Hospital, La Thanh Road, Hanoi, Vietnam
| | - Markus J Steiner
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
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Che Y, Taylor D, Luo D, Maldonado LY, Wang M, Wevill S, Vahdat H, Han X, Halpern V, Dorflinger L, Steiner MJ. Cohort study to evaluate efficacy, safety and acceptability of a two-rod contraceptive implant during third, fourth and fifth year of product use in China. Contracept X 2019; 1:100008. [PMID: 32494773 PMCID: PMC7252427 DOI: 10.1016/j.conx.2019.100008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 11/26/2022] Open
Abstract
Objective Sino-implant (II) is a contraceptive implant approved for 4 years of use in China. We evaluated the contraceptive efficacy during the third, fourth and fifth year, and assessed additional pharmacokinetics (PK), safety, and acceptability endpoints. Study design We enrolled a cohort of 255 current Sino-Implant (II) users entering their third year and a second cohort of 243 users entering their fourth year. We followed these two cohorts for 12 and 24 months, respectively. To characterize PK endpoints (i.e. levonorgestrel (LNG), sex hormone binding globulin and free LNG index) over 5 years, we collected blood samples in a subset of 50 participants we followed during the third, fourth and fifth year. We also enrolled small cohorts (n = 20) of Sino-implant (II) users entering their sixth month and second year and followed them each for up to 6 months. Our primary efficacy measures were the pregnancy Pearl Indices during Year 3 and 4. Secondary objectives included assessments of PK, safety, acceptability and efficacy in the fifth year. Results We recorded four pregnancies, with a higher pregnancy rate during Year 3 [1.34 (95% CI: 0.28–3.93)] than Year 4 [0.44 (95% CI: 0.01–2.47)] or Year 5 [0.00 (95% CI: 0.00–2.02)]. The overall pregnancy rate for the third, fourth and fifth years of product use was 0.63 per 100 WY; 95% CI: (0.17–1.62). Mean LNG concentrations remained well above 200 pg/mL (Year 3 = 280.9; Year 4 = 233.6; Year 5 = 270.6). Most participants (93.7%) described their bleeding pattern as acceptable. Conclusion Sino-implant (II) is a highly effective contraceptive method in this population of Chinese women over 5 years. Implications Sino-implant (II) is a highly effective contraceptive method with an estimated Pearl Index of less than 1% over the third, fourth and fifth years of use in a population of Chinese women of reproductive age.
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Affiliation(s)
- Y Che
- Key Laboratory of Reproduction Regulation of NPFPC (SIPPR, IRD, Fudan University), Shanghai 200032, China
| | - D Taylor
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - D Luo
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - L Y Maldonado
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - M Wang
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - S Wevill
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - H Vahdat
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - X Han
- Henan Provincial Research Institute for Population and Family Planning, Henan, 450002, China
| | - V Halpern
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - L Dorflinger
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
| | - M J Steiner
- Contraceptive Technology Innovation Division, FHI 360, 359 Blackwell Street, Durham, NC 27701, USA
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Gallo MF, Legardy-Williams J, Steiner MJ, Macaluso M, Carter M, Hobbs MM, Hylton-Kong T, Anderson C, Costenbader E, Warner L. Sexual Relationship Power and Semen Exposure Among Female Patients at a Sexually Transmitted Infection Clinic in Kingston, Jamaica. Arch Sex Behav 2017; 46:2157-2164. [PMID: 27305908 PMCID: PMC5500443 DOI: 10.1007/s10508-016-0771-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/05/2016] [Accepted: 05/10/2016] [Indexed: 06/06/2023]
Abstract
Women's power in sexual relationships is thought to be an important predictor of condom use. However, research on correlates of condom use often relies on participant reporting of behavior, which has questionable validity. We evaluated the association between scores from the modified Sexual Relationship Power Scale (SRPS-M) and biological detection of semen exposure in a prospective study of adult women attending a sexually transmitted infection clinic in Kingston, Jamaica with cervicitis or abnormal vaginal discharge in 2010-2011. At enrollment, women were counseled to avoid sex while on treatment and were asked to return in 6 days for a follow-up visit. At both study visits, women were administered a questionnaire and had vaginal swabs collected to test for prostate-specific antigen (PSA), a biological marker of recent semen exposure. We found no significant association at enrollment or follow-up between SRPS-M scores and semen exposure, as measured with either self-reported data or PSA positivity. Semen biomarkers could be used to develop and validate new scales on relationship power and self-efficacy related to condom use.
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Affiliation(s)
- Maria F Gallo
- Division of Epidemiology, College of Public Health, The Ohio State University, 324 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210-1351, USA.
