Impact of long-term contraceptive promotion on incident pregnancy: a randomized controlled trial among HIV-positive couples in Lusaka, Zambia

J Acquir Immune Defic Syndr. 2013 May 1;63(1):86-95. doi: 10.1097/QAI.0b013e31827ee19c.


Objectives: To evaluate the impact of family planning promotion on incident pregnancy in a combined effort to address Prongs 1 and 2 of prevention of mother-to-child transmission of HIV.

Design: We conducted a factorial randomized controlled trial of 2 video-based interventions.

Methods: "Methods" and "Motivational" messages promoted long-term contraceptive use among 1060 couples with HIV in Lusaka, Zambia.

Results: Among couples not using contraception before randomization (n = 782), the video interventions had no impact on incident pregnancy. Among baseline contraceptive users, viewing the "Methods video" which focused on the intrauterine device and contraceptive implant was associated with a significantly lower pregnancy incidence [hazard ratio (HR) = 0.38; 95% confidence interval (CI): 0.19 to 0.75] relative to those viewing control and/or motivational videos. The effect was strongest in concordant positive couples (HR = 0.22; 95% CI: 0.08 to 0.58) and couples with HIV-positive women (HR = 0.23; 95% CI: 0.09 to 0.55).

Conclusions: The "Methods video" intervention was previously shown to increase uptake of long-acting contraception and to prompt a shift from daily oral contraceptives to quarterly injectables and long-acting methods such as the intrauterine device and implant. Follow-up confirms sustained intervention impact on pregnancy incidence among baseline contraceptive users, in particular couples with HIV-positive women. Further work is needed to identify effective interventions to promote long-acting contraception among couples who have not yet adopted modern methods.

Trial registration: NCT00067522.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Contraception / methods*
  • Contraception Behavior / statistics & numerical data*
  • Counseling / methods*
  • Family Characteristics
  • Family Planning Services
  • Female
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • HIV Infections / transmission
  • HIV Seropositivity / epidemiology*
  • HIV Seropositivity / transmission
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Pregnancy
  • Sex Education
  • Treatment Outcome
  • Videotape Recording / methods
  • Zambia / epidemiology

Associated data