Few longitudinal studies have measured contraceptive continuation past one year in sub-Saharan Africa. We surveyed 674 women who had been randomized to receive the three-month intramuscular contraceptive injectable (DMPA-IM), levonorgestrel (LNG) implant, or copper intrauterine device (IUD) during the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial in South Africa and Zambia and were subsequently followed for two additional years to explore method continuation, reasons for discontinuation, and access to implant and IUD removal services. We also conducted in-depth qualitative interviews with 39 participants. We estimated cumulative discontinuation probabilities using Kaplan–Meier estimates and assessed factors associated with discontinuation using Cox-proportional hazards models. The LNG implant continuation rate over the maximum 44-month study period was 60 percent, while rates for the copper IUD and DMPA-IM were 52 percent and 44 percent, respectively. Reasons for method discontinuation included side effects, particularly menstrual changes, and method stock-outs. Most implant and IUD users who sought removal were able to access services; however, room for improvement exists. In this cohort originally randomized to receive a contraceptive method and attend regular study visits, implants and IUDs continued to be highly acceptable over an additional two years, but facilities should continue to ensure that insertions and removals are available as requested.

中文翻译：

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南非和赞比亚随机使用注射避孕药、左炔诺孕酮植入物和含铜宫内节育器的妇女的避孕延续和获得植入物和宫内节育器取出的经验

很少有纵向研究衡量撒哈拉以南非洲地区避孕药具持续使用超过一年的情况。我们调查了 674 名女性，她们在避孕选择和 HIV 结果证据 (ECHO) 试验期间被随机分配接受为期三个月的肌内注射避孕药 (DMPA-IM)、左炔诺孕酮 (LNG) 植入物或含铜宫内节育器 (IUD)南非和赞比亚，随后又被跟踪了两年，以探索方法的延续、停止的原因，以及获得植入和宫内节育器取出服务的机会。我们还对 39 名参与者进行了深入的定性访谈。我们使用 Kaplan-Meier 估计估计了累积停药概率，并使用 Cox 比例风险模型评估了与停药相关的因素。在最长 44 个月的研究期间，LNG 植入持续率为 60%，而铜宫内节育器和 DMPA-IM 的持续率分别为 52% 和 44%。方法中止的原因包括副作用，特别是月经变化和方法缺货。大多数寻求取出植入物和宫内节育器的用户都能够获得服务；然而，仍有改进的余地。在这个最初随机接受避孕方法并参加定期研究访问的队列中，植入物和宫内节育器在接下来的两年中仍然是高度可接受的，但设施应继续确保按要求提供插入和移除。方法中止的原因包括副作用，特别是月经变化和方法缺货。大多数寻求取出植入物和宫内节育器的用户都能够获得服务；然而，仍有改进的余地。在这个最初随机接受避孕方法并参加定期研究访问的队列中，植入物和宫内节育器在接下来的两年中仍然是高度可接受的，但设施应继续确保按要求提供插入和移除。方法中止的原因包括副作用，特别是月经变化和方法缺货。大多数寻求取出植入物和宫内节育器的用户都能够获得服务；然而，仍有改进的余地。在这个最初随机接受避孕方法并参加定期研究访问的队列中，植入物和宫内节育器在接下来的两年中仍然是高度可接受的，但设施应继续确保按要求提供插入和移除。