ArticleAIDS (London, England)2025
Effectiveness of levonorgestrel implant and depot medroxyprogesterone acetate injectable for women with HIV on efavirenz.
Article in AIDS (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Abstract
objectiveWe compared the contraceptive effectiveness of typical-use LNG implant and depot medroxyprogesterone acetate (DMPA) injectable during efavirenz use.
designWe conducted a prospective cohort study of women with HIV (WHIV) on efavirenz-containing antiretroviral treatment in Lilongwe, Malawi. Eligible participants were 18-40 years of age and initiating LNG implant or DMPA injectable with a desire to prevent pregnancy for 4+ years. Study visits and urine pregnancy testing occurred at enrollment, week 4, and every 24 weeks up to week 192. Malawi's efavirenz-to-dolutegravir transition shortened our duration of efavirenz follow-up.
methodsPregnancy incidence rates/100 person-years and an incidence rate difference (IRD) were estimated using an inverse-probability-weighted Poisson model.
resultsWe enrolled 1179 WHIV on efavirenz: 592 and 587 chose to initiate the LNG implant and DMPA, respectively. Median follow-up during efavirenz use was 1.1 years [interquartile range (IQR): 0.5-1.7]. Estimated pregnancy incidence rates were 6.6/100 person-years [95% confidence interval (95% CI): 5.0-8.7] in the LNG implant enrollment group (50 pregnancies) and 7.3/100 person-years (95% CI: 5.5-9.7) in the DMPA enrollment group (54 pregnancies), IRD -0.7/100 person-years (95% CI: -3.5 to 2.0). Results were similar in an analysis of first incident pregnancy during continued typical use of LNG implant (5.7/100 person-years) versus continued typical use of DMPA (5.7/100 person-years), IRD 0.0/100 person-years (95% CI: -2.6 to 2.7).
conclusionIn many settings, LNG implant has better contraceptive effectiveness than DMPA injectable. However, for WHIV on efavirenz, we observed similar typical-use effectiveness for LNG implant versus provider-administrated DMPA injectable during the initial 1-2 years of use.
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