Pregnancies among women living with HIV using contraceptives and antiretroviral therapy in western Kenya: a retrospective, cohort study.

Cohort Studies Contraceptive Agents Female HIV Infections / drug therapy Humans Kenya / epidemiology Pregnancy Retrospective Studies
Contraception Efavirenz HIV Implant Pregnancy Women living with HIV

Journal

BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723

Informations de publication

Date de publication:
13 08 2021
Historique:
received: 24 03 2021
accepted: 21 06 2021
entrez: 13 8 2021
pubmed: 14 8 2021
medline: 15 10 2021
Statut: epublish

Résumé

Preventing unintended pregnancies is paramount for women living with HIV (WLHIV). Previous studies have suggested that efavirenz-containing antiretroviral therapy (ART) reduces contraceptive effectiveness of implants, but there are uncertainties regarding the quality of the electronic medical record (EMR) data used in these prior studies. We conducted a retrospective, cohort study of EMR data from 2011 to 2015 among WLHIV of reproductive age accessing HIV care in public facilities in western Kenya. We validated a large subsample of records with manual chart review and telephone interviews. We estimated adjusted incidence rate ratios (aIRRs) with Poisson regression accounting for the validation sampling using inverse probability weighting and generalized raking. A total of 85,324 women contributed a total of 170,845 women-years (w-y) of observation time; a subset of 5080 women had their charts reviewed, and 1285 underwent interviews. Among implant users, the aIRR of pregnancy for efavirenz- vs. nevirapine-containing ART was 1.9 (95% CI 1.6, 2.4) using EMR data only and 3.2 (95% CI 1.8, 5.7) when additionally using both chart review and interview validated data. Among efavirenz users, the aIRR of pregnancy for depomedroxyprogesterone acetate (DMPA) vs. implant use was 1.8 (95% CI 1.5, 2.1) in EMR only and 2.4 (95% CI 1.0, 6.1) using validated data. Pregnancy rates are higher when contraceptive implants are concomitantly used with efavirenz-containing ART, though rates were similar to leading alternative contraceptive methods such as DMPA. Our data provides policymakers, program staff, and WLHIV greater confidence in guiding their decision-making around contraceptive and ART options. Our novel, 3-phase validation sampling provides an innovative tool for using routine EMR data to improve the robustness of data quality.

Sections du résumé

BACKGROUND
Preventing unintended pregnancies is paramount for women living with HIV (WLHIV). Previous studies have suggested that efavirenz-containing antiretroviral therapy (ART) reduces contraceptive effectiveness of implants, but there are uncertainties regarding the quality of the electronic medical record (EMR) data used in these prior studies.
METHODS
We conducted a retrospective, cohort study of EMR data from 2011 to 2015 among WLHIV of reproductive age accessing HIV care in public facilities in western Kenya. We validated a large subsample of records with manual chart review and telephone interviews. We estimated adjusted incidence rate ratios (aIRRs) with Poisson regression accounting for the validation sampling using inverse probability weighting and generalized raking.
RESULTS
A total of 85,324 women contributed a total of 170,845 women-years (w-y) of observation time; a subset of 5080 women had their charts reviewed, and 1285 underwent interviews. Among implant users, the aIRR of pregnancy for efavirenz- vs. nevirapine-containing ART was 1.9 (95% CI 1.6, 2.4) using EMR data only and 3.2 (95% CI 1.8, 5.7) when additionally using both chart review and interview validated data. Among efavirenz users, the aIRR of pregnancy for depomedroxyprogesterone acetate (DMPA) vs. implant use was 1.8 (95% CI 1.5, 2.1) in EMR only and 2.4 (95% CI 1.0, 6.1) using validated data.
CONCLUSION
Pregnancy rates are higher when contraceptive implants are concomitantly used with efavirenz-containing ART, though rates were similar to leading alternative contraceptive methods such as DMPA. Our data provides policymakers, program staff, and WLHIV greater confidence in guiding their decision-making around contraceptive and ART options. Our novel, 3-phase validation sampling provides an innovative tool for using routine EMR data to improve the robustness of data quality.

Identifiants

DOI: 10.1186/s12916-021-02043-z PMID: 34384443 PMC: PMC8361857
pubmed: 34384443
doi: 10.1186/s12916-021-02043-z
pii: 10.1186/s12916-021-02043-z
pmc: PMC8361857
doi:

Substances chimiques

Contraceptive Agents 0

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S. Research Support, U.S. Gov't, P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

178

Subventions

Organisme : NIH HHS
ID : TL1TR000449
Pays : United States
Organisme : NIH HHS
ID : UL1TR002319
Pays : United States
Organisme : NICHD NIH HHS
ID : T32 HD055172
Pays : United States
Organisme : NIH HHS
ID : UL1TR000448
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069911
Pays : United States
Organisme : NIAID NIH HHS
ID : R37 AI131771
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002345
Pays : United States
Organisme : NIH HHS
ID : U01AI069911
Pays : United States
Organisme : NIAID NIH HHS
ID : K23 AI120855
Pays : United States

Informations de copyright

© 2021. The Author(s).

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Auteurs

Rena C Patel (RC)

Division of Allergy and Infectious Diseases, Department of Medicine and Department of Global Health, University of Washington, UW Box 359927, 325 Ninth Avenue, Seattle, WA, 98104, USA. rcpatel@uw.edu.
ORCID: 0000-0001-9893-5856

Gustavo Amorim (G)

Department of Biostatistics, Vanderbilt University, Nashville, TN, USA.

Beatrice Jakait (B)

Moi Teaching & Referral Hospital/Moi University & Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.

Bryan E Shepherd (BE)

Department of Biostatistics, Vanderbilt University, Nashville, TN, USA.

A Rain Mocello (AR)

Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology & Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.

Beverly Musick (B)

Department of Biostatistics, School of Medicine, Indiana University, Indianapolis, IN, USA.

Caitlin Bernard (C)

Division of Family Planning, Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.

Maricianah Onono (M)

Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.

Elizabeth A Bukusi (EA)

Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.

Kara Wools-Kaloustian (K)

Department of Medicine, Indiana University, Indianapolis, IN, USA.

Craig R Cohen (CR)

Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology & Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.

Constantin T Yiannoutsos (CT)

Department of Biostatistics, R.M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.

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Classifications MeSH

questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Pregnancies among women living with HIV using...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents régulateurs de la reproduction › Contraceptifs › Pregnancies among women living with HIV using...
questionsmedicales.fr › Maladies du système immunitaire › Déficits immunitaires › Infections à VIH › Pregnancies among women living with HIV using...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Pregnancies among women living with HIV using...
questionsmedicales.fr › Régions géographiques › Afrique › Afrique subsaharienne › Afrique de l'Est › Kenya › Pregnancies among women living with HIV using...
questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › Pregnancies among women living with HIV using...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Pregnancies among women living with HIV using...