| | - Jennifer Legardy-Williams
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mail Stop K-34, Atlanta, GA, 30341-3724, USA
| | - Markus J Steiner
- Clinical Sciences Division, FHI 360, 2224 E NC Hwy 54, Durham, NC, 27713, USA
| | - Maurizio Macaluso
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, MLC 5041, 3333 Burnet Ave, Cincinnati, OH, 45229-3039, USA
| | - Marion Carter
- Health Services Research and Evaluation Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marcia M Hobbs
- Department of Medicine, University of North Carolina at Chapel Hill, CB #7031, 8317 MBRB, Chapel Hill, NC, 27599, USA
| | - Tina Hylton-Kong
- Comprehensive Health Centre/Epidemiology Research and Training Unit, Jamaica Ministry of Health, 55 Slipe Pen Rd, Kingston, Jamaica
| | - Clive Anderson
- Comprehensive Health Centre/Epidemiology Research and Training Unit, Jamaica Ministry of Health, 55 Slipe Pen Rd, Kingston, Jamaica
| | | | - Lee Warner
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mail Stop K-34, Atlanta, GA, 30341-3724, USA
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Sergison JE, Stalter RM, Callahan RL, Rademacher KH, Steiner MJ. Cost of Contraceptive Implant Removal Services Must Be Considered When Responding to the Growing Demand for Removals. Glob Health Sci Pract 2017; 5:330-332. [PMID: 28655806 PMCID: PMC5487094 DOI: 10.9745/ghsp-d-17-00100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/26/2017] [Indexed: 11/29/2022]
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Rademacher KH, Solomon M, Brett T, Bratt JH, Pascual C, Njunguru J, Steiner MJ. Expanding Access to a New, More Affordable Levonorgestrel Intrauterine System in Kenya: Service Delivery Costs Compared With Other Contraceptive Methods and Perspectives of Key Opinion Leaders. Glob Health Sci Pract 2016; 4 Suppl 2:S83-93. [PMID: 27540128 PMCID: PMC4990165 DOI: 10.9745/ghsp-d-15-00327] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/11/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The levonorgestrel intrauterine system (LNG IUS) is one of the most effective forms of contraception and offers important non-contraceptive health benefits. However, it is not widely available in developing countries, largely due to the high price of existing products. Medicines360 plans to introduce its new, more affordable LNG IUS in Kenya. The public-sector transfer price will vary by volume between US$12 to US$16 per unit; for an order of 100,000 units, the public-sector transfer price will be approximately US$15 per unit. METHODS We calculated the direct service delivery cost per couple-years of protection (CYP) of various family planning methods. The model includes the costs of contraceptive commodities, consumable supplies, instruments per client visit, and direct labor for counseling, insertion, removal, and resupply, if required. The model does not include costs of demand creation or training. We conducted interviews with key opinion leaders in Kenya to identify considerations for scale-up of a new LNG IUS, including strategies to overcome barriers that have contributed to low uptake of the copper intrauterine device. RESULTS The direct service delivery cost of Medicines360's LNG IUS per CYP compares favorably with other contraceptive methods commonly procured for public-sector distribution in Kenya. The cost is slightly lower than that of the 3-month contraceptive injectable, which is currently the most popular method in Kenya. Almost all key opinion leaders agreed that introducing a more affordable LNG IUS could increase demand and uptake of the method. They thought that women seeking the product's non-contraceptive health benefits would be a key market segment, and most agreed that the reduced menstrual bleeding associated with the method would likely be viewed as an advantage. The key opinion leaders indicated that myths and misconceptions among providers and clients about IUDs must be addressed, and that demand creation and provider training should be prioritized. CONCLUSION Introducing a new, more affordable LNG IUS product could help expand choice for women in Kenya and increase use of long-acting reversible contraception. Further evaluation is needed to identify the full costs required for introduction-including the cost of demand creation-as well as research among potential and actual LNG IUS users, their partners, and health care providers to help inform scale-up of the method.
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Callahan RL, Taylor D, Jenkins DW, Owen DH, Cheng L, Cancel AM, Dorflinger LJ, Steiner MJ. In vivo release of levonorgestrel from Sino-implant (II) — an innovative comparison of explant data. Contraception 2015; 92:350-5. [PMID: 26142619 DOI: 10.1016/j.contraception.2015.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Measuring the amount of progestin remaining in contraceptive implants used for different lengths of time provides useful information on in vivo release kinetics including change over time. We compared estimated in vivo levonorgestrel (LNG) release rates derived from Sino-implant (II) explants with similar data from removed Jadelle. STUDY DESIGN We measured LNG remaining in 44 sets of Sino-implant (II) used for up to 7 years and removed in four Chinese clinics. Results were compared with published data for Jadelle explants used for up to 36 months. We estimated and compared monthly and daily LNG release rates for the two products using prediction models for drug release. We also estimated the dissolution profile similarity factor, f2, for LNG release. RESULTS Both Sino-implant (II) and Jadelle release approximately 30% of total LNG load after 3 years. Results of fitting the data to a biologically plausible modified Higuchi prediction model indicate comparable release through 3 years. An estimated similarity factor of 80.6 (90% confidence interval: 70.8-85.7) indicates similarity in the dissolution profiles of the two implants. CONCLUSIONS LNG release in vivo measured through explant analysis suggest that Sino-implant (II) and Jadelle may perform similarly through 3 years of use and could remain highly effective beyond this time point. These results align with published data for Jadelle and Sino-implant (II) showing high effectiveness for 5 years. Ongoing clinical studies comparing the products over 5 years present an opportunity to verify this supportive measure of clinical effectiveness. IMPLICATIONS This innovative approach provides evidence that Sino-implant (II) may perform clinically similarly to Jadelle over 3 years and remain a highly effective contraceptive beyond this time point. Data from explant analyses show promise for investigating the equivalence of elusion profiles of contraceptive implants.
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Affiliation(s)
| | | | | | | | - Linan Cheng
- Shanghai Institute of Planned Parenthood Research (SIPPR), Shanghai, China
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Cheng L, Steiner MJ, Meng H, Luo D, Zhong Y, Cheng Y, Chen G, Ni H, Feldblum PJ. Implant removal experience with Sino-implant (II) at four Chinese sites. Contraception 2014; 90:249-52. [PMID: 24965314 DOI: 10.1016/j.contraception.2014.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/07/2014] [Accepted: 05/13/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Complications during contraceptive implant removal are important for users and programs. We describe breakage rates during Sino-implant (II) removals at four Chinese family planning clinics. STUDY DESIGN We collected data by observation of consecutive removal cases and subsequent data transcription onto a standardized case report form. Three sites used the "pull out" removal technique, and one site used the "U" technique. RESULTS Sino-implant (II) rods were removed from 318 women. There were 16 implant breaks (5.0%), with the breakage rate varying by site from 0% to 7.4%. All 16 breaks occurred at the three sites that used the standard "pull out" technique. Six implants were cut by the scalpel, five were snapped by the clamp, and five were unspecified. Other contributing factors included deeper or wider positioning of the implants (n=6) and implants that were enveloped by thick fibrous tissue (n=3). There was no relationship between breakage rate and duration of implant use. Less than 1% of removals took more than 10 min. CONCLUSIONS Both the standard "pull out" technique as well as the "U" technique can be used to remove Sino-implant (II). Breakage during implant removal may not be problematic if all fragments of the rod are readily removable. Breakage occurs with predictable low frequency, and training is needed to assure that providers can deal with breakage events. IMPLICATIONS Contraceptive implant removal complications are important for users and programs. These are some of the first data on breakage during removal of Sino-implant (II). More than one removal technique can be used, but training is required to ensure that providers can deal with the infrequent implant breaks.
