CHANGES IN GENITAL TRACT HIV TARGET CELLS WITH THREE PROGESTIN- BASED CONTRACEPTIVES
|
|
- Stanley Lawson
- 6 years ago
- Views:
Transcription
1 CHANGES IN GENITAL TRACT HIV TARGET CELLS WITH THREE PROGESTIN- BASED CONTRACEPTIVES Lisa B. Haddad 1, Alison Swaims Kohlmeier 2, Richard E. Haaland 2, Nakita L. Brown 3, L. Davis Lupo 2, Christina B. Mehta 4, Anandi N. Sheth 3, Kehmia Titanji 5, Clyde E. Hart 2, Igho Ofotokun 3 1 Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia; 2 Centers for Disease Control and Prevention, Laboratory Branch, Division of HIV/AIDS Prevention, Atlanta, GA; 3 Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, and Grady Healthcare System, Atlanta, Georgia; 4 Emory University Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, GA, United States 5 Emory University School of Medicine, Department of Medicine, Division of Endocrinology, Atlanta, Georgia, United States
2 none Disclosures
3 Contraception and HIV risk Epidemiologic studies suggest Depot Medroxyprogesterone acetate (DMPA) may increase the risk of HIV acquisition There are several potential mechanisms for increased acquisition CD4 + T cells are heterogeneous with regards to their HIV susceptibility Certain T cell phenotypes may be more likely to be infected during vaginal sex Ex. CD4+ T-cells expressing HIV binding protein (CCR5) and activated T cells (e.g. HLA-DR+, CD38+) Mucosal trafficking and migration to lymphoid tissue is CCR7 dependent Murphy, Irvin & Herold, AJRI 2014 There are limited data evaluating other progestin-based contraceptives Ralph LJ et al. Lancet Infect Dis Feb; 15(2):181-9.; Morrison CS et al. PLoS Med Jan 22; 12(1).; Murphy K, Irvin SC, Herold BC. Am J Reprod Immunol. 2014;72(2): Byrne, E.H. et al. Lancet Infect. Dis. 16, (2016).
4 Different Contraceptives
5 AIM: To evaluate changes to HIV target cell phenotypes in the genital mucosa and peripheral blood among HIV-negative women initiating DMPA, Etonogestrel Implant and Levonorgestrel Intrauterine Device (IUD).
6 Study Design Visits: Visit 1 - Luteal phase (>18 days post LMP) Visit 2 - Follicular (<10 days after LMP) Visit 3 and 4 12 & 14 weeks after contraception initiation Participants: age 18-45, HIV negative, regular cycles (22-35 days) x 3 months, not post partum/breastfeeding, no hormonal contraception/iud in 6 months
7 Study Design Multicolor flow cytometry on LSRII platform: stained for HIV target cells (Live/Dead viability dye and florochrome labeled T-cell markers (CD3, CD4, CD8), HIV susceptibility (CCR5), activation (CD38, HLA-DR) and trafficking markers (CCR7) Statistics Repeated-measures analyses using linear mixed models CVL model adjusted for PSA, blood, including CD3 counts >=100 Swaims-Kohlmeier A, et al. J Immunol May 27.
