Early Discontinuation of Postpartum Long-Acting Reversible Contraception Among Women Living With HIV (WLWH) [7D

Abstract

INTRODUCTION: The objective of this study was to determine if WLWH were more likely than HIV negative women to remove postpartum (pp) LARC <12 months of placement (ED). METHODS: This is an IRB-approved, retrospective cohort study of women who had a LARC device (IUD or implant) placed <90 days pp and documentation of removal during the study period (1/1/09-2/14/18). Key variables were delivery date, LARC device, dates of placement and removal, age, parity, race/ethnicity, pregnancy characteristics and outcomes. Outcomes were compared using bivariate analysis. Logistic regression was used to evaluate factors associated with ED. RESULTS: 794 women who had a LARC device placed <90 days pp were eligible for analysis: 50 WLWH and 744 HIV negative women. Most women selected IUDs (85%). Median time to insertion was 42 days (IQR 35-51 days). WLWH were more likely to use implants (52% vs 87%, P<0.0001) and were more likely to receive LARC <4 days pp (76% vs 17%, P<0.0001). WLWH were not more likely to have ED (38% vs 36%, P=.9). Placement of LARC <4 days pp was associated with ED [aOR 2.6, (95% CI 1.8-3.9)]. Women who bottle fed were less likely to have ED [aOR 0.6, (CI 0.4-0.8)]. CONCLUSION: WLWH were more likely to receive LARC <4 days pp, but they were not more likely to have ED. WLWH were found to have a significantly lower pp IUD use compared to controls. Further investigation is needed to elucidate disparities in pp IUD use among WLWH.