Women’s Health
Contraceptive Effectiveness of Levonorgestrel Implant and Depot Medroxyprogesterone Acetate Injectable for Women Living with HIV on Dolutegravir-based Antiretroviral Therapy Katie R. Mollan* Katie Mollan Brian W. Pence Daniel Westreich Agatha Bula Clara Lemani John Chapola Sam Phiri Jane Chiwoko Michael G. Hudgens Lameck Chinula Mina C. Hosseinipour Karen Diepstra Jennifer Winston Jill M. Hagey Mackenzie Cottrell Michele Jonsson Funk Audrey Pettifor Jennifer H. Tang
Introduction: In Malawi, dolutegravir (DTG)-based antiretroviral treatment (ART) is broadly prescribed to treat HIV. Highly effective contraceptive methods are crucial for the health of women living with HIV (WLHIV). Herein, we compare the typical-use effectiveness of two common contraceptive methods, levonorgestrel (LNG) implant and Depot-Medroxyprogesterone-Acetate (DMPA) injectable, for WLHIV on DTG.
Methods: We analyzed a prospective cohort study conducted in Lilongwe, Malawi (2017-2021). Eligible participants were WLHIV ages 18-40 years who desired to not become pregnant for 4+ years and chose to initiate LNG implant or DMPA injectable 0-28 days before study enrollment. Incident pregnancies were measured by urine pregnancy testing and reported pregnancy diagnoses at study visits every 24 weeks. Analysis follow-up began at contraceptive initiation with right-censoring at the earliest of study dropout, 2+ consecutive missed visits, or no longer using LNG/DMPA contraception. The parametric g-formula was applied to estimate the contraceptive effectiveness of LNG implant vs. DMPA injectable if the entire study cohort used DTG-based ART throughout and everyone completed follow-up. Typical-use effectiveness was measured without requiring DMPA compliance.
Results: 1,359 eligible participants were enrolled and contributed 2,575 person-years (PY). At enrollment, median age was 30 (IQR: 26, 34) and 63% were lactating. Under the scenario of sustained DTG-based ART, the 192-week estimated probability of incident pregnancy was 2.6% for LNG implant and 16.1% for DMPA injectable (probability difference: -13.5%, 95% CI: -20.1%, -7.5%). The 96-week estimated probability of incident pregnancy was 0.5% for LNG implant and 8.9% for DMPA injectable (Figure).
Conclusions: For WLHIV on DTG-based ART who are seeking a reversible method to prevent pregnancy, the LNG implant is a highly effective option with better real-world effectiveness than typical use of provider-administrated DMPA.