8 Description of Cohort
9 CCR5 expression on CD4-T-cells in FGT DMPA IMPLANT IUD Non-significant increase after DMPA use Post-pre E=11.75, p=0.054, V3 (trough) E=14.04, p=0.044; V4 (peak) 9.5 (8.1), p= 0.2 Significant increase after implant use Post-pre E=14.7, p=0.009 No increase after IUD use Post-pre E=-0.2, p=0.97
10 CCR5 expression on CD4-T-cells in PBMCs DMPA IMPLANT IUD Significant increase after DMPA use Post-pre E=1.6, p=0.005 V3 (trough): E=1.8 (0.7), p=0.009; V4 (peak): E=1.4 (0.7), p=0.047 No increase after Implant use Post-pre E=0.7, p=0.23 No increase after IUD use Post-pre E=-0.3, p=0.66
11 Pre mean CVL Post mean DMPA Model estimate (Post-Pre) P-value Pre mean Post mean PBMC Model estimate (Post-Pre) p-value CD4% 48.2 (16.2) 50.5 ( (10.9) 65.0(11.8) CD8% 28.7 (14.0) 25.0 (16.1) (11.6) 25.6 (13.6) Among CD4+ T-cells CCR5% 25.4 (17.1) 37.5 (27.1) (2.1) 5.7 (3.5) CD38% 35.9 (17.7) 38.6 (17.8) (6.5) 17.8 (6.6) HLADR% 23.3 (15.3) 20.9 (16.2) (3.4) 4.1 (2.2) Among CD4+CCR5+ T-cells CD38% 60.3 (20.4) 55.0 (18.6) (7.2) 23.2(8.1) HLADR% 33.6 (21.3) 29.8 (17.3) (8.8) 23.5 (8.1) CCR7% 48.2 (18.7) 47.7 (18.4) (15.4) 29.6 (11.8) No significant changes in other immune makers
12 Pre mean Etonogestrel Implant CVL Post mean Model estimate (Post-Pre) P-value Pre mean Post mean PBMC Model estimate (Post-Pre) p-value CD4% 49.9 (13.7) 45.2 (12.3) (9.0) 69.8 (10.0) CD8% 20.6 (7.4) 28.0(12.5) (8.3) 23.8 (10.0) Among CD4+ T-cells CCR5% 22.4(18.5) 36.1(18.3) (2.3) 4.6 (2.6) CD38% 35.1(11.8) 43.0 (7.7) (9.0) 18.2 (6.7) HLADR% 25.2 (16.4) 17.5 (11.0) (1.4) 2.4 (0.8) Among CD4+CCR5+ T-cells CD38% 64.6 (15.1) 63.5 (10.6) (10.6) 29.4 (8.9) HLADR% 40.2 (15.1) 25.5 (16.0) (6.27) 20.6 (5.6) CCR7% 35.8 (22.7) 49.6 (16.0) (11.9) 37.5 (12.0) Significant decrease in %HLA-DR+ on HIV target cells within the FGT Significant increases in %CD8+ T-cells within the FGT Significant increase in %CCR7+ on HIV targets cells from PMBCs No significant changes any other activation markers in FGT or PBMC
13 Pre mean Levonorgestrel IUD CVL Post mean Model estimate (Post-Pre) P-value Pre mean Post mean PBMC Model estimate (Post-Pre) p-value CD4% 55.8(13.2) 46.2 (23.3) (10.7) 63.9 (11.3) CD8% 22.8 (7.9) 33.4(15.0) (10.5) 28.4 (10.5) Among CD4+ T-cells CCR5% 20.2 (17.6) 21.9 (17.7) (1.4) 3.0 (1.3) CD38% 32.4 (9.2) 42.5 (14.9) (8.7) 18.9 (8.3) HLADR% 14.9 (9.5) 12.5 (6.4) (2.0) 4.0 (5.1) Among CD4+CCR5+ T-cells CD38% 64.0 (18.8) 67.2 (14.3) (6.1) 31.4 (7.7) HLADR% 26.8 (14.4) 19.9 (7.0) (8.4) 23.4 (10.9) CCR7% 33.1 (22.5) 38.8 (16.4) (13.9) 31.8 (11.6) Significant increases in %CD8+ T-cells in FGT and PBMCs No significant changes in other immune makers either in the FGT or PBMC
14 Implications Etonogestrel implant and DMPA are associated with increased HIV susceptibility markers in FGT Immune responses following different contraceptives are not uniform Larger evaluations of the comparative effects of contraceptives on various mechanisms associated with HIV transmission risk are needed
