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Hormonal contraceptive use in HIV-infected women using antiretroviral therapy: A Systematic review.

ABSTRACT: BACKGROUND:While extensive research has explored pharmacokinetic interactions between antiretroviral therapy and hormonal contraception, few studies have examined whether these interactions affect clinical outcomes. To address this gap, we conducted a systematic review of the literature that describes hormonal contraceptive among HIV infected women who also antiretroviral therapy, focusing on papers that address clinically important outcomes such as pregnancy or ovulation. METHODS:An electronic literature search was conducted of PUBMED and OVID to identify all articles that addressed hormonal contraception co-administered with antiretroviral therapy published in English between 01 January 1990 and 30 October 2014. In addition, manual reference checks of all articles of interest were conducted to identify articles not captured in the electronic search. Our search criteria identified 405 records. The title and abstract of data reports retrieved via the search were reviewed to identify potential articles of interest. Those with any indication of the main outcomes of interest were considered for inclusion (N=162). Abstracts were then reviewed to identify those manuscripts that would merit a review of the full text version (N=64). Eight articles that addressed the outcomes of interest were identified. The Newcastle-Ottawa Scale was used to assess the quality of these articles. RESULTS:The studies reviewed were limited in a number of ways that precluded their providing a rigorous assessment of the efficacy of contraception when co-administered with antiretroviral therapy. DISCUSSION:None of the studies were of adequate quality to provide the guidance that providers and HIV infected women need when considering contraceptive options. High quality, well-powered studies are required to address the efficacy of hormonal contraception when co-administered with antiretroviral therapy.

SUBMITTER: Womack JA

PROVIDER: S-EPMC5611808 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Hormonal contraceptive use in HIV-infected women using antiretroviral therapy: A Systematic review.

Womack Julie A JA Novick Gina G Goulet Joseph L JL

Open access journal of contraception 20150507

<h4>Background</h4>While extensive research has explored pharmacokinetic interactions between antiretroviral therapy and hormonal contraception, few studies have examined whether these interactions affect clinical outcomes. To address this gap, we conducted a systematic review of the literature that describes hormonal contraceptive among HIV infected women who also antiretroviral therapy, focusing on papers that address clinically important outcomes such as pregnancy or ovulation.<h4>Methods</h4 ...[more]

PMID: 28955156

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Project description:BackgroundDespite global progress in the fight to reduce maternal mortality, HIV-related maternal deaths remain persistently high, particularly in much of Africa. Lifelong antiretroviral therapy (ART) appears to be the most effective way to prevent these deaths, but the rates of three key outcomes--ART initiation, retention in care, and long-term ART adherence--remain low. This systematic review synthesized evidence on health systems factors affecting these outcomes in pregnant and postpartum women living with HIV.MethodsSearches were conducted for studies addressing the population of interest (HIV-infected pregnant and postpartum women), the intervention of interest (ART), and the outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. A four-stage narrative synthesis design was used to analyze findings. Review findings from 42 included studies were categorized according to five themes: 1) models of care, 2) service delivery, 3) resource constraints and governance challenges, 4) patient-health system engagement, and 5) maternal ART interventions.ResultsLow prioritization of maternal ART and persistent dropout along the maternal ART cascade were key findings. Service delivery barriers included poor communication and coordination among health system actors, poor clinical practices, and gaps in provider training. The few studies that assessed maternal ART interventions demonstrated the importance of multi-pronged, multi-leveled interventions.ConclusionsThere has been a lack of emphasis on the experiences, needs and vulnerabilities particular to HIV-infected pregnant and postpartum women. Supporting these women to successfully traverse the maternal ART cascade requires carefully designed and targeted interventions throughout the steps. Careful design of integrated service delivery models is of critical importance in this effort. Key knowledge gaps and research priorities were also identified, including definitions and indicators of adherence rates, and the importance of cumulative measures of dropout along the maternal ART cascade.

Dataset Information

Hormonal contraceptive use in HIV-infected women using antiretroviral therapy: A Systematic review.

Publications

Hormonal contraceptive use in HIV-infected women using antiretroviral therapy: A Systematic review.

Similar Datasets

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