Intrauterine contraceptive discontinuation reasons among female trial participants living with HIV in Cape Town, South Africa: A qualitative analysis

Subarna Pradhan; Elizabeth E Tolley; Nontokozo Langwenya; Heidi E Jones; Donald R Hoover; Gregory Petro; Landon Myer; Catherine S Todd

doi:10.3389/fgwh.2023.1010794

Intrauterine contraceptive discontinuation reasons among female trial participants living with HIV in Cape Town, South Africa: A qualitative analysis

Front Glob Womens Health. 2023 Mar 24:4:1010794. doi: 10.3389/fgwh.2023.1010794. eCollection 2023.

Authors

Subarna Pradhan¹, Elizabeth E Tolley¹, Nontokozo Langwenya², Heidi E Jones³, Donald R Hoover⁴, Gregory Petro⁵, Landon Myer², Catherine S Todd¹

Affiliations

¹ Global Health, Population, and Nutrition Department, FHI 360, Durham, NC United States.
² Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
³ Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, United States.
⁴ Department of Statistics and Institute for Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ, United States.
⁵ Department of Obstetrics and Gynaecology, University of Cape Town and New Somerset Hospital, Cape Town, South Africa.

Abstract

Introduction: While young women in South Africa may navigate both HIV infection and pregnancy risks, intrauterine contraceptive (IUC) use is low. Though IUCs have low failure rates, concerns exist about whether the IUC is an appropriate method choice for women living with HIV (WLHIV). In this qualitative study, we explore WLHIVs' experiences of using IUC and reasons for discontinuation.

Methods: This qualitative study included in-depth interviews (IDIs) with 17 WLHIV who electively discontinued their allocated IUC while participating in a randomized controlled trial comparing the safety of the levonorgestrel intrauterine system (LNG-IUS) and the copper intrauterine device (C-IUD) in Cape Town, South Africa. The transcripts were coded and emergent themes were grouped to examine women's experiences with IUC use and reasons for discontinuation, highlighting experiential differences between the two methods.

Results: Women's experience with the allocated IUC related most commonly to bleeding and/or abdominal pain just after insertion. Most C-IUD discontinuers, but only one LNG-IUS discontinuer, complained of pain and/or increased bleeding as the main reason for removal. Three women (two LNG-IUS, one C-IUD) requested removal because they desired pregnancy, while two others discontinued due to fears the IUC was exacerbating non-gynecologic conditions (hypertension, diabetes). Generally, women acknowledged advantages of IUC use and many expressed their desire to continue use if not for the side effects.

Conclusions: In the South African context, IUC use for WLHIV should be promoted with specific counseling considerations. Both providers and potential users should receive specific information about potential menstrual-related side effects and countering common misperceptions to enable informed contraceptive decision-making.

Keywords: HIV; bleeding side-effects; contraception; discontinuation; intrauterine device; long-acting reversible contraception.

Grants and funding

This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Development R01 HD071804 and by the United States Agency for International Development Prevention Technologies Agreement (No. GHO-A-00-09-00016-00). We received in-kind donations from Bayer Pharmaceuticals (Mirena LNG-IUS), the Western Cape Government (C-IUDs), Sekisui Diagnostics (a portion of Osom BV Blue and Trichomonas), Cepheid Inc (a portion of Xpert CT/NG cartridges), and Alere-Abbott (Determine Syphilis RDTs). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.