15 Study Participants Emory: Nakita L. Brown Christina B. Mehta Anandi N. Sheth Kehmia Titanji Igho Ofotokun Gina Herring Susan Robinson Rachael Farah-Abraham Rama Amara Grady WIHS Staff Thank you This research supported by 1K23HD A1 (Haddad), Emory Center for AIDS Research (P30AI050409, CFAR03 (Haddad) and Emory Medical Care Foundation (Haddad). CDC: Alison Swaims Kohlmeier Richard E. Haaland L. Davis Lupo Clyde E. Hart
Progesterone Increases are Associated With HIV Susceptibility Factors in Women
Progesterone Increases are Associated With HIV Susceptibility Factors in Women Alison Y Swaims 1, Tammy Evans-Strickfaden 1, L Davis Lupo 1, Alfredo Aguirre 2, Anandi Sheth 2, Igho Ofotokun 2, Clyde E
More informationRepeat Pregnancies and HIV Care Engagement among Postpartum HIV-infected Women in Atlanta, Georgia,
Repeat Pregnancies and HIV Care Engagement among Postpartum HIV-infected Women in Atlanta, Georgia, 2011-2015 Anandi N. Sheth, Christina M. Meade, Martina Badell, Susan A. Davis, Stephanie Hackett, Joy
More informationEXPLORING THE IMPACT OF SEX DISCREPANCIES IN HIV TREATMENT AND CURE
EXPLORING THE IMPACT OF SEX DISCREPANCIES IN HIV TREATMENT AND CURE CECILE DELILLE LAHIRI, M.D, M.SC ASSISTANT PROFESSOR DIVISION OF INFECTIOUS DISEASES MAY 18, 2016 OUTLINE Describe discrepancy between
More informationSexual Violence and HIV Risk. Gina M. Brown, M.D. Office of AIDS Research, NIH
Sexual Violence and HIV Risk Gina M. Brown, M.D. Office of AIDS Research, NIH Defining intimate partner violence Violence perpetrated by a current or former boyfriend, cohabiting partner, husband, or date
More informationDOES HORMONAL CONTRACEPTION INCREASE HIV ACQUISITION RISK AMONG ZAMBIAN WOMEN IN DISCORDANT COUPLES?
DOES HORMONAL CONTRACEPTION INCREASE HIV ACQUISITION RISK AMONG ZAMBIAN WOMEN IN DISCORDANT COUPLES? Kristin M. Wall, PhD kmwall@emory.edu Department of Epidemiology Rwanda Zambia HIV Research Group Emory
More information1. Ng M et a l. Global, regional, and national prevalence of overweight and obesity in children and adults during : A systematic analysis
1 2 3 1. Ng M et a l. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980 2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet
More informationContraception and gynecological pathologies
1 Contraception and gynecological pathologies 18 years old, 2 CMI normal First menstruation at 14 years old Irregular (every 2/3 months), painful + She does not need contraception She is worried about
More informationStrategic Communication for Hormonal Contraception and HIV: An Evidence Review
Strategic Communication for Hormonal Contraception and HIV: An Evidence Review 2016 Laura Wando, WellShare International Uganda, Courtesy of Photoshare Elizabeth C. Mallalieu, MPH; Lynn M. Van Lith, MPA;
More informationContraception for Adolescents: What s New?
