{"id":36643,"date":"2019-09-30T08:41:35","date_gmt":"2019-09-30T08:41:35","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=36643"},"modified":"2019-09-30T13:10:56","modified_gmt":"2019-09-30T13:10:56","slug":"low-rates-of-pregnancy-with-three-methods-of-contraception-in-the-echo-trial","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/36643","title":{"rendered":"Low rates of pregnancy with three methods of contraception in the ECHO trial"},"content":{"rendered":"

\"\"Polly Clayden, HIV i-Base<\/span><\/strong><\/p>\n

Both perfect and typical use of all contraceptive methods \u2013 DMPA-IM, copper IUD, or LNG implant \u2013\u00a0 resulted in low pregnancy rates at 18 months in a secondary analysis of the ECHO trial. Typical copper IUD use was associated with statistically significant higher pregnancy risk compared to LNG implants.<\/b><\/p>\n

The ECHO Trial looked at HIV incidence among 7829 women from sites in Eswatini, Kenya, South Africa and Zambia who were be randomised to one of the three methods.<\/p>\n

The pregnancy analyses were performed for perfect use and typical use among 7710 women \u2013 these findings were presented at IAS 2019.<\/p>\n

Baseline demographics and behavioral data were similar across <\/span>the three<\/span>groups<\/span>of women: <\/span>median age was 23 years<\/span>, the m<\/span>ajority<\/span>women\u00a0<\/span>were\u00a0<\/span>single and never married (80%), had some or complete secondary education (74%), a BMI <\/span><<\/span>30<\/span>kg\/m2<\/sup> (74%), and <\/span>1\u20132\u00a0<\/span>living children (66%).\u00a0<\/span>Approximately half had used DMP-IM before\u00a0<\/span>(<\/span>51%<\/span>) compared with very few who used either LNG implant (6.4%) or copper IUD (0.8%). <\/span>There was high prevalence of STIs:\u00a018% chlamydia trachomatis and 4.7% gonorrhea.<\/span><\/p>\n

There were 70 pregnancies during perfect use and <\/span>and 85 during typical use.<\/p>\n

Incidence pregnancy rates for perfect use at 18 months were: 0.61 per 100 woman-years (wy) for DMPA-IM (95% CI: 0.36 to 0.96), 1.06 for copper IUD (95% CI: 0.72 to 1.50) and 0.63 for LNG implants (95% CI: 0.39 to 0.96). But the copper IUD appeared to have a different slope: starting lower (to approximately 6 months) and rising relatively higher when compared to the other two methods.<\/p>\n

In pairwise comparisons, there was no statistically significant difference in terms of the risk of pregnancy incidence between method pairs.<\/span><\/p>\n

Typical use incidence rates were 0.87 per 100 wy for DMPA-IM (95% CI: 0.58 to1.25), 1.11 for copper IUD (95% CI: 0.77 to 1.54), and 0.63 for LNG implants (95% CI: 0.39 to 0.96). Typical use of copper IUD was associated with statistically significant higher risk of pregnancy compared to LNG implants: aHR 1.74 \u00a0(95% CI: 1.01 to 2.99), p=0.044. The other comparisons did not reach significance.<\/p>\n

comment<\/span><\/h3>\n

Presenting author <\/span><\/b>Dr Maricianah Onono noted that DMPA-IM pregnancy incidence with typical use was much lower than usually reported in routine settings. She suggested that this might be attributed to proactive tracing by research staff.<\/span><\/b><\/p>\n

One suggestion during questions after the presentation was, as the copper IUD appeared to be working better up to 6 months, this would be a good time for a routine visit to check that it is in place. It would also be a good opportunity to check for HIV and STIs.<\/span><\/b><\/p>\n

Reference<\/span><\/p>\n

Onono M et al. Comparison of pregnancy incidence among African women in a randomised trial of intramuscular depomedroxyprogesterone acetate (DMPA-IM), the levonorgestrel (LNG) implant, and the copper intrauterine device (IUD).10th IAS Conference on HIV Science. Mexico City, Mexico (IAS 2019), 21\u201324 July 2019. Oral abstract MOAX0103LB.
\n<\/span>http:\/\/programme.ias2019.org\/Abstract\/Abstract\/4810<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Polly Clayden, HIV i-Base Both perfect and typical use of all contraceptive methods \u2013 DMPA-IM, copper IUD, or LNG implant \u2013\u00a0 resulted in low pregnancy rates at 18 months in a secondary analysis of the ECHO trial. Typical copper IUD …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,35],"tags":[273],"class_list":["post-36643","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-pmtct-and-maternal-health","tag-ias-10-mexico-city-2019"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/36643","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=36643"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/36643\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=36643"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=36643"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=36643"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}