A Randomized Trial of IUD Versus Hormonal Contraception in HIV-infected Women in Zambia

The University of Alabama at Birmingham

Status and phase: Completed; Phase 3

Conditions: HIV Infection; Pregnancy

Treatments: Drug: Hormonal Contraception; Device: Copper T Intrauterine Contraceptive Device

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT00336245

EGPAF PG-51161

Details and patient eligibility

About

A randomized trial of the intrauterine contraceptive device (IUD) versus user's choice hormonal contraception (injectable progestins or oral contraceptive pills) among HIV-infected, recently post-partum women in Lusaka, Zambia.

Full description

In the year 2000, there were over 37, 000 new acceptors of family planning in the Lusaka District Clinics. A variety of methods were prescribed, including combined oral contraceptive pills, injectable progestins, the intrauterine copper device, condoms, and others. The most recent sentinel survey of reproductive age women estimated that approximately 30% of reproductive age women in Lusaka are HIV-infected. Since voluntary HIV counseling and testing is not yet universally available in many of the district clinics, women receive all different types of contraception regardless of their HIV status.

There is some observational data published recently that suggests hormonal contraception may increase HIV viral load in the female genital tract and potentially increase HIV transmission to the male partner. By contrast, barrier methods have historically been very unpopular in stable couples and are not used consistently in many cases despite intensive counseling. The IUCD represents one of the most inexpensive and effective methods of birth control available in Lusaka. However, it has not been studied adequately to make policy recommendations regarding its use in HIV infected women. The purpose of this study will be to evaluate safety and acceptability of the IUCD versus hormonal methods of contraception in HIV-infected and uninfected women in Lusaka. Specifically, we will 1) compare the contraceptive effectiveness of the IUCD to the standard practices of user-chosen hormonal contraception, 2) compare the rates of pelvic infection between IUD and hormonal contraceptive users, and 3) compare rates of method discontinuation.

Patients who have a continuing second trimester pregnancy, serologically confirmed HIV infection, a desire for 24 months of contraception, and a willingness to be randomly assigned either an IUCD or hormonal contraception postpartum will be screened at 32 weeks in their pregnancies to receive either an IUCD or user chosen hormonal contraception postpartum. Women will then be seen at postpartum weeks 4-6 for method randomization and then at months 6, 12, 18 and 24 to monitor pregnancy, continuation of method, side effects and any other problems. Women will be encouraged to return for problems at any time. At least once yearly, women will have a complete physical exam. CD4 and HIV clinical status will be monitored regularly.

Sex: Female

Ages: 16+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• desire for at least 2 years of continuous contraception
• two or fewer sexual partners in the prior year

Exclusion criteria

• advanced HIV disease (WHO Stage III or IV)
• history of a bleeding disorder
• history of PID within the prior five years
• less than 16 years of age (the "age of majority" in Zambia).

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

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600 participants in 2 patient groups

Copper T Intrauterine Contraceptive Device

Experimental group

Treatment:

Device: Copper T Intrauterine Contraceptive Device

Hormonal Contraception

Active Comparator group

Treatment:

Drug: Hormonal Contraception