Contraception for Adolescents: What s New? US Medical Eligibility Criteria for Contraceptive Use Kathryn M. Curtis, PhD Division of Reproductive Health, CDC Expanding Our Experience and Expertise: Implementing
More informationHormonal Contraception and HIV: The WHO Responds. Ward Cates MTN Annual Meeting February 21, 2012
Hormonal Contraception and HIV: The WHO Responds Ward Cates MTN Annual Meeting February 21, 2012 Acknowledgments Colleagues from: FHI 360 The MTN USAID University of Washington WHO And many more Woman
More informationHormonal contraceptive methods & HIV acquisition in women: updated systematic review of epidemiological evidence
Hormonal contraceptive methods & HIV acquisition in women: updated systematic review of epidemiological evidence CHELSEA B. POLIS, PHD SEPTEMBER 16, 2016 AVAC WEBINAR GUTTMACHER INSTITUTE 2016 Acknowledgements
More informationContraception & HIV Still searching for answers after >2 decades
Contraception & HIV Still searching for answers after >2 decades R Scott McClelland, MD, MPH University of Washington Inter CFAR Symposium on HIV Research in Women September 20 th 2012 Overview Global
More informationMedical Eligibility for Contraception Use
Medical Eligibility for Contraception Use DIVISION OF REPRODUCTIVE HEALTH CENTERS FOR DISEASE CONTROL AND PREVENTION 2016 US Medical Eligibility Criteria for Contraceptive Use (US MEC) Purpose To assist
More informationHormonal Contraception and HIV
Hormonal Contraception and HIV A ROUNDTABLE AT THE INTEREST WORKSHOP, LUSAKA, 2014 Professor Helen Rees, Wits RHI, Johannesburg, SA Dr Mike Mbizvo, Zimbabwe Dr Chelsea Polis, USAID, Washington Dr Nelly
More informationTime Topic Speaker Abbreviation
1. Programme Sunday, 4 th November 2018 Time Topic Speaker Abbreviation 08:00 Welcome, distribution materials 08:30 Overview of the Medical Eligibility Criteria (2015), and the Selected Practices Recommendations
More informationInstruction for the patient
WS 4 Case 3 STI and IUD Your situation Instruction for the patient You are 32 years old, divorced and have one child; you have just started a new relationship You underwent surgical resection of the left
More informationContraception for Obese Women RENEE E. MESTAD, MD, MSCI ACOG DISTRICT II UPSTATE MEETING APRIL 29, 2016
Contraception for Obese Women RENEE E. MESTAD, MD, MSCI ACOG DISTRICT II UPSTATE MEETING APRIL 29, 2016 Disclosure I am a Nexplanon trainer for Merck. Objectives Understand how obesity may affect pharmacokinetics
More informationAnnex 2: GRADE evidence profiles
Annex 2: GRADE evidence profiles GRADE table 1: Does the use of a particular method of hormonal contraception directly increase the risk of HIV acquisition in women? Outcome ( participants) Injectable
More informationMucosal Assays in HIV Prevention Trials: Vaginal Microbicide Trials
Mucosal Assays in HIV Prevention Trials: Vaginal Microbicide Trials Charlene S. Dezzutti, PhD University of Pittsburgh Magee-Womens Research Institute Use of Mucosal Assays in Microbicide Trials August
More informationAn Analysis of Genital Tract Derived HIV from Heterosexual Transmission Pairs. Debrah Boeras Emory University October 14, 2008
An Analysis of Genital Tract Derived HIV from Heterosexual Transmission Pairs Debrah Boeras Emory University October 14, 2008 Background A majority of HIV-1 infections occur through heterosexual exposure
More informationBIOLOGICAL/IMMUNOLOGICAL CONSIDERATIONS MOVING TOWARD A 3-MONTH CONTRACEPTIVE DAPIVIRINE RING
BIOLOGICAL/IMMUNOLOGICAL CONSIDERATIONS MOVING TOWARD A 3-MONTH CONTRACEPTIVE DAPIVIRINE RING Sharon Achilles, MD, PhD MTN Annual Meeting March 15, 2016 Nothing to disclose. Research funding: NIH/NIAID
More informationNelly Mugo, MBChB, MMed, MPH Kenya Medical Research Institute. May 2015
Nelly Mugo, MBChB, MMed, MPH Kenya Medical Research Institute May 2015 Outline Rationale for the trial Design and objectives Contraceptive methods to be evaluated Study population and follow-up Potential
More informationContraception Choices: An Evidence Based Approach Case Study Approach. Susan Hellier PhD, DNP, FNP-BC, CNE
Contraception Choices: An Evidence Based Approach Case Study Approach Susan Hellier PhD, DNP, FNP-BC, CNE Objectives Describe the U.S. Medical Eligibility Criteria for Contraceptive Use, 2016 (U.S. MEC)
More informationWhat makes the transmitted HIV-1 in newly infected patients unique from the donor inoculum?
