Contraceptive method continuation among a prospective cohort study of Malawian women on antiretroviral treatment initiating the Levonorgestrel Implant or the Depot Medroxyprogesterone Acetate Injectable for pregnancy prevention (the FP-ART study).

Limited prospective data exist for long-term hormonal contraceptive continuation rates among women living with HIV. We conducted a prospective cohort study of women living with HIV in Lilongwe, Malawi from 2017 to 2021 and evaluated their contraceptive method continuation and ART regimens. Participants initiating either depot medroxyprogesterone acetate (DMPA) injection or levonorgestrel (LNG) implant were followed every 24 weeks for up to 192 weeks. 1,359 participants enrolled in the study; 689 initiated the DMPA injection, and 670 initiated the LNG implant. At enrollment, DMPA and implant users had similar age, body mass index, educational levels, number of children, breastfeeding status, future pregnancy intention, CD4 count, and HIV viral load. 1,179 participants (86.8%) usedefavirenz-based therapy at enrollment, with 874 (74.1%) switching to dolutegravir-based therapy by their last study visit. During study follow-up, 225 (32.7%) DMPA and 141 (21.0%) implant users discontinued their initial contraceptive method. Time to method discontinuation differed between the two contraceptive groups (log-rank p < 0.001). The time by which 25% of women had discontinued their initial contraceptive also differed markedly: 76.0 weeks for the DMPA group and 142.7 weeks for the implant group. Future studies can evaluate the factors that lead to contraceptive continuation versus discontinuation among WLWH.