{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:57:48Z","timestamp":1753869468516,"version":"3.41.2"},"reference-count":31,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T00:00:00Z","timestamp":1662595200000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Contraceptive implants containing etonogestrel and levonorgestrel have emerged as popular contraceptive options among women in areas of high HIV burden in sub\u2010Saharan Africa. However, recent pharmacokinetic data have shown drug\u2013drug interactions between implants and efavirenz\u2010containing antiretroviral therapy (ART), reducing the effectiveness of the implants. Here, we evaluated pregnancy incidence in 6\u2010month intervals following implant initiation among women using efavirenz and contraceptive implants to assess whether the risk of breakthrough pregnancy is higher after specific periods of implant use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used data from a retrospective longitudinal analysis of women living with HIV ages 18\u201345 years in western Kenya who attended HIV\u2010care facilities between 2011 and 2015. We used Cox proportional hazard models to compute hazard ratios (HRs) for breakthrough pregnancy by implant type and ART regimen. Depending on the model, we adjusted for socio\u2010demographic and clinical factors, programme, site and interaction between calendar time and ART regimen. We utilized inverse probability weights (IPWs) to account for three sampling phases (electronic medical record [EMR], chart review and phone interview) and calculated overall parameter estimates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Women contributed 14,768 woman\u2010years from the largest sampling phase (EMR). The median age was 31 years. Women used etonogestrel implants for 26\u201369% of the time and levonorgestrel implants for 7\u201331% of the time, depending on the sampling phase. Women used efavirenz, nevirapine or no ART for 27\u201333%, 40\u201346% and 15\u201326% of follow\u2010ups, respectively. When combining sampling phases, there was little evidence to suggest that the relative hazard of pregnancy among efavirenz\u2010containing ART users relative to nevirapine\u2010containing ART changed with length of time on implants: IPW\u2010adjusted HR of 3.1 (CI: [1.5; 6.4]) at 12 months, 3.4 (CI: [1.8; 6.3]) at 24 months, 3.8 (CI: [1.9; 7.7]) at 36 months and 4.2 (CI: [1.6; 11.1]) at 48 months (interaction <jats:italic>p<\/jats:italic>\u2010value = 0.88). Similarly, no significant change in HRs over time was found when comparing women not using ART to nevirapine\u2010containing ART users (interaction <jats:italic>p<\/jats:italic>\u2010value = 0.49).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We did not find evidence to suggest implants being more fallible from drug\u2013drug interactions with efavirenz at later time intervals of implant use. Thus, we would not recommend shortening the duration of implant use or replacing implants sooner when concomitantly used with efavirenz.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26001","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T13:24:25Z","timestamp":1662643465000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Contraceptive implant use duration is not associated with breakthrough pregnancy among women living with HIV and using efavirenz: a retrospective, longitudinal analysis"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2619-7721","authenticated-orcid":false,"given":"Randy M.","family":"Stalter","sequence":"first","affiliation":[{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Amorim","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. Rain","family":"Mocello","sequence":"additional","affiliation":[{"name":"Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology &amp; Reproductive Sciences University of California San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatrice","family":"Jakait","sequence":"additional","affiliation":[{"name":"Moi Teaching &amp; Referral Hospital\/Moi University &amp; Academic Model Providing Access to Healthcare (AMPATH)  Eldoret Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan E.","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beverly","family":"Musick","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science School of Medicine Indiana University  Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin","family":"Bernard","sequence":"additional","affiliation":[{"name":"Division of Family Planning Department of Obstetrics &amp; Gynecology Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A.","family":"Bukusi","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kara","family":"Wools\u2010Kaloustian","sequence":"additional","affiliation":[{"name":"Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig R.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology &amp; Reproductive Sciences University of California San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constantin T.","family":"Yiannoutsos","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science R.M. Fairbanks School of Public Health Indiana University  Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rena C.","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases Department of Medicine and Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the Implant\/Efavirenz Study Group and the East Africa IeDEA regional consortium","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,9,8]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-018-2346-4"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3217-3"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0091-2182(98)00063-9"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1744-8603-10-36"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1728-4465.2008.00148.x"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0066593"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001055"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-17-00396"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2011.01.021"},{"key":"e_1_2_12_11_1","unstructured":"DataLab.The DHS Program Statcompiler. 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