...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>PLoS Medicine >Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial
【24h】

Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial

机译：在乌干达西南部感染艾滋病毒的妇女中提供计划生育凭单和及早开始使用产后避孕药：一项随机对照试验

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Background Unwanted pregnancies remain a burden for women living with HIV (WLWH). Family planning prevents unplanned pregnancies while promoting longer birth intervals, key strategies to eliminate perinatal transmission of HIV and promote maternal and child health. We evaluated the effect of a family planning voucher, inclusive of immediate postpartum counseling, on uptake, early initiation, and continuation of modern contraceptive methods among recently postpartum WLWH delivering at a publicly funded regional referral hospital in rural, southwestern Uganda. Methods and findings We performed a randomized controlled trial between October, 2016 and June, 2018 at a referral hospital in southwestern Uganda. This interim analysis includes adult WLWH randomized and enrolled equally to receive a family planning voucher or standard of care (control). Enrolled postpartum WLWH completed an interviewer-administered questionnaire at enrollment and 6 months postpartum. Our primary outcome of interest for this analysis is initiation of a modern family planning method within 8 weeks postpartum. Secondary outcomes included family planning initiation at 12, 14, 16, and 20 weeks postpartum, family planning discontinuation and/or change, pregnancy incidence, and mean time without contraception. The trial was registered with clinicaltrials.gov (NCT02964169). At enrollment, half of the women in both the voucher (N = 87, 55%) and control (N = 86, 54%) groups wanted to have a child in 2 years postpartum. Over 80% of referent pregnancies in the voucher (N = 136, 86%) and control (N = 128, 81%) groups were planned. All women were accessing ART. The mean CD4 count was 396 cells/mmsup3/sup (SD = 61) for those enrolled in the control group versus 393 cells/mmsup3/sup (SD = 64) in the family planning voucher group. By 8 weeks postpartum, family planning was initiated in 144 (91%) participants in the voucher group and 83 (52%) participants in the control group (odds ratio [OR] 9.42; CI 4.67–13.97, P 0.001). We also found high family planning uptake rates for both groups, with higher rates among the intervention group at 12 weeks (OR 5.66; CI 2.65–12.12, P 0.001), 14 weeks (OR 2.51; CI 1.31–4.79, P 0.001), 16 weeks (OR 4.02; CI 1.66–9.77, P = 0.001), and 20 weeks (OR 3.65; CI 1.40–9.47, P = 0.004) postpartum. The average time to family planning initiation was reduced to 5.9 weeks (SD = 2.4) for those in the voucher group compared to 9.3 weeks (SD = 5) in the control (P 0.001). One pregnancy was recorded in the group receiving standard of care; none were reported in the voucher group. Method mix did not differ by group: injectables were selected by most women (N = 150, 50%), and 52% of this proportion were in the experimental arm, with 10% in each arm selecting condoms, oral contraception, or intrauterine devices (IUDs). Similar proportions of women changed contraceptive methods over the 6-month follow-up in the voucher and control groups (N = 8, 5% versus N = 5, 4%; P = 0.467). More women in the control group discontinued contraception for 1 to 2 weeks (N = 19, 13% versus N = 7, 5%; P = 0.008) or more than 4 weeks (N = 15, 10% versus N = 3, 2%; P = 0.002) compared to those given a family planning voucher. The main limitation of this study is that its findings may not be generalized to settings without improved availability of contraceptives in publicly funded facilities. Conclusion These findings indicate that a well-structured, time-bound family planning voucher program appeared to increase early postpartum contraceptive uptake and continuation in a setting in which users are faced with financial, knowledge, and structural barriers to contraceptive services. Further work should clarify the role of vouchers in empowering WLWH to avoid unintended pregnancies over time.
机译：背景意外怀孕仍然是艾滋病毒携带者的负担。计划生育可以防止计划外的怀孕，同时延长生育间隔，这是消除围产期艾滋病毒传播和促进母婴健康的关键策略。我们评估了计划生育代金券（包括立即的产后咨询）对乌干达西南部农村地区一家公立区域转诊医院最近产后WLWH分娩的现代避孕方法的吸收，早期启动和延续的效果。方法和发现我们在2016年10月至2018年6月之间在乌干达西南部的转诊医院进行了一项随机对照试验。这项中期分析包括成年WLWH，他们随机分组并平等地接受了计划生育券或照护标准（对照）。登记的产后WLWH在登记时和产后6个月内完成了由访调员管理的问卷。我们对此分析感兴趣的主要结果是在产后8周内开始采用现代计划生育方法。次要结果包括产后12、14、16和20周开始计划生育，计划生育终止和/或改变，怀孕发生率以及无避孕的平均时间。该试验已在Clinicaltrials.gov（NCT02964169）上注册。入学时，代金券（N = 87，55％）和对照组（N = 86，54％）的女性中有一半希望在产后2年内生育孩子。计划在优惠券（N = 136，86％）和对照组（N = 128，81％）组中进行超过80％的参考怀孕。所有妇女都在接受ART治疗。对照组的平均CD4计数为396个细胞/ mm 3 （SD = 61），而该家庭的平均CD4计数为393个细胞/ mm 3 （SD = 64）计划凭证组。到产后8周，凭证组的144名参与者（91％）和对照组的83名（52％）参与者开始了计划生育（赔率[OR] 9.42; CI 4.67-13.97，P <0.001）。我们还发现两组的计划生育吸收率较高，干预组在12周时（OR 5.66; CI 2.65–12.12，P <0.001），14周（OR 2.51; CI 1.31–4.79，P <0.001）较高。 ），产后16周（OR 4.02; CI 1.66–9.77，P = 0.001）和20周（OR 3.65; CI 1.40–9.47，P = 0.004）。优惠券组平均开始计划生育的时间减少至5.9周（SD = 2.4），而对照组为9.3周（SD = 5）（P <0.001）。接受标准护理的组中有1人怀孕。凭证组中没有任何报告。方法的组合在各组之间没有差异：大多数女性选择了注射剂（N = 150，50％），其中52％在实验组中，每组中<10％选择避孕套，口服避孕药或子宫内注射设备（IUD）。在代金券和对照组的六个月随访中，类似比例的妇女改变了避孕方法（N = 8，5％，N = 5，4％; P = 0.467）。对照组中有更多妇女中止避孕1至2周（N = 19，13％vs N = 7，5％; P = 0.008）或超过4周（N = 15，10％vs N = 3，2 ％; P = 0.002）与计划生育券相比。这项研究的主要局限性在于，如果没有改善公共资助设施中避孕药具的可获得性，其研究结果可能无法推广到其他地区。结论这些发现表明，在用户面临避孕服务的财务，知识和结构性障碍的情况下，结构良好，有时间限制的计划生育代金券计划似乎会增加产后早期的避孕药吸收和持续使用。进一步的工作应阐明凭证在赋予WLWH权力方面的作用，以免随着时间的推移意外怀孕。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号