Hormonal Contraception and Female-to-Male HIV Transmission Risk Among Sero-discordant Couples, Zambia 1994-2012 公开

Abstract

Background: The effect of hormonal contraceptive methods (oral contraceptive pills (OCPs), implants, injectables) on HIV transmission risk from HIV-positive women to HIV-negative male partners has long been debated and is a critical public health issue, especially in areas with high HIV prevalence. Given the uncertainty of current literature, stakeholders and decision-makers require further evidence to make recommendations on contraceptive use among HIV-affected women.

Methods: HIV-discordant couples in Zambia were followed longitudinally from 1994-2012. Only couples where the woman was HIV-positive and the man was HIV-negative (M-F+) at baseline were considered in this study. Baseline and time-varying measures on demographics, behavioral, and clinical risk factors for HIV were collected at 3-month intervals. A multivariate Cox model was used to evaluate the association between hormonal contraception and time to HIV transmission from HIV+ women to HIV- male partners among couples where HIV infection was determined to be genetically linked.

Results: Out of 1,656 sero-discordant M-F+ couples that were considered in this study, 171 couples experienced genetically linked HIV transmission form the woman to man during the study period. Neither OCPs (aHR 0.92; 95% CI 0.55 - 1.55) nor implants (aHR 0.88; 95% CI 0.34 - 2.29) nor injectables (aHR 0.62; 95% CI 0.33 - 1.15) was found to be significantly associated with time to HIV infection when compared to non-hormonal methods (intrauterine device, condoms, permanent methods or no contraceptive method). These results are controlled for man's age, viral load of HIV-positive woman, male circumcision status, pregnancy status, and measures for unprotected sex (self-report, sperm present on wet prep, genital inflammation in either partner, genital ulceration among men).

Conclusion: Hormonal contraception usage among HIV-positive women does not appear to significantly increase the risk of HIV transmission to male partners among sero-discordant Zambian couples. However, the body of literature surrounding this issue remains relatively small and further research must be conducted to fully support evidence-based policy recommendations on contraceptive usage among HIV-positive women.

Table of Contents

CHAPTER I

Background 1

CHAPTER II

Introduction 6

Methods 7

Results 11

Discussion 13

References 17

Tables 21

CHAPTER III

Summary 27

Public Health Implications 28

Future Possible Directions 29

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
关键词	HIV discordant couples HIV risk longitudinal cohort Zambia hormonal contraception
Committee Chair / Thesis Advisor	Wall, Kristin, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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