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Affiliation(s)
- Linan Cheng
- Shanghai Institute of Planned Parenthood Research (SIPPR); Shanghai, China
| | | | | | | | - Yi Zhong
- Obs/Gyn Hospital of Fudan University
| | - Ying Cheng
- Shanghai International Peace Maternity and Child Health Hospital
| | - Guohu Chen
- Zhejiang Province, Reian City Family Planning Technical Instruction Clinic
| | - Hong Ni
- Zhejiang Province, Tongxiang City Family Planning Technical Instruction Clinic
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Abstract
BACKGROUND Dual-method contraception refers to using condoms as well as another modern method of contraception. The latter (usually non-barrier) method is commonly hormonal (e.g., oral contraceptives) or a non-hormonal intrauterine device. Use of two methods can better prevent pregnancy and the transmission of HIV and other sexually transmitted infections (STIs) compared to single-method use. Unprotected sex increases risk for disease, disability, and mortality in many areas due to the prevalence and incidence of HIV/STI. Millions of women, especially in lower-resource areas, also have an unmet need for protection against unintended pregnancy. OBJECTIVES We examined comparative studies of behavioral interventions for improving use of dual methods of contraception. Dual-method use refers to using condoms as well as another modern contraceptive method. Our intent was to identify effective interventions for preventing pregnancy as well as HIV/STI transmission. SEARCH METHODS Through January 2014, we searched MEDLINE, CENTRAL, POPLINE, EMBASE, COPAC, and Open Grey. In addition, we searched ClinicalTrials.gov and ICTRP for current trials and trials with relevant data or reports. We examined reference lists of pertinent papers, including review articles, for additional reports. SELECTION CRITERIA Studies could be either randomized or non-randomized. They examined a behavioral intervention with an educational or counseling component to encourage or improve the use of dual methods, i.e., condoms and another modern contraceptive. The intervention had to address preventing pregnancy as well as the transmission of HIV/STI. The program or service could be targeted to individuals, couples, or communities. The comparison condition could be another behavioral intervention to improve contraceptive use, usual care, other health education, or no intervention.Studies had to report use of dual methods, i.e., condoms plus another modern contraceptive method. We focused on the investigator's assessment of consistent dual-method use or use at last sex. Outcomes had to be measured at least three months after the behavioral intervention began. DATA COLLECTION AND ANALYSIS Two authors evaluated abstracts for eligibility and extracted data from included studies. For the dichotomous outcomes, the Mantel-Haenszel odds ratio (OR) with 95% CI was calculated using a fixed-effect model. Where studies used adjusted analysis, we presented the results as reported by the investigators. No meta-analysis was conducted due to differences in interventions and outcome measures. MAIN RESULTS We identified four studies that met the inclusion criteria: three randomized controlled trials and a pilot study for one of the included trials. The interventions differed markedly: computer-delivered, individually tailored sessions; phone counseling added to clinic counseling; and case management plus a peer-leadership program. The latter study, which addressed multiple risks, showed an effect on contraceptive use. Compared to the control group, the intervention group was more likely to report consistent dual-method use, i.e., oral contraceptives and condoms. The reported relative risk was 1.58 at 12 months (95% CI 1.03 to 2.43) and 1.36 at 24 months (95% CI 1.01 to 1.85). The related pilot study showed more reporting of consistent dual-method use for the intervention group compared to the control group (reported P value = 0.06); the investigators used a higher alpha (P < 0.10) for this pilot study. The other two trials did not show any significant difference between the study groups in reported dual-method use or in test results for pregnancy or STIs at 12 or 24 months. AUTHORS' CONCLUSIONS We found few behavioral interventions for improving dual-method contraceptive use and little evidence of effectiveness. A multifaceted program showed some effect but only had self-reported outcomes. Two trials were more applicable to clinical settings and had objective outcomes measures, but neither showed any effect. The included studies had adequate information on intervention fidelity and sufficient follow-up periods for change to occur. However, the overall quality of evidence was considered low. Two trials had design limitations and two had high losses to follow up, as often occurs in contraceptive trials. Good quality studies are still needed of carefully designed and implemented programs or services.
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Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Laurie L Stockton
- FHI 360Health Services Research359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Mario Chen
- FHI 360Division of Biostatistics359 Blackwell St, Suite 200Durham, NCNorth CarolinaUSA27709
| | - Markus J Steiner
- FHI 360Contraceptive Innovation Initiative Dept359 Blackwell StreetDurhamNorth CarolinaUSA27701
| | - Maria F Gallo
- The Ohio State UniversityDivision of EpidemiologyRoom 324 Cunz Hall1841 Neil AvenueColumbusOhioUSA43210‐1351
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Lopez LM, Chen M, Steiner MJ, Gallo MF. Behavioral interventions for improving dual-method contraceptive use. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd010915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Owen DH, Jenkins D, Cancel A, Carter E, Dorflinger L, Spieler J, Steiner MJ. Development and implementation of a quality assurance program for a hormonal contraceptive implant. Contraception 2013; 87:473-9. [DOI: 10.1016/j.contraception.2012.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 07/11/2012] [Accepted: 07/16/2012] [Indexed: 10/28/2022]
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Anderson C, Gallo MF, Hylton-Kong T, Steiner MJ, Hobbs MM, Macaluso M, Figueroa JP, Jamieson DJ, Legardy-Williams J, Wiener J, Warner L. Randomized controlled trial on the effectiveness of counseling messages for avoiding unprotected sexual intercourse during sexually transmitted infection and reproductive tract infection treatment among female sexually transmitted infection clinic patients. Sex Transm Dis 2013; 40:105-10. [PMID: 23321990 PMCID: PMC3811001 DOI: 10.1097/olq.0b013e31827938a1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effectiveness of counseling messages to avoid unprotected sex during short-term treatment for curable sexually transmitted infections is unknown. METHODS We randomized 300 female STI clinic patients 18 years or older with cervicitis and/or vaginal discharge in Kingston, Jamaica, in 2010 to 2011, to 1 of 2 counseling messages for their course of syndromic treatment: abstinence only or abstinence backed up by condom use. At a follow-up visit 6 days afterward, we collected vaginal swabs to test for prostate-specific antigen (PSA), a biological marker of recent semen exposure, and administered a questionnaire assessing sexual behavior. RESULTS No differences were found in the proportions of women testing positive for PSA at follow-up in the abstinence-plus-condom group (11.9%) and abstinence-only group (8.4%) (risk difference, 3.5; 95% confidence interval, -3.5 to 10.5). There also was no significant difference in reporting of unprotected sex between groups. Reporting a history of condom use before enrollment significantly modified the effect of counseling arm on PSA positivity (P = 0.03). Among those reporting recent condom use, 10.3% in the abstinence-only arm and 4.8% in the abstinence-plus-condom arm tested positive for PSA. Conversely, among those not reporting recent condom use, 6.5% in the abstinence-only arm and 17.3% in the abstinence-plus-condom arm had PSA detected. CONCLUSIONS We found no evidence to support the superiority of either counseling message. Post hoc analyses suggest that women with recent condom experience may benefit significantly more from abstinence-plus-condom messages, whereas women without such experience may benefit significantly more from abstinence-only messages. Providers should weigh individual condom use history when determining the most appropriate counseling message.
