背景:高效长效可逆避孕(LARC)方法可降低意外怀孕率;但是,这些方法没有得到充分利用。LOWE试验干预提供了结构化的避孕咨询,导致LARC的摄取增加。LOWE研究的纵向随访通过调查12个月时的避孕药具使用,重点是继续使用LARC,评估了干预措施的长期影响。
方法:在整群随机LOWE试验中,流产,青春,和孕产妇保健诊所随机提供结构化避孕咨询(干预)或标准避孕咨询(对照).干预包括一个关于避孕方法的教育视频,医疗保健提供者提出的关键问题,一个分层的有效性图表和一盒避孕模型。年龄≥18岁的女性,在接下来的6个月内性活跃或计划性活跃,可以参与研究。我们在三岁时评估了自我报告的避孕药具使用情况,6个月和12个月。对避孕药具的选择和切换进行描述性统计分析。使用混合逻辑回归分析12个月时的避孕药具使用和持续使用LARC,临床包括作为随机效应。对缺失数据进行了估算值的分析,以测试结果的稳健性。
结果:总体而言,12个月时,与对照组相比,干预组女性更有可能使用LARC方法(aOR1.90,95%CI:1.31~2.76),而使用短效可逆避孕(SARC)方法(aOR0.66,95%CI:0.46~0.93)的可能性较小.接受堕胎咨询的妇女(aOR2.97,95%CI:1.36-6.75)和青年诊所(aOR1.81,95%CI:1.08-3.03)更有可能使用LARC方法,而在孕产妇保健诊所中没有发现显着差异(aOR1.84,95%CI:0.96-3.66)。在启动LARC的女性中,12个月时的延续率在研究组之间没有差异(63.9%vs.63.7%)。停止避孕的最常见原因是希望怀孕,其次是不规则出血,和情绪变化。
结论:LOWE试验干预在12个月时也导致LARC使用增加。需要进一步研究如何维持LARC使用的策略。
BACKGROUND: Highly effective long-acting reversible contraceptive (LARC) methods reduce unintended pregnancy rates; however, these methods are underutilized. The LOWE trial intervention provided structured contraceptive counseling resulting in increased uptake of LARC. This longitudinal follow up of the LOWE study assessed the long-term impact of the intervention by investigating the contraceptive use at 12 months with a focus on continued use of LARC.
METHODS: In the cluster randomized LOWE trial, abortion, youth, and maternal health clinics were randomized to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of an educational video on contraceptive methods, key questions asked by the health care provider, a tiered effectiveness chart and a box of contraceptive models. Women ≥ age 18, who were sexually active or planned to be in the upcoming 6 months, could participate in the study. We assessed self-reported contraceptive use at three, six and 12 months. Contraceptive choice and switches were analyzed with descriptive statistics. Contraceptive use at 12 months and continued use of LARC were analyzed using mixed logistic regressions, with clinic included as a random effect. Analysis with imputed values were performed for missing data to test the robustness of results.
RESULTS: Overall, at 12 months, women in the intervention group were more likely to be using a LARC method (aOR 1.90, 95% CI: 1.31-2.76) and less likely to be using a short-acting reversible contraceptive (SARC) method (aOR 0.66, 95% CI: 0.46-0.93) compared to the control group. Women counseled at abortion (aOR 2.97, 95% CI: 1.36-6.75) and youth clinics (aOR 1.81, 95% CI: 1.08-3.03) were more likely to be using a LARC method, while no significant difference was seen in maternal health clinics (aOR 1.84, 95% CI: 0.96-3.66). Among women initiating LARC, continuation rates at 12 months did not differ between study groups (63.9% vs. 63.7%). The most common reasons for contraceptive discontinuation were wish for pregnancy, followed by irregular bleeding, and mood changes.
CONCLUSIONS: The LOWE trial intervention resulted in increased LARC use also at 12 months. Strategies on how to sustain LARC use needs to be further investigated.