Search

Objective: To create and assess a clinic model to address the unmet need for effective contraception among women living with HIV in Botswana, where half of all pregnancies are unintended and 30% of women of reproductive age are living with HIV.\ud Methods: We introduced family planning services into an HIV clinic in Gaborone, Botswana. Our intervention gave HIV providers brief training on contraceptive counseling plus the option of immediate referral of interested patients to an on-site contraception\ud provider. We administered a survey to patients and providers before and after intervention. Patients were female, aged 18–45 years and using antiretrovirals. \ud Results: At baseline, 6% of 141 patients discussed contraception with their HIV-care provider, compared with 61% of 107 post intervention (P < 0.001). At baseline, 6% of patients reported wanting to use long-acting reversible contraception (LARC). Post intervention, 45% of patients chose to meet with the contraception provider, and 29%\ud wanted to use LARC (P < 0.001 versus baseline). All providers strongly agreed that they were better informed about contraception post intervention and were satisfied with their ability to counsel and refer women for contraception.\ud Conclusions: Provision of on-site contraceptive services in this HIV clinic encouraged family planning discussions and increased interest in LARC.\ud K E YWORDS\ud Botswana, contraception, family planning, HIV, service integration

Objective\ud To compare plasma etonogestrel concentrations sampled from the contralateral- versus ipsilateral-to-implant arm.\ud Study design\ud Sub-analysis of a cross-sectional study in Botswana in 33 participants who provided contralateral and ipsilateral blood samples.\ud Results\ud Plasma etonogestrel concentrations in contralateral and ipsilateral specimens were highly correlated (correlation coefficient = 0.99; p < 0.0001). Bland–Altman analysis of agreement showed that etonogestrel levels were on average 5.9 pg/mL higher (2.1%) in ipsilateral compared to contralateral specimens (95% confidence interval: −4.1, 15.9 pg/mL).\ud Conclusions\ud We found no meaningful differences in plasma etonogestrel concentrations between samples taken from the contralateral- versus ipsilateral-to-implant arm.\ud Implications\ud Our data suggest that etonogestrel plasma concentrations are unlikely to be meaningfully different between samples drawn from the ipsilateral- versus the contralateral-to-implant arms in etonogestrel contraceptive implant users.

Objectives:\ud To evaluate whether etonogestrel concentrations are reduced to a level that could potentially reduce contraceptive efficacy when the etonogestrel contraceptive implant is used concomitantly with dolutegravir-based antiretroviral therapy (ART).\ud \ud Study Design:\ud We conducted a non-randomized, open-label, cross-sectional pharmacokinetic study among women using single-rod etonogestrel contraceptive implants in Botswana. We compared plasma etonogestrel concentrations, sampled at a single time-point between 3 and 12 months from implant insertion, among implant users living with HIV and receiving dolutegravir-based ART with HIV-negative implant users. We also assessed concentrations among implant users living with HIV and receiving efavirenz-based ART. We compared geometric mean etonogestrel concentrations analyzing data from 142 participants: 97 HIV-negative, 30 using dolutegravir, and 15 using efavirenz.\ud \ud Results:\ud The groups were similar. Duration of implant use was between 3 and 12 months (median=5). Geometric mean etonogestrel plasma concentrations and 90% confidence intervals of the mean were 227.5(212.4-243.8), 289.6(251.8-333.0) and 76.4(63.9-91.4) pg/mL among the HIV-negative, dolutegravir- and efavirenz-based ART groups, respectively. All women in the HIV-negative and dolutegravir-based ART groups had etonogestrel concentrations above 90pg/mL; 9/15 women (60%) using efavirenz-based ART had concentrations below 90 pg/mL. On average, etonogestrel levels were lower among individuals who had implants inserted for longer durations.\ud \ud Conclusions:\ud Implant users receiving dolutegravir-based ART had a higher mean etonogestrel concentration compared to HIV-negative women, and none had etonogestrel concentrations below the posited threshold for ovulation suppression. In contrast, women in the efavirenz-group had much lower etonogestrel concentrations. Overall, these data provide evidence that the etonogestrel implant may be effectively combined with dolutegravir-based ART regimens.

The etonogestrel (ENG) subdermal contraceptive implant (Implanon NXT®) is a safe and highly effective method of contraception which is increasing in popularity globally. This case report describes a 26-year-old woman who requested removal of the Implanon NXT® contraceptive implant. She reported that her implant had bent following direct trauma. The implant was removed in accordance with her request and without complication, but was noted to be incompletely fractured. We compare this case with a summary of the existing literature on fractured or damaged contraceptive implants. Structural damage detected whilst the implant is in situ is one potential complication of contraceptive implant use. The incidence of this complication and the implications for contraceptive efficacy are unknown. Damaged implants may present healthcare providers with more technically challenging ―difficult removals‖. With the scale-up of services for implant provision, consideration should be given to this issue in order to inform counselling and removal services.Keywords: Contraception, contraceptive implant, implant removal, fractured implant, Implanon NXT®L'implant contraceptif sous-cutané étonogestrel (ENG) (Implanon NXT®) est une méthode de contraception sûre et très efficace qui gagne en popularité dans le monde entier. Ce rapport de cas décrit une femme de 26 ans qui a demandé le retrait de l'implant contraceptif du type Implanon NXT®. Elle a signalé que son implant s'était plié à la suite d'un traumatisme direct. L'implant a été retiré conformément à sa demande et sans complication, mais il a été noté qu'il était incomplètement fracturé. Nous comparons ce cas avec un résumé de la documentation existante sur les implants contraceptifs fracturés ou endommagés. Les dommages structuraux détectés lorsque l'implant est in situ sont une complication potentielle de l'utilisation d'implants contraceptifs. L'incidence de cette complication et les implications pour l'efficacité contraceptive sont inconnues. Les implants endommagés peuvent présenter aux prestataires de soins de santé des «déménagements difficiles» plus difficiles sur le plan technique. Avec l'intensification des services de fourniture d'implants, il convient de tenir compte de cette question afin d'informer les services de conseil et de retrait.Mots-clés: Contraception, implant contraceptif, retrait d'implant, implant fracturé, Implanon NXT®