Do women using long-acting reversible contraception reduce condom use? A novel study design incorporating semen biomarkers.

Maria F Gallo,Markus J Steiner,Lee Warner,Denise J Jamieson

doi:10.1155/2011/107140

Abstract

Long-acting reversible contraceptive (LARC) methods are highly effective against pregnancy. A barrier to their widespread promotion can include the concern they will lead reduced condom use and, thus, will put couples at higher risk for sexually transmitted infections (STIs). We review evidence from previous studies of condom “migration” associated with the use of LARC and propose a novel study design to address the two main methodological issues that have limited these earlier studies. Namely, we propose to use a randomized controlled trial design and to use a biological marker of semen exposure for measuring changes in condom use.

Highlights

Because long-acting reversible contraception (LARC) methods have very high efficacy and low burden to users after their initiation, the American College of Obstetricians and Gynecologists recommends that women be offered LARC as first-line contraceptive methods [1]
While LARC methods are extremely effective against pregnancy, they offer no protection against the transmission of HIV and other sexually transmitted infections (STIs)
We propose a randomized design for studying the effect of introducing a specific type of LARC method (i.e., intrauterine devices (IUD), IUS, or contraceptive implant) on condom use that addresses both major methodological weaknesses inherent in the previous studies

Summary

Introduction

Because long-acting reversible contraception (LARC) methods have very high efficacy and low burden to users after their initiation, the American College of Obstetricians and Gynecologists recommends that women be offered LARC as first-line contraceptive methods [1]. Because condoms, used consistently and correctly, remain the most effective method of protection against HIV/STIs for sexually active individuals [4, 5], changes in condom use patterns from the introduction of LARC could put women and their partners at increased risk of infection. Confounding by indication could occur if the women who choose to use LARC methods (or the women whose providers promote LARC methods to) are predominantly those at low risk of HIV/STIs and, infrequent users of condoms. Those who opt to initiate a LARC method may have inherently different patterns of condom use than those who choose not to use the method; earlier studies could be biased as a result of systematic differences between groups. Participant reports of condom use could be inaccurate for many reasons, including recall bias or—especially in intervention studies

Randomized Controlled Trial Using a Semen Biomarker

Challenges to Study Design

Conclusions