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Affiliation(s)
- Clive Anderson
- Comprehensive Health Centre/Epidemiology Research and Training Unit, Jamaica Ministry of Health, Kingston, Jamaica
| | - Maria F. Gallo
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tina Hylton-Kong
- Comprehensive Health Centre/Epidemiology Research and Training Unit, Jamaica Ministry of Health, Kingston, Jamaica
| | | | - Marcia M. Hobbs
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Maurizio Macaluso
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, MLC, Cincinnati, OH
| | - J. Peter Figueroa
- Department of Community Health and Psychiatry, University of West Indies, Mona, Kingston, Jamaica
| | - Denise J. Jamieson
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Jeffrey Wiener
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lee Warner
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
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Carter MW, Bailey A, Snead MC, Costenbader E, Townsend M, Macaluso M, Jamieson DJ, Hylton-Kong T, Warner L, Steiner MJ. Exploring discordance between biologic and self-reported measures of semen exposure: a qualitative study among female patients attending an STI clinic in Jamaica. AIDS Behav 2013; 17:728-36. [PMID: 22893195 PMCID: PMC4544859 DOI: 10.1007/s10461-012-0286-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We explored the use of qualitative interviews to discuss discrepancies between two sources of information on unprotected sex: biomarker results and self-reported survey data. The study context was a randomized trial in Kingston, Jamaica examining the effect of STI counseling messages on recent sexual behavior using prostate-specific antigen (PSA) as the primary study outcome. Twenty women were interviewed. Eleven participants were selected because they tested positive for PSA indicating recent semen exposure, yet reported no unprotected sex in a quantitative survey ("discordant"): 5 reported abstinence and 6 reported condom use. Nine participants who also tested positive for PSA but reported unprotected sex in the survey were interviewed for comparison ("concordant"). Qualitative interviews with 6 of the 11 discordant participants provided possible explanations for their PSA test results, and 5 of those were prompted by direct discussion of those results. Rapid PSA testing combined with qualitative interviews provides a novel tool for investigating and complementing self-reported sexual behavior.
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Affiliation(s)
- Marion W Carter
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Weaver MA, Joanis C, Toroitich-Ruto C, Parker W, Gyamenah NA, Rinaldi A, Omungo Z, Steiner MJ. The effects of condom choice on self-reported condom use among men in Ghana, Kenya and South Africa: a randomized trial. Contraception 2011; 84:291-8. [PMID: 21843696 DOI: 10.1016/j.contraception.2011.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Male condoms are readily available and affordable in many settings, but risky sexual acts still go unprotected. STUDY DESIGN This unblinded randomized trial, conducted in Ghana, Kenya and South Africa, was designed to assess the impact of providing a choice of condoms on self-reported use and uptake over 6 months. RESULTS We enrolled 1,274 men. The mean subject-specific proportion of protected acts with all partners increased from baseline to 6 months by 0.07 in the control group compared to 0.03 in the choice group (p=.025). The observed results were largely consistent across all three countries. In the choice group, men clearly preferred one condom type over the others, and this preference was consistent across all three countries. CONCLUSIONS Providing one type of male condom in public sector programs appears justified. Programs should not focus on the number of brands available, but should encourage effective promotion and consistent and correct use of available brands.
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Affiliation(s)
- Mark A Weaver
- FHI, P.O. Box 13950, Research Triangle Park, NC 27709, USA.
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Tumlinson K, Steiner MJ, Rademacher KH, Olawo A, Solomon M, Bratt J. The promise of affordable implants: is cost recovery possible in Kenya? Contraception 2011; 83:88-93. [DOI: 10.1016/j.contraception.2010.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 06/24/2010] [Accepted: 06/29/2010] [Indexed: 11/29/2022]
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Hobbs MM, Steiner MJ, Rich KD, Gallo MF, Warner L, Macaluso M. Vaginal swab specimen processing methods influence performance of rapid semen detection tests: a cautionary tale. Contraception 2010; 82:291-5. [PMID: 20705160 DOI: 10.1016/j.contraception.2010.02.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 01/05/2010] [Accepted: 02/24/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Detection of semen biomarkers in vaginal fluid can be used to assess women's recent exposure to semen. Quantitative tests for detection of prostate-specific antigen (PSA) perform well, but are expensive and require specialized equipment. We assessed two rapid immunochromatographic strip tests for identification of semen in vaginal swabs. STUDY DESIGN We tested 581 vaginal swabs collected from 492 women. Vaginal secretions were eluted into saline, and PSA was measured using the quantitative IMx (Abbott Laboratories, Abbott Park, IL, USA) assay. Specimens were also tested using the ABAcard p30 test (Abacus Diagnostics, West Hills, CA, USA) for detection of PSA and RSID-Semen test (Independent Forensics, Hillside, IL, USA) for detection of semenogelin (Sg). RESULTS Vaginal swab extraction using saline was compatible with direct assessment of vaginal swab eluates using ABAcard for PSA detection, but not for Sg detection using RSID. The rapid PSA test detected 91% of specimens containing semen compared to 74% by the rapid Sg test. CONCLUSION Investigators are urged to optimize vaginal swab specimen preparation methods for performance of RSID or other tests to detect semen components other than PSA. Previously described methods for PSA testing are not uniformly applicable to other tests.