What makes the transmitted HIV-1 in newly infected patients unique from the donor inoculum? What happens during primary infection? Los Alamos National Laboratories Evidence of the genetic bottleneck at
More informationResearch. Reported weight gain is one of the
Research www.ajog.org GENERAL GYNECOLOGY Validity of perceived weight gain in women using long-acting reversible contraception and depot medroxyprogesterone acetate Ashley M. Nault, BS; Jeffrey F. Peipert,
More informationHormonal contraception and HIV risk
Hormonal contraception and HIV risk Jared Baeten, MD, PhD Departments of Global Health, Medicine, and Epidemiology, University of Washington On behalf of the ECHO Consortium HPTN Annual Meeting Washington
More informationThe Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial
The Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial A Multi-Center, Open-Label, Randomised Clinical Trial Comparing HIV Incidence and Contraceptive Benefits in Women using Depot Medroxyprogesterone
More informationContraception and Risk of HIV Progression
Contraception and Risk of HIV Progression Catherine Hankins BA MD MSc FRCPC Deputy Director, Science Amsterdam Institute for Global Health and Development Honorary Professor London School of Hygiene and
More informationContraceptive Updates and Recommendations
Contraceptive Updates and Recommendations Emily M. Godfrey, MD MPH Associate Professor, Departments of Family Medicine and Obstetrics and Gynecology, University of Washington, Seattle WA Guest Researcher,
More informationContraceptive Updates and Recommendations
Contraceptive Updates and Recommendations Emily M. Godfrey, MD MPH Associate Professor, Departments of Family Medicine and Obstetrics and Gynecology, University of Washington, Seattle WA Guest Researcher,
More informationWhat s New in Adolescent Contraception?
What s New in Adolescent Contraception? Abby Furukawa, MD Legacy Medical Group Portland Obstetrics and Gynecology April 29, 2017 Objectives Provide an update on contraception options for the adolescent
More informationHIV Prevention and Reproductive Choices
HIV Prevention and Reproductive Choices Renee Heffron, PhD MPH University of Washington Virology Education International Workshop on HIV & Women Boston, 20-21 February 2016 Reproductive choices & pregnancy
More informationThe role of the genital microbiome and injectable hormonal contraception in HIV acquisition in women
The role of the genital microbiome and injectable hormonal contraception in HIV acquisition in women Doug Kwon, M.D. Ph.D. Ragon Institute of MGH, MIT and Harvard Massachusetts General Hospital Technical
More informationHIV-1 Genital Shedding is Suppressed in the Setting of High Genital Antiretroviral Drug Concentrations Throughout the Menstrual Cycle
MAJOR ARTICLE HIV-1 Genital Shedding is Suppressed in the Setting of High Genital Antiretroviral Drug Concentrations Throughout the Menstrual Cycle Anandi N. Sheth, 1 Tammy Evans-Strickfaden, 2 Richard
More informationThe past 20 years have seen an explosion
CONTRACEPTION Highlights (and lowlights) from the past year in : the US unintended pregnancy rate and controversies in providing Tami Rowen, MD, MS Dr. Rowen is a fourthyear ObGyn resident in the Department
More informationLinda Gregg NP, Janet Isabell NP, Sue Montei NP Clinical Reviewers Reproductive Health Unit
Linda Gregg NP, Janet Isabell NP, Sue Montei NP Clinical Reviewers Reproductive Health Unit What We Plan To Do Describe the U.S. Medical Eligibility Criteria for Contraceptive Use, 2016 (U.S. MEC) Explain
More informationDepartment of Gynecology and Obstetrics Emory University School of Medicine Recognition and Awards 2011
EMORY Gynecology & Obstetrics Department of Gynecology and Obstetrics Emory University School of Medicine Recognition and Awards 2011 45 th Annual John D. Thompson Resident Research Day The 45 th Annual
More informationImpact of Sex & Semen on TFV-Based PrEP MTN 011. Betsy C. Herold, M.D. MTN PROTOCOL TEAM
