Comparative Effectiveness of Levonorgestrel Implant and Depot Medroxyprogesterone Acetate Injectable for Women Living With HIV on Dolutegravir-Based Antiretroviral Therapy.

BACKGROUND

Dolutegravir (DTG)-based antiretroviral treatment (ART) is broadly prescribed to treat HIV. Effective family planning methods are important for the health of women with HIV (WWH) and their families. For WWH on DTG-based ART, we compared the typical-use effectiveness of levonorgestrel (LNG) implant and Depot-Medroxyprogesterone-Acetate (DMPA) injectable, two commonly used contraceptive methods.

METHODS

We analyzed a prospective cohort study conducted in Lilongwe, Malawi from 2017 to 2021. Eligible participants were WWH ages 18-40 years who desired not to get pregnant for ≥ 4 years and chose to initiate either LNG implant or provider-administered DMPA injectable 0-28 days before study enrollment. Incident pregnancies were measured by urine pregnancy testing and pregnancy diagnoses at study visits every 24 weeks. The parametric g-formula was applied to estimate the contraceptive effectiveness of LNG implant compared to provider-administered DMPA injectable, assuming the entire study cohort had used DTG-based ART throughout. Contraceptive effectiveness was measured during typical, continued use.

RESULTS

Overall, 1359 eligible participants were enrolled. At enrollment, the median age was 30 (IQR: 26, 34), and 63% were breastfeeding. With DTG-based ART, the estimated 96-week pregnancy risk was 0.5% with LNG implant and 8.9% with DMPA injectable. The estimated 192-week pregnancy risk was 2.6% with LNG implant and 16.1% with DMPA injectable (risk difference: -13.5 percentage points, 95% CI: -20.1%, -7.5%).

CONCLUSIONS

For WWH on DTG-based ART who are seeking reversible contraception, the LNG implant is an effective contraceptive and has substantially higher effectiveness than provider-administered DMPA injectables.