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Affiliation(s)
- Marcia M Hobbs
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Steiner MJ, Lopez LM, Grimes DA, Cheng L, Shelton J, Trussell J, Farley TMM, Dorflinger L. Sino-implant (II)--a levonorgestrel-releasing two-rod implant: systematic review of the randomized controlled trials. Contraception 2010; 81:197-201. [PMID: 20159174 PMCID: PMC3758670 DOI: 10.1016/j.contraception.2009.10.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 10/30/2009] [Accepted: 10/30/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sino-implant (II) is a subdermal contraceptive implant manufactured in China. This two-rod levonorgestrel-releasing implant has the same amount of active ingredient (150 mg levonorgestrel) and mechanism of action as the widely available contraceptive implant Jadelle. We examined randomized controlled trials of Sino-implant (II) for effectiveness and side effects. STUDY DESIGN We searched electronic databases for studies of Sino-implant (II) and then restricted our review to randomized controlled trials. The primary outcome of this review was pregnancy. RESULTS Four randomized trials with a total of 15,943 women assigned to Sino-implant (II) had first-year probabilities of pregnancy ranging from 0.0% to 0.1%. Cumulative probabilities of pregnancy during the 4 years of the product's approved duration of use were 0.9% and 1.06% in the two trials that presented date for 4-year use. Five-year cumulative probabilities of pregnancy ranged from 0.7% to 2.1%. In one trial, the cumulative probability of pregnancy more than doubled during the fifth year (from 0.9% to 2.1%), which may be why the implant is approved for 4 years of use in China. Five-year cumulative probabilities of discontinuation due to menstrual problems ranged from 12.5% to 15.5% for Sino-implant (II). CONCLUSIONS Sino-implant (II) is one of the most effective contraceptives available today. These available clinical data, combined with independent laboratory testing, and the knowledge that 7 million women have used this method since 1994, support the safety and effectiveness of Sino-implant (II). The lower cost of Sino-implant (II) compared with other subdermal implants could improve access to implants in resource-constrained settings.
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Affiliation(s)
- Markus J Steiner
- Family Health International, Research Triangle Park, NC 27709, USA.
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Steiner MJ, Boler T, Obhai G, Hubacher D. Assessment of a disposable trocar for insertion of contraceptive implants. Contraception 2010; 81:140-2. [DOI: 10.1016/j.contraception.2009.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 08/13/2009] [Accepted: 08/19/2009] [Indexed: 12/01/2022]
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Minnis AM, Steiner MJ, Gallo MF, Warner L, Hobbs MM, van der Straten A, Chipato T, Macaluso M, Padian NS. Biomarker validation of reports of recent sexual activity: results of a randomized controlled study in Zimbabwe. Am J Epidemiol 2009; 170:918-24. [PMID: 19741042 DOI: 10.1093/aje/kwp219] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Challenges in the accurate measurement of sexual behavior in human immunodeficiency virus (HIV) prevention research are well documented and have prompted discussion about whether valid assessments are possible. Audio computer-assisted self-interviewing (ACASI) may increase the validity of self-reported behavioral data. In 2006-2007, Zimbabwean women participated in a randomized, cross-sectional study that compared self-reports of recent vaginal sex and condom use collected through ACASI or face-to-face interviewing (FTFI) with a validated objective biomarker of recent semen exposure (prostate-specific antigen (PSA) levels). Of 910 study participants, 196 (21.5%) tested positive for PSA, an indication of semen exposure during the previous 2 days. Of these 196 participants, 23 (11.7%) reported no sex in the previous 2 days, with no difference in reported sexual activity between interview modes (12.5% ACASI vs. 10.9% FTFI; Fisher's exact test: P = 0.72). In addition, 71 PSA-positive participants (36.2%) reported condom-protected vaginal sex only; their reports also indicated no difference between interview modes (33.7% ACASI vs. 39.1% FTFI; P = 0.26). Only 52% of PSA-positive participants reported unprotected sex during the previous 2 days. Self-report was a poor predictor of recent sexual activity and condom use in this study, regardless of interview mode, providing evidence that such data should be interpreted cautiously.
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Affiliation(s)
- Alexandra M Minnis
- Women's Global Health Imperative, RTI International, San Francisco, CA 94104, USA.
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Abstract
BACKGROUND Knowledge of contraceptive effectiveness is crucial to making an informed choice. The consumer has to comprehend the pros and cons of the contraceptive methods being considered. Choice may be influenced by understanding the likelihood of pregnancy with each method and factors that influence effectiveness. OBJECTIVES To review all randomized controlled trials comparing strategies for communicating to consumers the effectiveness of contraceptives in preventing pregnancy. SEARCH STRATEGY We searched the computerized databases MEDLINE, POPLINE, CENTRAL, PsycINFO, and EMBASE for studies of communicating contraceptive effectiveness. We also examined references lists of relevant articles, and wrote to known investigators for information about other published or unpublished trials. SELECTION CRITERIA We included randomized controlled trials that compared methods for communicating contraceptive effectiveness to consumers. The comparison could be usual practice or an alternative to the experimental intervention. DATA COLLECTION AND ANALYSIS Data were abstracted by two authors and entered into RevMan. For dichotomous variables, the Peto odds ratio (OR) with 95% confidence intervals (CI) was calculated. For continuous variables, the weighted mean difference (WMD) was computed. MAIN RESULTS Five trials met the inclusion criteria. In one study, knowledge gain favored a slide-and-sound presentation versus a physician's oral presentation (WMD -19.00; 95% CI -27.52 to -10.48). Another trial showed a table with effectiveness categories led to more correct answers than one based on numbers [ORs were 2.42 (95% CI 1.43 to 4.12) and 2.19 (95% CI 1.21 to 3.97)] or a table with categories and numbers [ORs were 2.58 (95% CI 1.5 to 4.42) and 2.03 (95% CI 1.13 to 3.64)]. One trial examined contraceptive choice: women in the expanded program were more likely to choose sterilization (OR 4.26; 95% CI 2.46 to 7.37) or use a modern contraceptive method (OR 2.35; 95% CI 1.82 to 3.03). No trial had an explicit theoretical base, but each used concepts from common theories or models. AUTHORS' CONCLUSIONS We have limited evidence about what works to help consumers choose an appropriate contraceptive method. For presenting pregnancy risk data, one trial showed that categories were better than numbers. In another trial, audiovisual aids worked better than the usual oral presentation. Strategies for communicating information should be examined in clinical settings and assessed for effect on contraceptive choice and retention of knowledge. To expand the knowledge base of what works in contraceptive counseling, randomized trials could intentionally use and test theories or models.
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Affiliation(s)
- L M Lopez
- Family Health International, Behavioural and Biomedical Research, P.O. Box 13950, Research Triangle Park, North Carolina 27709, USA.
