Dr. Othman Kakaire's PhD Defence: Intrauterine contraception among HIV positive women in Uganda; a randomised controlled trial

Friday, March 11, 2016 - 10:00
Dr. Othman Kakaire's PhD Defence: Intrauterine contraception among HIV positive women in Uganda; a randomised controlled trial

Kindly see below details about Dr. Othman Kakaire's PhD Defence. Dr.
Kakaire is a Senior Lecturer in the Department of Obstetrics and Gynaecology in the School of Medicine, MakCHS. Kindly plan to be there and support him. Attached is his abstract.

PRESENTER: Dr Kakaire Othman

TOPIC: Intrauterine contraception among HIV positive women in
Uganda: a randomised controlled trial

Date: Friday 11 March 2016

Time: 09.00am

Venue: Davies Lecture Theatre

OPPONENT:

Prof Staffan Bergstrom MD, Phd. Division of Global Health Karolinska Institutet, Stockholm, Sweden.

SUPERVISORS:

1. Assoc Prof. Byamugisha Josaphat, MBChB, MMED, PhD, Makerere
University College of Health Sciences School of Medicine

1. Assoc Prof Nazarius M Tumwesigye, B.Stat, MSc, PhD Makerere
University College of Health Sciences School of Public Health

2. Prof. Kristina Gemzell-Danielsson Md, PhD, Division Of obstetrics
And Gynaecology Department of Women and Child Health Karolinska Institutet , Sweden.

_ _

EXTERNAL EXAMINER:

Prof. G. A. B Buga, MBChB, MMED, PhD Dept of Obstetrics & Gnynaecology, Waiter Sisulu University, South Africa.

INTERNAL EXAMINERS:

2. Prof. George Nasinyama PhD , Makerere University College of
Veterinary Medicine Animal Resources and Biosecurity

3. Assoc. Prof. Makumbi Fredrick B.Stat, MHS, PhD Makerere
University College of Health Sciences School of Public Health
------------------------
PhD Candidate: Othman Kakaire
Supervisors: Nazarius M Tumwesigye, Josaphat K Byamugisha, Kristina Gemzell-Danielsson.
Title: Intrauterine Contraception among Women Living with the Human Immunodeficiency Virus. A randomized clinical trial.

Abstract

Background: Unintended pregnancy among women in HIV care remains a global public health challenge. Use of effective and safe contraceptives is an important strategy for preventing unintended pregnancy and vertical and horizontal transmission of HIV. Intrauterine contraception is effective, long acting, reversible and does not interfere with any form of medications. Despite these qualities, there is poor utilization of intrauterine contraception in sub Saharan Africa.
Aim: determine safety and acceptability of intrauterine contraception among HIV positive women.

Methods: This was a randomized controlled trial with a factorial design. The study participants were HIV positive women attending care at Makerere University Joint Aids Program clinic. All participants underwent syndromic screening for sexually transmitted infections. Women eligible for insertion of intrauterine contraceptive devices were first randomized to receive either additional laboratory test or no additional laboratory test. Thereafter they were randomised to receive levonorgestrel intrauterine system or copper intrauterine device. Baseline data for the additional laboratory screened participants was used to assess the prevalence and factors associated with asymptomatic sexually transmitted infections (I). Analysis was by intention to treat (II & III), Proportions of Nisseria Gonorrhoea, Trichomonas Vaginalis and Chlamydia trachomatis were estimated (I) Proportions of acceptability was calculated at every follow-up visit and an acceptability trend plotted (IV). Multivariable regression analysis was conducted.

Results: The overall prevalence of Nisseria Gonorrhoea, Trichomonas Vaginalis and Chlamydia Trachomatis was 11.1% (49/351). The individual prevalence for Nisseria Gonorrhoea, Trichomonas Vaginalis and Chlamydia Trachomatis was 5.9%, 5.4% and 0.9% respectively. Primary education (OR= 2.3, 95% CI: 1.09 - 4.85), having a spouse of not more than primary education (OR= 3.3, 95% CI: 1.6 - 6.78) and Muslim faith (OR= 0.2, 95% CI: 0.04 - 0.78) were the only factors independently associated with sexually transmitted infections (Paper I). There was no difference in the rate of removal of intrauterine contraception which was 8.8% (29/331) in the no additional screening group and 8.0% (27/341) in the additional laboratory screening group IRR 1.1 (95% CI 0.63-1.93) (Paper II). In total, 8.6% (29/338) women in the copper group compared with 8.1% (27/334) in the levonorgestrel group discontinued intrauterine conception within 1 year of placement (adjusted incidence rate ratio 1.1 [95% CI 0.64ÔÇô1.96]) (Paper III). Acceptability decreased from 94.3% at one month to 87.7% at twelve months in the copper group and from 96.3% at one month to 86.7% at twelve months in the levonorgestrel group and there was no difference between the two groups p-value 0.97 (Paper IV).

Conclusion: The prevalence of asymptomatic STIs related with pelvic inflammatory disease (Neisseria gonorrrheae and Chlamydia trachomatis) among HIV positive women undergoing intrauterine device insertion was low. The rates of intrauterine device removals among women who had additional Laboratory testing were similar to those who did not get additional laboratory testing for STI. In suitable candidates, discontinuation of intrauterine contraception is low regardless whether participants used levonorgestrel intrauterine system or copper intrauterine device. The acceptability of the two intrauterine devices is high and there was no difference between the two groups.

Implication: Intrauterine contraception among HIV positive women in Uganda was effective, safe and highly acceptable with a high continuation rate. Syndromic screening for STIs can be used in indentifying HIV positive women who are suitable for use of intrauterine contraception. Intrauterine contraception should be readily accessible for women in HIV/AIDS care.