Impact of Sex & Semen on TFV-Based PrEP MTN 011 Betsy C. Herold, M.D. Albert Einstein College of Medicine Bronx, New York, USA and the MTN PROTOCOL TEAM Making of TFV Gel Trial Results Discrepancy preclinical
More informationHormonal Contraception and HIV Acquisition: Getting on the Same Page. Zambia October 2015
Hormonal Contraception and HIV Acquisition: Getting on the Same Page Zambia October 2015 Key questions for three populations HIV-negative men Whether HIV-negative men are at higher risk of acquiring HIV
More informationfor Women Living with HIV Infection
Preconception Counseling for Women Living with HIV Infection Introduction Routine incorporation of preconception care and counseling in primary care settings is needed in order to: 1. Prevent unintended
More informationUpdate on the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial
Update on the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial A Multi-Center, Open-Label, Randomised Clinical Trial Comparing HIV Incidence and Contraceptive Benefits in Women using Depot
More informationPsychosocial Aspects of Family Planning: Hormonal Contraception and Mood
Psychosocial Aspects of Family Planning: Hormonal Contraception and Mood Overview: This case discusses possible psychological effects that may be caused by hormonal contraception (HC). The reader should
More informationReproductive Health Care: Agenda. Reproductive Health Care: Reproductive Life Plans. Reproductive Life Plans: Provider Prospective
Agenda An Integrated Approach Kimberly McClellan, MSN, WHNP-BC, CRNP Family Planning Council April 11, 2013 Primary Care Reproductive Health HIV Services Context for Integrative Services Contraceptive
More information10/6/2015. Outline. 1) Activation = efficient production. Inflammation and HIV Susceptibility. Immune Activation and HIV Acquisition Risk
/6/25 Outline Immune Activation and HIV Acquisition Risk. Immune Activation and HIV Susceptibility 2. work and HIV risk STI and HIV World Congress 25 Brisbane, AU Sept 6, 25 Keith Fowke Professor and Head,
More informationLESSON 5. Counseling clients about DMPA and Sayana Press
LESSON 5 Counseling clients about DMPA and Sayana Press 1 LESSON 5 Learning objectives List possible side effects of DMPA. Describe what to do if a client has concerns or is experiencing side effects.
More information2
1 2 3 1. Usinger KM et al. Intrauterine contraception continuation in adolescents and young women: a systematic review. J Pediatr Adolesc Gynecol 2016; 29: 659 67. 2. Kost K et al. Estimates of contraceptive
More informationExpanding Access to Birth Control: Will Women Get the Care They Need?
Expanding Access to Birth Control: Will Women Get the Care They Need? Target Audience: Pharmacists ACPE#: 0202-0000-18-045-L01-P Activity Type: Application-based Target Audience: ACPE#: Activity Type:
More informationMultipurpose Intravaginal Ring: Tenofovir / Levonorgestrel
MTN Annual Meeting Bethesda, MD March 17, 2015 Multipurpose Intravaginal Ring: Tenofovir / Levonorgestrel Christine Mauck, MD, MPH Why develop a multipurpose ring? Providing drug in a ring is likely to
More informationSimplifying Vide Contraception. University of Utah Department of Ob/Gyn Post Grad Course February 13, 2017 David Turok
Simplifying Vide Contraception University of Utah Department of Ob/Gyn Post Grad Course February 13, 2017 David Turok Background Objectives At the conclusion of this presentation participants will be able
More informationArdhanu Kusumanto Oktober Contraception methods for gyne cancer survivors
Ardhanu Kusumanto Oktober 2017 Contraception methods for gyne cancer survivors Background cancer treatment Care of gyn cancer survivor Promotion of sexual, cardiovascular, bone, and brain health management
More informationMedicaid Family Planning Waiver Services CPT Codes and ICD-10 Diagnosis Codes
CPT Code Description of Covered Codes Evaluation and Management 99384FP 99385FP Family planning new visit 99386FP 99394FP 99395FP Family planning established visit 99396FP 99401FP HIV counseling (pre-test)
