Contraceptive method switching among women living in sub-Saharan Africa participating in an HIV-1 prevention trial: a prospective cohort study

Objective: Long-acting reversible contraceptive (LARC) method uptake has been low within the context of HIV prevention trials. Within a multinational study (MTN-020/ASPIRE), the Contraceptive Action Team improved LARC accessibility and uptake. In this secondary analysis, we determined the rate of contraceptive method continuation among the women enrolled.

Study design: ASPIRE was a randomized, double-blinded, placebo-controlled phase III safety and effectiveness study of the Dapivirine Vaginal Ring for HIV-1 prevention. Between 2012 and 2014, sexually active women aged 18-45 from Malawi, South Africa, Uganda and Zimbabwe were enrolled. All participants were required to use contraception for enrollment to the study and could choose between all highly effective contraceptive methods available in their respective countries. Women were seen monthly and could change methods at any time. Continuation rates from study enrollment to 6 and 12 months were determined.

Results: The overall contraceptive method continuation rate was 77% (1972/2551) at 6 months and 66% (1694/2551) at 12 months. The 6- and 12-month continuation rates were highest for implantable contraceptives (89%, 82%) followed by copper intrauterine device (83%, 77%). Rates of continuation for injectable contraceptives depot medroxyprogesterone acetate (80%, 69%) and norethisterone enanthate (71%, 54%) were higher than for oral contraceptives, which were continued at 47% at 6 months and 35% at 12 months. The continuation rates of all methods did not differ by users with and without previous contraceptive experience.

Conclusions: LARC methods have the highest rates of continuation at 12 months and should be routinely offered in the context of HIV prevention trials in sub-Saharan Africa.

Implications: Intrauterine devices and contraceptive implant continuation was high at 12 months among women participating in an HIV prevention trial in sub-Saharan Africa and LARCs and should be routinely offered.