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Steiner MJ, Kwok C, Stanback J, Byamugisha JK, Chipato T, Magwali T, Mmiro F, Rugpao S, Sriplienchan S, Morrison C. Injectable contraception: what should the longest interval be for reinjections? Contraception 2008; 77:410-4. [PMID: 18477489 DOI: 10.1016/j.contraception.2008.01.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 01/28/2008] [Accepted: 01/29/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Progestin-only injectable contraceptives continue to gain in popularity, but uncertainty remains about pregnancy risk among women late for reinjection. The World Health Organization (WHO) recommends a "grace period" of 2 weeks after the scheduled 13-week reinjection. Beyond 2 weeks, however, many providers send late clients home to await menses. STUDY DESIGN A prospective cohort study in Uganda, Zimbabwe and Thailand followed users of depot-medroxyprogesterone acetate (DMPA) for up to 24 months. Users were tested for pregnancy at every reinjection, allowing analysis of pregnancy risk among late comers. RESULTS The analysis consists of 2290 participants contributing 13,608 DMPA intervals. The pregnancy risks per 100 women-years for "on time" [0.6; 95% confidence interval (CI), 0.33-0.92], "2-week grace" (0.0; 95% CI, 0.0-1.88) and "4-week grace" (0.4; 95% CI, 0.01-2.29) injections were low and virtually identical. CONCLUSION Extending the current WHO grace period for DMPA reinjection from 2 to 4 weeks does not increase pregnancy risk and could increase contraceptive continuation.
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Affiliation(s)
- Markus J Steiner
- Family Health International, Research Triangle Park, NC 27709, USA.
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Steiner MJ, Cates W, Genuis SJ. Are condoms the answer to rising rates of non-HIV sexually transmitted infection? Assoc Med J 2008. [DOI: 10.1136/sbmj.0803096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Consistent condom use can reduce the spread of HIV, and Markus Steiner and Willard Cates believe condoms are the answer to other sexually transmitted infections. But Stephen Genuis argues that a more comprehensive approach is needed
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Affiliation(s)
- Markus J Steiner
- Family Health International, Research Triangle Park, NC 27709, USA
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Gallo MF, Steiner MJ, Warner L, Hylton-Kong T, Figueroa JP, Hobbs MM, Behets FM. Self-reported condom use is associated with reduced risk of chlamydia, gonorrhea, and trichomoniasis. Sex Transm Dis 2008; 34:829-33. [PMID: 17579339 DOI: 10.1097/olq.0b013e318073bd71] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the association between self-reported condom use and prevalent and incident chlamydia, gonorrhea, and trichomoniasis. STUDY DESIGN Prospective study of 414 males attending a sexually transmitted infection (STI) clinic in Jamaica. Condom use and STI status were assessed at enrollment and at 4 follow-up visits. RESULTS The analyses on condom use and prevalent STI included data from 414 men, while those on incident STI were based on 1111 intervals from 355 men. We diagnosed prevalent STI (chlamydia, gonorrhea, and/or trichomoniasis) in 54.6% (n = 226) of the participants at enrollment. About 14% (n = 51) of participants had at least 1 of the study STIs during follow-up. Follow-up visits in which participants reported consistent condom use (100% of acts) for the past 7 days had less incident STI (adjusted OR, 0.4; 95% CI, 0.2-0.9) compared with visits where no condom use was reported. Self-reported condom use was more closely correlated with incident than prevalent STI. For example, the adjusted OR for prevalent infection for participants reporting consistent versus no condom use in past 7 days was 0.7 (95% CI, 0.4-1.2). Classifications based on the number of unprotected acts yielded findings similar to those based on the proportion of acts protected. CONCLUSIONS Consistent condom use was associated with reduced risk of incident urethral STI. Research on condom effectiveness should focus on incident STI outcomes, where the temporal relationship between condom use and infection is clearer.
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Affiliation(s)
- Maria F Gallo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.
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Steiner MJ, Trussell J, Johnson S. Communicating contraceptive effectiveness: an updated counseling chart. Am J Obstet Gynecol 2007; 197:118. [PMID: 17618790 DOI: 10.1016/j.ajog.2007.03.049] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 03/13/2007] [Indexed: 11/20/2022]
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Gallo MF, Behets FM, Steiner MJ, Thomsen SC, Ombidi W, Luchters S, Toroitich-Ruto C, Hobbs MM. Validity of self-reported 'safe sex' among female sex workers in Mombasa, Kenya--PSA analysis. Int J STD AIDS 2007; 18:33-8. [PMID: 17326860 DOI: 10.1258/095646207779949899] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We assessed the validity of self-reported sex and condom use by comparing self-reports with prostate-specific antigen (PSA) detection in a prospective study of 210 female sex workers in Mombasa, Kenya. Participants were interviewed on recent sexual behaviours at baseline and 12-month follow-up visits. At both visits, a trained nurse instructed participants to self-swab to collect vaginal fluid specimens, which were tested for PSA using enzyme-linked immunosorbent assay (ELISA). Eleven percent of samples (n = 329) from women reporting no unprotected sex for the prior 48 hours tested positive for PSA. The proportions of women with this type of discordant self-reported and biological data did not differ between the enrolment and 12-month visit (odds ratio [OR] 1.1; 95% confidence interval [CI] 0.99, 1.2). The study found evidence that participants failed to report recent unprotected sex. Furthermore, because PSA begins to clear immediately after exposure, our measures of misreported semen exposure likely are underestimations.
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Affiliation(s)
- M F Gallo
- Family Health International Research Triangle Park, NC, USA.
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Hubacher D, Kimani J, Steiner MJ, Solomon M, Ndugga MB. Contraceptive implants in Kenya: current status and future prospects. Contraception 2007; 75:468-73. [PMID: 17519154 DOI: 10.1016/j.contraception.2007.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 02/22/2007] [Accepted: 02/23/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since introducing Norplant over 20 years ago in Kenya, demand for contraceptive implants has remained high and implant costs are dropping substantially. METHODS An assessment of the Kenyan experience with implants was conducted to understand level of demand, capacity to provide services and reproductive health impact of possible increased use. Interviews were conducted with 35 key Kenyan informants. By modeling increases in national implant use (at the expense of oral contraceptives), reductions in the annual number of unintended pregnancies were estimated. RESULTS Kenya has an unmet need for implants and the current network of trained providers appears ready to increase the volume of services. If 100,000 users of oral contraceptives switch to implants, then an estimated 26,000 unintended pregnancies can be averted over a 5-year period. CONCLUSION With increased purchases of implants by international donor agencies, Kenya can reduce reliance on short-term hormonal methods and reduce the 45% prevalence rate of unintended pregnancy.
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Affiliation(s)
- David Hubacher
- Family Health International, Research Triangle Park, NC 27709, USA.