More informationContraception Update: what s new in 2016? Felicity Young MA BSc (Hons) RMN RGN RM NDFSRH A08 Consultant Nurse for Sexual and Reproductive Healthcare
Contraception Update: what s new in 2016? Felicity Young MA BSc (Hons) RMN RGN RM NDFSRH A08 Consultant Nurse for Sexual and Reproductive Healthcare Declaration of Competing Interests I have not received
More informationInstructions how to use the ESC teach the teachers course and self-learning tool
Instructions how to use the ESC teach the teachers course and self-learning tool Welcome to the ESC advanced learning tool To improve and facilitate knowledge and use of contraception, abortion, sexually
More informationEffects of three long-acting reversible contraceptive methods on HIV target cells in the human uterine cervix and peripheral blood
Li et al. Reproductive Biology and Endocrinology (2019) 17:26 https://doi.org/10.1186/s12958-019-0469-8 RESEARCH Open Access Effects of three long-acting reversible contraceptive methods on HIV target
More informationU.S. Medical Eligibility Criteria for Contraceptive Use, 2010
U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 Division of Reproductive Health Centers for Disease Control and Prevention August 1, 2013 National Center for Chronic Disease Prevention and
More informationLARC IN THE OFFICE BASE SETTING. Regina Lewis, DO Associate Professor of Family Medicine OSU Family Medicine
SHIFT HAPPENS! LARC IN THE OFFICE BASE SETTING Regina Lewis, DO Associate Professor of Family Medicine OSU Family Medicine 1. the effects of teen and unplanned pregnancies 2. types of LARC products 3.
More informationInstructions how to use the ESC teach the teachers course and self-learning tool
Instructions how to use the ESC teach the teachers course and self-learning tool Welcome to the ESC advanced learning tool To improve and facilitate knowledge and use of contraception, abortion, sexually
More informationReviewer No.2 Commentary: contraceptive medicines: does choice make a difference?
Reviewer No.2 Commentary: contraceptive medicines: does choice make a difference? The detailed review by Andrew Gray and colleagues (Systematic review of contraceptive medicines: does choice make a difference?
More information4. Timing of post-abortion contraception
Web annexes: Medical management of abortion: evidence summary* 4. Timing of post-abortion contraception * This publication forms part of the WHO guideline entitled Medical Management of Abortion. The full
More informationLEARNING OBJECTIVES. Beyond the Pill: Long Acting Contraception. Distribution Of Contraception Use By Women In The Us. Unintended Pregnancy is Common
4:15 5 pm Beyond the Pill: Long Acting Contraceptives and IUDs Presenter Disclosure Information The following relationships exist related to this presentation: Christine L. Curry, MD, PhD: No financial
More informationContraception: Common Problems Faced in Office Practice. Jane S. Sillman, MD Brigham and Women s Hospital
Contraception: Common Problems Faced in Office Practice Jane S. Sillman, MD Brigham and Women s Hospital Disclosures I have no conflicts of interest Contraception: Common Problems How to discuss contraception
More informationChoices TABLE OF CONTENTS
Choices TABLE OF CONTENTS PAGE ABSTINENCE...1-2 OUTERCOURSE... 3 WITHDRAWAL... 4 CONDOMS: Male...5-7 CONDOMS: Female... 8 DUAL METHODS/FERTILITY AWARENESS METHODS... 9 BREASTFEEDING... 10 SPERMICIDES (Film,
More informationTable I. Examples of Hormone and Tapering Regimens
Table I. Examples of Hormone and Tapering Regimens Severe AUB Heavy bleeding (soaking through 2 maxi pads an hour, 2 hours in a row) History of heavy menses Hemodynamically un (tachycardia, hypotensive,
More informationPopulation attributable fraction of genital inflammation and ulceration in HIV risk among discordant couples, Zambia,
Population attributable fraction of genital inflammation and ulceration in HIV risk among discordant couples, Zambia, 1994-2012 10 th International Workshop on HIV Transmission Kristin M. Wall, PhD kmwall@emory.edu
More informationLARC: Disclosures. Long Acting Reversible Contraception. Objectives 10/23/2013. I have no relevant financial disclosures
