{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T13:23:11Z","timestamp":1788355391623,"version":"build-2803163510"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2019,9,5]],"date-time":"2019-09-05T00:00:00Z","timestamp":1567641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UM1 AI068634"],"award-info":[{"award-number":["UM1 AI068634"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UM1 AI068636"],"award-info":[{"award-number":["UM1 AI068636"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UM1 AI69471"],"award-info":[{"award-number":["UM1 AI69471"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UM1 AI106701"],"award-info":[{"award-number":["UM1 AI106701"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Effective contraception is critical to young women with HIV-associated tuberculosis (TB), as unintended pregnancy is associated with increased perinatal morbidity and mortality. The effects of co-administration of efavirenz and rifampicin on the pharmacokinetics of depot medroxyprogesterone acetate (DMPA) are unknown. We hypothesized that clearance of medroxyprogesterone acetate (MPA) would increase when given with rifampicin and efavirenz, thus increasing risk of ovulation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This pharmacokinetics (PK) study assessed DMPA among HIV\/TB coinfected women on an efavirenz-based antiretroviral treatment and rifampicin-based TB treatment. Plasma MPA concentrations and progesterone were measured predose (MPA only) and 2, 4, 6, 8, 10, and 12 weeks after a single DMPA 150 mg intramuscular injection. The primary outcome measure, MPA concentration (&amp;lt;0.1 ng\/mL) at week 12, was assessed using exact 95% Clopper-Pearson confidence intervals. MPA PK parameters were calculated using noncompartmental analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 42 PK-evaluable women from 5 African countries, median age was 32 years and median CD4 was 414 cells\/mm3. Five women (11.9%; 95% CI, 4.0\u201325.6%) had MPA &amp;lt;0.1 ng\/mL at week 12; of these, one had MPA &amp;lt;0.1 ng\/mL at week 10. The median clearance of MPA was 19 681 L\/week compared with 12 118 L\/week for historical controls. There were no adverse events related to DMPA, and progesterone concentrations were &amp;lt;1 ng\/mL for all women for the study duration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>DMPA, when given with rifampicin and efavirenz, was safe. MPA clearance was higher than in women with HIV not on ART, leading to subtherapeutic concentrations of MPA in 12% of women, suggesting that more frequent dosing might be needed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trials Registration<\/jats:title>\n                  <jats:p>NCT02412436.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciz863","type":"journal-article","created":{"date-parts":[[2019,9,4]],"date-time":"2019-09-04T19:28:14Z","timestamp":1567625294000},"page":"517-524","source":"Crossref","is-referenced-by-count":9,"title":["Pharmacokinetics and Pharmacodynamics of Depot Medroxyprogesterone Acetate in African Women Receiving Treatment for Human Immunodeficiency Virus and Tuberculosis: Potential Concern for Standard Dosing Frequency"],"prefix":"10.1093","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6540-5733","authenticated-orcid":false,"given":"Rosie","family":"Mngqibisa","sequence":"first","affiliation":[{"name":"Enhancing Care Foundation, Durban International Clinical Research Site (CRS), Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle A","family":"Kendall","sequence":"additional","affiliation":[{"name":"Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Dooley","sequence":"additional","affiliation":[{"name":"Johns Hopkins Medical Institutions, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingye (Shirley)","family":"Wu","sequence":"additional","affiliation":[{"name":"Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Firnhaber","sequence":"additional","affiliation":[{"name":"University of Colorado Hospital CRS, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Mcilleron","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology, University of Cape Town, Mowbray, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Robinson","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoninah","family":"Cramer","sequence":"additional","affiliation":[{"name":"Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L","family":"Rosenkranz","sequence":"additional","affiliation":[{"name":"Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jhoanna","family":"Roa","sequence":"additional","affiliation":[{"name":"AIDS Clinical Trial Group Network Coordinating Center, Silver Spring, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine","family":"Coughlin","sequence":"additional","affiliation":[{"name":"Frontier Science and Technology Research Foundation, Amherst, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajeeda","family":"Mawlana","sequence":"additional","affiliation":[{"name":"Enhancing Care Foundation, Durban International Clinical Research Site (CRS), Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharlaa","family":"Badal-Faesen","sequence":"additional","affiliation":[{"name":"Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Schnabel","sequence":"additional","affiliation":[{"name":"Kisumu CRS, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayotunde","family":"Omoz-Oarhe","sequence":"additional","affiliation":[{"name":"Gaborone CRS, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wadzanai","family":"Samaneka","sequence":"additional","affiliation":[{"name":"Parirenyatwa CRS, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Godfrey","sequence":"additional","affiliation":[{"name":"Division of AIDS, Rockville, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan E","family":"Cohn","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Infectious Diseases Division, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the A5338 Study Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,9,5]]},"reference":[{"key":"2020072708271659500_CIT0001","volume-title":"Global tuberculosis report. 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