Kristin M. Wall|William Kilembe|Bellington Vwalika|Naw Htee Khu|Ilene Brill|Elwyn Chomba|Brent A. Johnson|Lisa Haddad|Amanda Tichacek|Susan Allen
Hormonal contraception does not increase women’s HIV acquisition risk in Zambian discordant couples, 1994–2012
Emory University|Rwanda Zambia HIV Research Group|Rwanda Zambia HIV Research Group|Emory University|Rwanda Zambia HIV Research Group|Emory University|University of Zambia|Rwanda Zambia HIV Research Group|Emory University|University of Alabama at Birmingham|Rwanda Zambia HIV Research Group|Emory University|Ministry of Community Development, Mother and Child Health|University of Rochester Medical Center|Rwanda Zambia HIV Research Group|Emory University|Rwanda Zambia HIV Research Group|Emory University|Rwanda Zambia HIV Research Group|Emory University
objective determine impact hormonal contraceptive methods risk hiv acquisition among hivnegative women cohabiting hivpositive male partners study design 19942012 hiv discordant couples recruited couples voluntary hiv counseling testing center lusaka zambia followed longitudinally hivnegative partners tested quarterly analysis restricted couples man hivpositive woman hivnegative enrollment man antiretroviral treatment multivariate cox models evaluated associations timevarying contraceptive methods hiv acquisition among women sensitivity analyses explored exposure misclassification timevarying confounder mediation results among 1393 couples 252 incident infections occurred women 2842 coupleyears 89 infections per 100 coupleyears 95 ci 78100 multivariate cox models indicated neither injectable adjusted hazard ratio ahr12 95 ci 0817 oral contraceptive pill ocp ahr13 95 ci 0918 implant ahr11 95 ci 0522 use significantly associated hiv acquisition relative nonhormonal contraception controlling womans age literacy timevarying measures genital ulcerationinflammation remained true looking subset infections acquired spouse 82 infections additionally controlling baseline hiv viral load male partner pregnancy status timevarying measures sperm vaginal swab wet prep selfreported unprotected sex ocp injectable users reported unprotected sex p001 ocp users likely sperm vaginal swab p1 nonhormonal method users conclusions found association hormonal contraception hiv acquisition risk women condom use reinforced condom counseling always recommended hiv discordant couples hiv testing sex partners together critical establish hiv risk ascertain couple fertility intentions counsel appropriately implications findings add controversial literature uniquely address several common design analytic challenges faced previous studies controlling confounders found association hormonal contraception hiv acquisition risk women support promoting condoms hiv prevention increasing contraceptive method mix decrease unintended pregnancy