Evidence map›Paper›PMID 26520927›Full record

ReviewThe lancet. HIV2015

Pregnancy rates in HIV-positive women using contraceptives and efavirenz-based or nevirapine-based antiretroviral therapy in Kenya: a retrospective cohort study.

Rena C Patel, Maricianah Onono, Monica Gandhi, Cinthia Blat, Jill Hagey, Starley B Shade, Eric Vittinghoff, Elizabeth A Bukusi, Sara J Newmann, Craig R Cohen

Open access · greenAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in The lancet. HIV, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
57citing papers in PubMed, 2 pooled it
6.8field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

57 citing papers in PubMed, 2 syntheses or guidelines pooled it, 81 citations in OpenAlex.

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  14. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2024
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 2 countries.

Rena C PatelDivision of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA. Electronic address: rcpatel@uw.edu.
Maricianah OnonoResearch, Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.
Monica GandhiDivision of HIV/AIDS, University of California, San Francisco, San Francisco, CA, USA.
Cinthia BlatBixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
Jill HageySchool of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Starley B ShadeCenter for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA.
Eric VittinghoffDepartment of Medicine, and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
Elizabeth A BukusiResearch, Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.
Sara J NewmannBixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
Craig R CohenBixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
University of California, San Francisco · USIbis Reproductive Health · USKenya Medical Research Institute · KE

Funding

SUPPORTING THE IMPLEMENTATION AND EXPANSION OF HIGH QUALITY HIVU2GPS001913 · PS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI COHEN, CRAIG R · 2010 to 2016
$57.6M
Clinical and Transtional Science InstituteKL2TR000143 · NCATS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI GRANDIS, JENNIFER RUBIN · 2012 to 2015
$11.9M
BIOLOGY OF INFECTIOUS DISEASES TRAINING PROGRAMT32AI007641 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI MATTHEW G DORSEY · 2000 to 2026
$6.9M
Plugging Hair ARV Levels as Adherence Biomarkers into HIV Prevention TrialsR01AI098472 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI GANDHI, MONICA · 2012 to 2021
$5.6M
“Hair Lengthening”: Using Hair Levels to Interpret Long-Acting PrEP Studies.R37AI098472 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Monica Gandhi · 2023 to 2026
$3.2M
Investigating interactions between efavirenz-based antiretroviral therapy and contraceptive implantsK23AI120855 · NIAID · UNIVERSITY OF WASHINGTON · PI PATEL, RENA CHIMAN · 2015 to 2019
$850k
NCATS NIH HHS KL2 TR000143NCATS NIH HHS KL2TR000143NCHHSTP CDC HHS PS001913NIAID NIH HHS K23 AI120855NIAID NIH HHS K23AI120855NIAID NIH HHS R37 AI098472NIAID NIH HHS T32 AI007641NIAID NIH HHS T32AI007641PEPFAR
6 · The paper itself

Abstract

backgroundConcerns have been raised about efavirenz reducing the effectiveness of contraceptive implants. We aimed to establish whether pregnancy rates differ between HIV-positive women who use various contraceptive methods and either efavirenz-based or nevirapine-based antiretroviral therapy (ART) regimens.

methodsWe did this retrospective cohort study of HIV-positive women aged 15-45 years enrolled in 19 HIV care facilities supported by Family AIDS Care and Education Services in western Kenya between Jan 1, 2011, and Dec 31, 2013. Our primary outcome was incident pregnancy diagnosed clinically. The primary exposure was a combination of contraceptive method and efavirenz-based or nevirapine-based ART regimen. We used Poisson models, adjusting for repeated measures, and demographic, behavioural, and clinical factors, to compare pregnancy rates among women receiving different contraceptive and ART combinations.

findings24,560 women contributed 37,635 years of follow-up with 3337 incident pregnancies. In women using implants, adjusted pregnancy incidence was 1.1 per 100 person-years (95% CI 0.72-1.5) for nevirapine-based ART users and 3.3 per 100 person-years (1.8-4.8) for efavirenz-based ART users (adjusted incidence rate ratio [IRR] 3.0, 95% CI 1.3-4.6). In women using depot medroxyprogesterone acetate, adjusted pregnancy incidence was 4.5 per 100 person-years (95% CI 3.7-5.2) for nevirapine-based ART users and 5.4 per 100 person-years (4.0-6.8) for efavirenz-based ART users (adjusted IRR 1.2, 95% CI 0.91-1.5). Women using other contraceptive methods, except for intrauterine devices and permanent methods, had 3.1-4.1 higher rates of pregnancy than did those using implants, with 1.6-2.8 higher rates in women using efavirenz-based ART.

interpretationAlthough HIV-positive women using implants and efavirenz-based ART had a three-times higher risk of contraceptive failure than did those using nevirapine-based ART, these women still had lower contraceptive failure rates than did those receiving all other contraceptive methods except for intrauterine devices and permanent methods. Guidelines for contraceptive and ART combinations should balance the failure rates for each contraceptive method and ART regimen combination against the high effectiveness of implants.

fundingNone.

Indexed as

Pregnancy RateAdolescentAdultAlkynesAnti-HIV AgentsBenzoxazinesContraceptive AgentsCyclopropanesDrug Therapy, CombinationFemaleHIV InfectionsHumansKenyaLongitudinal StudiesNevirapinePregnancyAlkynesAnti-HIV AgentsBenzoxazinesContraceptive AgentsCyclopropanesefavirenzNevirapine

Identifiers

PMID26520927
PMCPMC4632202
OpenAlexW2111348288

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.