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Steiner MJ, Taylor D, Hylton-Kong T, Mehta N, Figueroa JP, Bourne D, Hobbs M, Behets F. Decreased condom breakage and slippage rates after counseling men at a sexually transmitted infection clinic in Jamaica. Contraception 2007; 75:289-93. [PMID: 17362708 DOI: 10.1016/j.contraception.2006.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 12/05/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE Our objective was to evaluate condom failure (breakage and slippage) rates before and those during a trial that provided instructions on correct condom use. METHOD Our analysis was based on 314 men who presented with urethral discharge at Jamaica's largest sexually transmitted infection clinic and were enrolled into our 6-month trial. RESULTS Participants reported breaking 18.5% (95% confidence interval=12.8-24.1%) of their condoms during the 7 days prior to the screening visit and having 3.5% (95% confidence interval=1.2-5.7%) of their condoms slip off completely. After the condom counseling provided during the screening visit, breakage rates decreased (p<.05) and remained below 10% throughout the trial. During in-depth interviews, the men who reported frequent condom failures cited (1) improper storage/exposure to heat, (2) improper handling while putting on condoms and (3) use of lubricants/improper lubricants as the possible reasons for their high failure rates. CONCLUSION Although the rates of reported condom breakage and slippage decreased significantly after counseling, we need to improve the quality of condom counseling to further reduce failure rates.
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Affiliation(s)
- Markus J Steiner
- Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709, USA.
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Gallo MF, Behets FM, Steiner MJ, Hobbs MM, Hoke TH, Van Damme K, Ralimamonjy L, Raharimalala L, Cohen MS. Prostate-specific antigen to ascertain reliability of self-reported coital exposure to semen. Sex Transm Dis 2006; 33:476-9. [PMID: 16865047 DOI: 10.1097/01.olq.0000231960.92850.75] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to assess the validity of women's reports of recent unprotected sex by testing for prostate-specific antigen (PSA) in vaginal samples. STUDY DESIGN The authors conducted prospective research with 332 female sex workers attending 2 public dispensaries in Madagascar. RESULTS Among women who reported no sex or protected sex only within the past 48 hours, 21% and 39%, respectively, tested positive for PSA. Among those testing positive for PSA, no differences in PSA concentrations were found among those reporting no sex, protected sex only, or at least one unprotected act. CONCLUSIONS The substantial disagreement between self-reports and measurement of a biologic marker of semen exposure in vaginal specimens substantiates that self-reports of sexual behavior cannot be assumed to be valid measures. Future sexually transmitted infection/HIV and pregnancy prevention studies should confirm the validity of self-reports or use end points that do not rely on self-reported data.
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Affiliation(s)
- Maria F Gallo
- Family Health International (FHI), Research Triangle Park, North Carolina, USA.
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Steiner MJ, Trussell J, Mehta N, Condon S, Subramaniam S, Bourne D. Communicating contraceptive effectiveness: A randomized controlled trial to inform a World Health Organization family planning handbook. Am J Obstet Gynecol 2006; 195:85-91. [PMID: 16626610 DOI: 10.1016/j.ajog.2005.12.053] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 12/19/2005] [Accepted: 12/22/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of the study was to compare 3 different approaches for increasing clients' understanding of contraceptive effectiveness. STUDY DESIGN We randomized 900 reproductive-age women in India and Jamaica to 1 of 3 charts presenting pregnancy risk. RESULTS The most important reason for choosing a contraceptive was how well it prevents pregnancy (54%) followed by few side effects (17%). At baseline, knowledge about contraceptive effectiveness was poor. About half knew oral contraceptive pills are more effective than condoms (46%) and intrauterine devices are more effective than injectables (50%). All 3 charts improved knowledge significantly (P < .01) for these 2 questions. No chart improved knowledge better than any other (P > .05). The chart ranking contraceptive methods on a continuum was judged slightly easier to understand than the other 2 charts. CONCLUSION Only with accurate understanding of pregnancy risk can clients make informed choices. Our results have already informed a global handbook for family planning providers to use the chart ranking contraceptive methods on a continuum.
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Affiliation(s)
- Markus J Steiner
- Family Health International, Research Triangle Park, NC 27709, USA.
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41
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Affiliation(s)
- Markus J Steiner
- Institute for Family Health at Family Health International, Research Triangle Park, NC, USA
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Lamvu G, Steiner MJ, Condon S, Hartmann K. Consistency between most important reasons for using contraception and current method used: the influence of health care providers. Contraception 2006; 73:399-403. [PMID: 16531175 DOI: 10.1016/j.contraception.2005.10.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Revised: 09/25/2005] [Accepted: 10/10/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify factors related to consistency between women's "most important" reason for using contraception and their current contraceptive method. METHODS A sample of 433 women completed a written questionnaire on demographics, contraceptive use history and the "most important" reason for using contraception. Women were grouped by whether their current contraceptive method "agreed" or "disagreed" with their "most important" reason for contracepting. Multivariable regression was used to identify factors associated with consistency between stated "most important" reason and current method used ("agreed"). RESULTS Current contraceptive method was inconsistent with the "most important" reason for using a method in 25% of women. Demographic characteristics and knowledge of contraceptive effectiveness did not differ between the "agreed" and "disagreed" groups. Women using a method consistent with their reason were more likely to have discussed contraception with a health care provider (RR=1.59, 95% CI 1.13-2.25) even after adjusting for source of contraceptive method or source of contraceptive information (RR=1.57, 95% CI 1.10-2.23). CONCLUSION Contact with a health care provider was the only factor associated with consistency between birth control method and reasons for initiating contraception. This association appears to be independent of knowledge about contraceptive effectiveness.
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Affiliation(s)
- Georgine Lamvu
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, 27599, USA.
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Steiner MJ, Hylton-Kong T, Figueroa JP, Hobbs MM, Behets F, Smikle M, Tweedy K, Powell S, McNeil L, Brathwaite A. Does a choice of condoms impact sexually transmitted infection incidence? A randomized, controlled trial. Sex Transm Dis 2006; 33:31-5. [PMID: 16385220 DOI: 10.1097/01.olq.0000187200.07639.c6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess whether providing a choice of condoms would increase condom acceptability, increase self-reported use, and decrease incident sexually transmitted infection. STUDY We randomized 414 men presenting with urethral discharge in Jamaica to receive either the "standard" clinic condom or a choice of 4 different types of condoms. Men were treated presumptively at enrollment and followed up at 1, 2, 4, and 6 months. RESULTS Participants in the choice group had a strong preference (P <0.01) for the most popular condom available in Jamaica. This preference did not translate into higher condom use (P = 0.16). The 6-month cumulative probability of first incidence of gonorrhea, chlamydia, or trichomoniasis was slightly higher in the choice group (21%; 95% confidence interval [CI], 15-28%) versus the control group (17%; 95% CI, 11-23%); the difference in the survival curves was not significant (P = 0.35). CONCLUSION A choice of condoms may increase perceived acceptability but not lead to increased condom use and subsequently lower sexually transmitted infection rates.
