Browsing by Subject "Contraception"
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Item Open Access Cervical and systemic concentrations of long acting hormonal contraceptive (LARC) progestins depend on delivery method: Implications for the study of HIV transmission.(PloS one, 2019-01) Buckner, Lyndsey R; Drobnis, Erma Z; Augustine, Molly S; Rogers, Lynette K; Akers, Jill; Mott, Patricia D; Hope, Thomas J; Quayle, Alison J; Schust, Danny JProgestin-only long-acting reversible contraceptives (LARCs) are increasingly popular among women seeking contraception; however, recent epidemiological studies suggest that systemically administered medroxyprogesterone acetate (MPA) may increase HIV acquisition. In order to determine the exact mechanisms underlying increases in transmission specific to MPA use and to test safer, alternative contraceptive progestin types and delivery methods, in vitro modeling studies must be performed. To achieve this, it is imperative that accurate hormone concentrations be utilized when modeling progestin-mediated outcomes, as the down-stream effects are dose-dependent. The local concentrations of progestins to which the lower female genital tract tissues are exposed after initiation of LARCs are unknown, but they likely differ from peripheral concentrations, dependent upon the progestin type and delivery method. Here, we measured in vivo endocervical and plasma concentrations of (1) systemically-delivered depo MPA (DMPA), (2) levonorgestrel (LNG) delivered via intrauterine system (IUS) and (3) etonogestrel (ETG) delivered via vaginal ring in women who recently initiated contraception treatment. Levels of ETG and LNG in cervical secretions were 100-200 fold higher than plasma levels. In contrast, measurable MPA levels were approximately 10-fold higher in plasma compared to cervical secretions. These results will inform the design of accurate in vitro studies on the influence of progestins on epithelial cells, tissue explants, and peripheral blood cells, to be able to better predict in vivo outcomes. Subsequent observations will aid in determining how MPA might influence HIV acquisition and may facilitate identification of optimal progestin-containing LARC alternatives for women at high risk for HIV infection.Item Open Access Effects of three long-acting reversible contraceptive methods on HIV target cells in the human uterine cervix and peripheral blood.(Reproductive biology and endocrinology : RB&E, 2019-02) Li, Liping; Zhou, Jie; Wang, Weijia; Huang, Lina; Tu, Jiaoqin; Baiamonte, Lyndsey; Stark, Moselle; Mills, Mistie; Hope, Thomas J; Drobnis, Erma Z; Quayle, Alison J; Schust, Danny JBackground
Hormonal contraceptives, particularly depot medroxyprogesterone acetate (DMPA), have been reported to be associated with substantially enhanced HIV acquisition; however, the biological mechanisms of this risk remain poorly understood. We aimed to investigate the effects of different hormonal contraceptives on the expression of the HIV co-receptors, CXCR4 and CCR5, on female endocervical and peripheral blood T cells.Methods
A total of 59 HIV-negative women were enrolled, including 15 initiating DMPA, 28 initiating a levonorgestrel-releasing intrauterine device (LNG-IUD) and 16 initiating an etonogestrel (ETG)-delivering vaginal ring. Peripheral blood and endocervical cytobrush specimens were collected at enrollment and 3-4 weeks after contraception initiation to analyze the expression of CXCR4 and CCR5, on CD4+ and CD8+ T cells using flow cytometry.Results
Administration of DMPA increased the percentages of CD4+ and CD8+ T cells expressing CCR5 in the endocervix but not in the peripheral blood. Administration of the LNG-IUD or the ETG vaginal ring did not affect the percentages of T lymphocytes expressing CXCR4 or CCR5 in the female cervix or peripheral blood.Conclusions
Increase in the percentage of endocervical T cells expressing CCR5 upon DMPA exposure provides a plausible biological explanation for the association between DMPA use and an elevated risk of HIV infection.Item Open Access Exploring Multilevel Factors associated with Dual-Method Contraceptive use among Adolescent and Young Adult Women(2024) Holt, Lauren MarieSexually transmitted infections (STIs) continue to rise in the US, and adolescent and young adult women (AYAW) between ages 18 and 24 have some of the highest STI rates in the country. Further, AYAW who use prescribed contraceptives (commonly referred to as birth control) are less likely to use condoms and more likely to be diagnosed with an STI than non-prescribed contraceptive users. The purpose of this dissertation is to understand multilevel factors contributing to condom use decision-making and STI risk perception analysis among AYAW who use prescribed contraceptives. Data was using qualitative research methods in two separate studies. In one study, a grounded theory approach was used to explain the processes associated with STI risk perception and dual-method contraceptive decision-making. In a separate study, sex education policy experts in Texas were interviewed to identify barriers and facilitators to implementing comprehensive sex education at a local level. Additionally, legal and ethical issues in conducting sexual health research with AYAW were explored. The findings suggest that dual-method contraceptive decision-making is a complex process that is influenced by individual, relationship, community, and societal factors. Instead of having conversations about STIs, AYAW are making assumptions about the STI status of their partners based on partner and relationship factors and are deferring to their partners for dual-method contraceptive decision-making. Additionally, societal, community, and relationship factors influence how AYAW perceive STIs in comparison to pregnancy. To increase STI risk perception and dual-method contraceptive use a multilevel holistic approach is recommended.
Item Open Access Factors Associated with Birth Spacing and Contraceptive Use in Leogane, Haiti(2012) Chakhtoura, NahidaAbstractAbstractAbstractAbstract Abstract
Spacing the inter-pregnancy interval to more than two years reduces maternal and neonatal morbidity and mortality. Modern contraceptive use can reduce maternal morbidity and mortality by contributing to birth spacing and reducing the total fertility rate. This study is designed to understand the factors associated with appropriate birth spacing and the barriers to modern contraceptive use in Leogane, Haiti. A cross sectional survey of 552 reproductive age women in Leogane proper was performed from June to July of 2011. Univariate, multivariate, and logisitic regressions were used to analyze the data. The results demonstrate the importance of education, employment status, contraceptive use and stable relationships in influencing appropriate birth spacing. Women who spaced their births tended to have less complications compared to women who did not, however this difference was not statistically significant. Barriers to contraceptive use were cultural factors such as religion, and low socioeconomic status. However, contraceptive use was positively influenced by education and partner acceptance of contraceptives. These findings indicate that family programs focused on educating women and their partners on the benefits of contraception and birth spacing would be successful in Leogane, Haiti.