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Contraceptive uptake among adolescent girls and young women pre-screened for the MTN-034/ REACH study  

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BACKGROUND:

MTN-034/REACH is an 18-month cross-over study of oral Truvada and monthly Dapivirine ring among adolescent girls and young women (AGYW) with a choice period. As eligibility criteria includes use of reliable contraceptives for at least two months prior to enrolment, AGYW were offered choices of long (LARC) and short acting reversible contraception (SARC) as part of recruitment and pre-screening efforts. We define the pre-screening and contraceptive initiation strategies implemented at the Ugandan and Johannesburg sites conducting the REACH study and compare contraception uptake among minors (16-17 years) and young women (18-21) in different African settings.


METHODS:

Analysis included data from 205 sexually active 16-21-year old AGYW pre-screened in Johannesburg (n=89) and Uganda (n=116) between January 2019 and March 2020. A pre-screening questionnaire was implemented to explore previous contraceptive history and current contraception needs of AGYW followed by individualized contraceptive counselling and contraceptive method initiation. Chart-notes were used to document contraceptive challenges.


RESULTS:

At the Johannesburg site, 76.5% of AGYW preferred LARC (Table 1). Minors favoured LARC over SARC (92.6% vs 7.4%) as did the young women cohort (69.3% vs 30.7%). Similarly, Uganda’s data also indicated a preference for LARC (80.2%) vs SARC (19.8%). Table 1 Contraceptive Method Johannesburg Uganda Minors (n=27) Adults (n=62) Total (n=89) Minors (n=41) Adults (n=75) Total (n=116) LARC Implanon (Implant) 21 (77.8%) 24 (38.7%) 45 (50.6%) 24 (58.6%) 35 (46.7%) 59 (50.9%) Jadelle (Implant) N/A N/A N/A 6 (14.6%) 5 (6.6%) 11 (9.5%) Copper T 380A (IUD) 4 (14.8%) 16 (25.8%) 20 (22.5%) 7 (17.1%) 13 (17.3%) 20 (17.2%) Mirena (Hormonal IUD) 0 3 (4.8%) 3 (3.4%) 1 (2.4%) 2 (2.7%) 3 (2.6%) SARC Depo-Provera 1 (3.7%) 12 (19.4%) 13 (14.6%) 3 (7.3%) 20 (26.7%) 23 (19.8%) Nur-Isterate 1 (3.7%) 7 (11.3%) 8 (8.9%) N/A N/A N/A Oral Contraceptives 0 0 0 0 0 0 Common challenges related to contraceptive method uptake by AGYW included influence of family members, partners, peers and the community along with associated myths and misconceptions with use of these methods. AGYW cited lack of knowledge around contraception and fear of LARC insertions as key barriers to uptake. Use of pre-screening questionnaires and education sessions assisted in addressing these issues, whilst the accompanying extensive counselling and reassurance was key to sustained use. These sessions also provided opportunity to develop rapport with AGYW without the pressure of being enrolled in the study.


CONCLUSIONS:

Use of pre-screening strategies provides valuable insight into AGYW’s contraceptive preferences and allows provision of adequate and suitable contraceptives.