{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:53:30Z","timestamp":1787961210133,"version":"build-2784847793"},"reference-count":38,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,12,25]],"date-time":"2022-12-25T00:00:00Z","timestamp":1671926400000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K23AI120855"],"award-info":[{"award-number":["K23AI120855"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The rollout of dolutegravir (DTG) in low\u2010 and middle\u2010income countries was disrupted by a potential association reported with periconceptional DTG exposure among women living with HIV (WLHIV) and infant neural tube defects. This prompted countries to issue interim guidance limiting DTG use among women of reproductive potential to those on effective contraception. Data to understand the potential impact of such guidance on WLHIV are limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort analysis of WLHIV 15\u201349 years initiating DTG\u2010containing antiretroviral treatment (ART) in Kenya from 2017 to 2020. We determined baseline effective (oral, injectable or lactational amenorrhea) and very effective (implant, intrauterine device or female sterilization) contraception use among women who initiated DTG before (Group 1) or during (Group 2) the interim guideline period. We defined incident contraception use in each group as the number of contraceptive methods initiated \u2264180 days post\u2010guideline (Group 1) or post\u2010DTG initiation (Group 2). We determined the proportions of all women who switched from DTG\u2010 to non\u2010nucleoside reverse transcriptase inhibitor (NNRTI)\u2010 (efavirenz or nevirapine) containing ART \u226412 months post\u2010DTG initiation, compared their viral suppression (&lt;1000 copies\/ml) and conducted multivariable logistic regression to determine factors associated with switching from DTG to NNRTI\u2010containing ART.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 5155 WLHIV in the analysis (median age 43 years), 89% initiated DTG after transitioning from an NNRTI. Baseline effective and very effective contraception use, respectively, by the group were: Group 1 (12% and 13%) and Group 2 (41% and 35%). Incident contraception use in each group was &lt;5%. Overall, 498 (10%) women switched from DTG to an NNRTI. Viral suppression among those remaining on DTG versus switched to NNRTI was 95% and 96%, respectively (<jats:italic>p<\/jats:italic> = 0.63). In multivariable analysis, incident effective and very effective contraception use was not associated with switching.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Baseline, but not incident, effective contraception use was higher during the interim guideline period compared to before it, suggesting women already using effective contraception were preferentially selected to initiate DTG after the guideline was released. These findings reveal challenges in the implementation of policy which ties antiretroviral access to contraceptive use. Future guidance should capture nuances of contraception decision\u2010making and support women's agency to make informed decisions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26046","type":"journal-article","created":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T04:28:27Z","timestamp":1672028907000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Contraception use and HIV outcomes among women initiating dolutegravir\u2010containing antiretroviral therapy in Kenya: a retrospective cohort study"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3156-1065","authenticated-orcid":false,"given":"John M.","family":"Humphrey","sequence":"first","affiliation":[{"name":"Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Omodi","sequence":"additional","affiliation":[{"name":"Academic Model Providing Access to Healthcare (AMPATH)  Eldoret Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6753-1098","authenticated-orcid":false,"given":"Caitlin","family":"Bernard","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercy","family":"Maina","sequence":"additional","affiliation":[{"name":"Academic Model Providing Access to Healthcare (AMPATH)  Eldoret Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Thorne","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Mwangi","sequence":"additional","affiliation":[{"name":"Department of Behavioural Science School of Medicine Moi University  Eldoret Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara","family":"Wools\u2010Kaloustian","sequence":"additional","affiliation":[{"name":"Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9893-5856","authenticated-orcid":false,"given":"Rena C.","family":"Patel","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Global Health Washington University  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,25]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(20)30231-9"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1807653"},{"key":"e_1_2_12_4_1","unstructured":"European Medicines Agency. New study suggests risk of birth defects in babies born to women on HIV medicine dolutegravir.Amsterdam;2018."},{"key":"e_1_2_12_5_1","volume-title":"FDA to evaluate potential risk of neural tube birth defects with HIV medicine dolutegravir (Juluca, Tivicay, Triumeq)","author":"Food and Drug Administration","year":"2018"},{"key":"e_1_2_12_6_1","volume-title":"Updated recommendations on first\u2010line and second\u2010line antiretroviral regimens and post\u2010exposure prophylaxis and recommendations on early infant diagnosis of HIV: interim guidelines. Supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection","author":"World Health Organization","year":"2018"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1905230"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(20)30268-X"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002719"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(19)30270-X"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.7326\/M21-3037"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-05580-0"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25352"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0b013e3180cc29f1"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32831cc0e6"},{"key":"e_1_2_12_16_1","volume-title":"Guidelines on use of antiretroviral drugs for treating and preventing HIV infection in Kenya","author":"National AIDS and STI Control Programme","year":"2018"},{"key":"e_1_2_12_17_1","unstructured":"Academic Model Providing Access to Healthcare.AMPATH;2017."},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyr080"},{"key":"e_1_2_12_19_1","volume-title":"Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach","author":"World Health Organization","year":"2018"},{"key":"e_1_2_12_20_1","volume-title":"Guidelines on use of antiretroviral drugs for treating and preventing HIV infection in Kenya","author":"National AIDS and STI Control Programme","year":"2016"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_2_12_22_1","unstructured":"Kenya Ministry of Health.Statement on the use of dolutegravir in women of child bearing age (15\u201349 yrs).Nairobi;2018."},{"key":"e_1_2_12_23_1","volume-title":"Update of recommendations on first\u2010 and second\u2010line antiretroviral regimens","author":"World Health Organization","year":"2019"},{"issue":"1","key":"e_1_2_12_24_1","first-page":"372","article-title":"The AMPATH medical record system: creating, implementing, and sustaining an electronic medical record system to support HIV\/AIDS care in western Kenya","volume":"129","author":"Tierney WM","year":"2007","journal-title":"Stud Health Technol Inform"},{"key":"e_1_2_12_25_1","volume-title":"Family planning\/contraception methods","author":"World Health Organization","year":"2020"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003081-199606000-00008"},{"key":"e_1_2_12_27_1","unstructured":"BernardC ThorneJ HumphreyJ MainaM JakaitB PatelR.Chaguo Langu \u2010 My Choice: patient perspectives on counseling and shared decision\u2010making around antiretroviral therapy and contraceptive choices.Poster session presented at: 23rd International AIDS Conference;2020Jul 6\u201310; San Francisco (virtual)."},{"key":"e_1_2_12_28_1","unstructured":"ThorneJ MainaM BernardC HumphreyJ KerichC ChangwonyS et\u00a0al.Changuo Langu: is it really her choice? Examining healthcare provider perspectives on dolutegravir and contraceptive counselling for women of reproductive age at a tertiary referral centre in Western Kenya.Poster session presented at: 23rd International AIDS Conference;2020Jul 6\u201310; San Francisco (virtual)."},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e318237ca80"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25227"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.12468"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dky497"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001279"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(16)30091-1"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-3358"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-021-05850-0"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0222229"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(20)30238-1"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab086"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26046","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.26046","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26046","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T11:36:10Z","timestamp":1692531370000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.26046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12]]},"references-count":38,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1002\/jia2.26046"],"URL":"https:\/\/doi.org\/10.1002\/jia2.26046","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12]]},"assertion":[{"value":"2021-12-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e26046"}}