Population-level impact of hormonal contraception on incidence of HIV infection and pregnancy in women in Durban, South Africa [Impact au niveau de la population de la contraception hormonale sur l'incidence de l'infection par le VIH et sur la grossesse c
HIV Prevention Research Unit, Medical Research Council, 123 Jan Hofmeyr Road, Westville, Durban, 3630, South Africa; The Kirby Institute, University of New South Wales, Sydney, Australia
Ramjee, G., HIV Prevention Research Unit, Medical Research Council, 123 Jan Hofmeyr Road, Westville, Durban, 3630, South Africa; Wand, H., The Kirby Institute, University of New South Wales, Sydney, Australia
Objective To estimate the potential impact of using hormonal contraceptives on rates of infection with human immunodeficiency virus type 1 (HIV-1) and pregnancy by theoretically removing the use of hormonal contraceptives from a study population. Methods A prospective cohort study included 3704 HIV-negative women who were enrolled in two biomedical trials that tested two vaginal microbicides (PRO 2000 and CarraguardĀ®) for the prevention of HIV-1 in Durban, South Africa, in 2004-2009. Cox proportional hazards regression models along with partial population attributable risks (PARs) and their 95% confidence intervals (CIs) were calculated to assess the relative population-level impact of the use of hormonal contraceptives on HIV-1 seroconversion rates and on pregnancy rates. Findings Women who reported using hormonal contraceptives at enrolment in the trial had a higher risk of HIV-1 seroconversion (adjusted hazards ratio: 1.24; 95% CI: 0.97-1.58) than women who reported using other types of contraceptives at enrolment. At the population level, the use of hormonal contraceptives (pills or injectables) at baseline and during study follow-up accounted for approximately 20% (95% CI: 16-22) of HIV-1 seroconversions. However, the partial PAR indicated a relative impact of 12% (95% CI: 9.0-15.7). On the other hand, 72% (95% CI: 66-77) of the pregnancies could have been avoided if all women had used hormonal contraceptives. Conclusion Women using hormonal contraceptives need comprehensive counselling on simultaneous prevention of HIV-1 infection.
carrageenan; contraceptive agent; pro 2000; contraceptive use; disease control; disease incidence; disease transmission; health impact; health risk; human immunodeficiency virus; pregnancy; womens health; adult; article; cohort analysis; condom; female; health education; hormonal contraception; human; Human immunodeficiency virus infection; incidence; pregnancy; pregnancy rate; proportional hazards model; prospective study; risk assessment; seroconversion; sexual behavior; South Africa; Adult; Age Distribution; Anti-Infective Agents; Contraceptives, Oral, Hormonal; Educational Status; Female; HIV Infections; HIV Seronegativity; HIV Seropositivity; HIV-1; Humans; Incidence; Infectious Disease Transmission, Vertical; Pregnancy; Proportional Hazards Models; Prospective Studies; Risk Factors; Sexual Behavior; South Africa; Young Adult; Durban; KwaZulu-Natal; South Africa; Human immunodeficiency virus 1