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Affiliation(s)
- Markus J Steiner
- Family Health International, Research Triangle Park, North Carolina 27707, USA.
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Magwali TL, Steiner MJ, Toms H, Brown JM. How are condoms used in a family planning setting: evidence from Zimbabwe. Cent Afr J Med 2005; 51:79-84. [PMID: 17849824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES (To determine the level and consistency of condom use among family planning clients at three family planning clinics in Zimbabwe.) DESIGN A prospective cross sectional study. SETTING The study was carried out at three Zimbabwe National Family Planning Council clinics. SUBJECTS We interviewed 899 consecutive women seeking family planning services at these three clinics using a structured questionnaire. MAIN OUTCOME MEASURES The prevalence of condom use among this population of family planning clients and the factors predicting condom use were the main outcome measures. We define dual method use (DMU) as the use of condoms in conjunction with another highly effective contraceptive and dual purpose use (DPU) as the use of condoms for both pregnancy and STI/HIV prevention. We measured self-reported condom use during the last 30 days prior to each interview. RESULTS The prevalence of condom use among this population of family planning clients was 38%. Of all the study participants, 32% were DMU clients while 5% were DPU clients. Fifty eight percent of the DMU clients and 89% of the DPU clients clients reported consistent condom use respectively. Logistic regression analysis showed that young age and reporting high risk sexual behaviour were predictors of condom use. CONCLUSIONS The level of condom use among this population of family plannig clients is too low for a country with such a high HIV prevalence. Condom users were more likely to report DMU than DPU. Those reporting DPU were more likely to report consistent condom use.
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Affiliation(s)
- T L Magwali
- University of Zimbabwe, Department of Obstetrics and Gynaecology, PO Box A 178, Avondale, Harare, Zimbabwe.
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Abstract
The standard method for estimating the effectiveness of emergency contraceptive pills (ECPs) uses external data to calculate the proportion of expected pregnancies averted by the treatment. Because these data may not be applicable to ECP study populations, this approach could result in substantial overestimation of effectiveness. We used data from two published randomized trials of the levonorgestrel and Yuzpe ECP regimens to calculate the minimum effectiveness of the levonorgestrel regimen. Conservatively assuming that the Yuzpe regimen was entirely ineffective in these trials, we estimate that the levonorgestrel regimen prevented at least 49% of expected pregnancies (95% confidence interval: 17%, 69%). Because physiologic data suggests that the Yuzpe regimen does, in fact, have some efficacy, the effectiveness of the levonorgestrel regimen is likely to be higher than our minimum estimate.
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Affiliation(s)
- Elizabeth Raymond
- Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA.
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Steiner MJ, Dalebout S, Condon S, Dominik R, Trussell J. Understanding risk: a randomized controlled trial of communicating contraceptive effectiveness. Obstet Gynecol 2003; 102:709-17. [PMID: 14551000 DOI: 10.1016/s0029-7844(03)00662-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine which of three different approaches increased women's understanding of risk of pregnancy associated with different contraceptive methods. METHODS We randomly assigned 461 reproductive-age women to one of three tables presenting pregnancy risk (Food and Drug Administration table with numbers, World Health Organization table with numbers and categories, or table with categories). We evaluated participant knowledge before and after being shown the assigned table. RESULTS The most important reason for choosing a contraceptive was how well it works (53%), followed by ease of use (13%), and protection against sexually transmitted disease or human immunodeficiency virus (11%). Before looking at the tables, about half the participants knew that hormone shots are more effective than pills (48%) and that pills are more effective than condoms (57%). For these two key comparisons, the category table compared to the Food and Drug Administration table with numbers improved knowledge significantly more (37% versus 20% and 27% versus 14%; both P <.05). Compared with those assigned to the Food and Drug Administration table with numbers, significantly fewer participants assigned to the category table said the table was difficult to read (6% versus 19%; P <.01). Most participants in all three groups said their assigned table provided enough information to choose a contraceptive method. CONCLUSION The table with categories communicated relative contraceptive effectiveness better than the tables with numbers. However, without being presented with numbers, participants grossly overestimated the absolute risk of pregnancy using contraceptives. A combination of categories and a general range of risk for each category may provide the most accurate understanding of both relative and absolute pregnancy risk.
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Affiliation(s)
- Markus J Steiner
- Family Health International, Research Triangle Park, North Carolina, USA.
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Doiron-Leyraud N, Walker IR, Taillefer L, Steiner MJ, Julian SR, Lonzarich GG. Fermi-liquid breakdown in the paramagnetic phase of a pure metal. Nature 2003; 425:595-9. [PMID: 14534580 DOI: 10.1038/nature01968] [Citation(s) in RCA: 162] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2003] [Accepted: 07/30/2003] [Indexed: 11/09/2022]
Abstract
Fermi-liquid theory (the standard model of metals) has been challenged by the discovery of anomalous properties in an increasingly large number of metals. The anomalies often occur near a quantum critical point--a continuous phase transition in the limit of absolute zero, typically between magnetically ordered and paramagnetic phases. Although not understood in detail, unusual behaviour in the vicinity of such quantum critical points was anticipated nearly three decades ago by theories going beyond the standard model. Here we report electrical resistivity measurements of the 3d metal MnSi, indicating an unexpected breakdown of the Fermi-liquid model--not in a narrow crossover region close to a quantum critical point where it is normally expected to fail, but over a wide region of the phase diagram near a first-order magnetic transition. In this regime, corrections to the Fermi-liquid model are expected to be small. The range in pressure, temperature and applied magnetic field over which we observe an anomalous temperature dependence of the electrical resistivity in MnSi is not consistent with the crossover behaviour widely seen in quantum critical systems. This may suggest the emergence of a well defined but enigmatic quantum phase of matter.
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Affiliation(s)
- N Doiron-Leyraud
- Cavendish Laboratory, University of Cambridge, Cambridge CB3 0HE, UK.
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