LARC: Long Acting Reversible Contraception Disclosures I have no relevant financial disclosures Jennifer Kerns, MD, MPH Assistant Professor, UCSF Obstetrics, Gynecology and Reproductive Sciences San Francisco
More informationImplants and ART: weighing the evidence to guide programs
Implants and ART: weighing the evidence to guide programs Presented by: Jennifer Mason, MPH; Tabitha Sripipitana, MPH; and Sarah Yeiser, MPH Office of Population & Reproductive Health, USAID Office of
More informationReview of priorities in research Hormonal contraception and IUDs and HIV infection
WHO/RHR/10.21 Review of priorities in research Hormonal contraception and IUDs and HIV infection Report of a technical meeting Geneva, 13 15 March 2007 WHO/RHR/10.21 Review of priorities in research on
More informationJennifer Zeng. Chapel Hill. Summer Daniel Jonas. 7/10/18 Date. Leila Kahwati. 6/29/2018 Date
Effect of Long Acting Reversible Contraceptives on Dual Method Use and Incidence of Sexually Transmitted Infections among Female Adolescents and Young Adults in the United States: A Systematic Review By
More informationASTHO LARC Learning Community Virtual Learning Session Training. February 19, :00-4:00p ET , ext #
ASTHO LARC Learning Community Virtual Learning Session Training February 19, 2014 2:00-4:00p ET 866-740-1260, ext. 5273187# Agenda 2:00 Welcome and Introductions 2:10 State Team Updates 2:40 State Presentation:
More informationCODING GUIDELINES FOR CONTRACEPTIVES. Effective June 1, 2017 Version 1.40
CODING GUIDELINES FOR CONTRACEPTIVES Effective June 1, 2017 Version 1.40 TABLE OF CONTENTS ICD-10 CM Diagnosis Codes: Encounter for Contraception page 2 Coding for IUD Insertion and Removal Procedures
More informationHormonal Contraception and the Risk of HIV Acquisition
Hormonal Contraception and the Risk of HIV Acquisition Charles Morrison, PhD International Conference on Family Planning Kampala, Uganda November 16, 2009 Hormonal Contraception and HIV About 16 million
More informationThe Balanced Counseling Strategy Plus: A Toolkit for Family Planning Service Providers Working in High STI/HIV Prevalence Settings.
The Balanced Counseling Strategy Plus: A Toolkit for Family Planning Service Providers Working in High STI/HIV Prevalence Settings Counseling Cards Checklist to be reasonably sure a woman is not pregnant
More informationHIV and contraception the latest recommendations
1 8-11 June 2015, Chiang-Mai HIV and contraception the latest recommendations Mary Lyn Gaffield, Sharon Phillips, Rachel Baggaley, Petrus Steyn, and Marleen Temmerman 2 Medical eligibility criteria for
More informationHormonal Implants Technical Update June 23, Jeff Spieler Senior Technical Advisor for Science and Technology GH/PRH
Hormonal Implants Technical Update June 23, 2009 Jeff Spieler Senior Technical Advisor for Science and Technology GH/PRH TOPICS: Elements of Successful FP Programs LAPMs Implants Introduction to the Implant
More informationThe safety of hormonal contraceptives for women living with HIV and their sexual partners
Contraception 93 (2016) 11 16 Review article The safety of hormonal contraceptives for women living with HIV and their sexual partners Sharon J. Phillips a, Chelsea B. Polis b, Kathryn M. Curtis c a Department
More informationCONFERENCE SCHEDULE. Demonstrate correct hand skills necessary for placement of the copper IUD and each of the three levonorgestrel IUDs.
PRECONFERENCE SCHEDULES ATLANTA, GA } THURSDAY, NOVEMBER 1, 2018 PRECONFERENCE A (8:00 A.M. - 12:15 P.M.) IUD PLACEMENT FUNDAMENTALS: A PRACTICUM (Space is limited to 50 participants. Register early. This
More informationLearning objectives. Some fun facts. Presenter Disclosure Information. Discuss the newest contraceptive options available
2:15 3pm Advances and Options in Female Contraception SPEAKER Pelin Batur, MD, FACP, NCMP, CCD Presenter Disclosure Information The following relationships exist related to this presentation: Pelin Batur,
More informationBLEEDING PATTERNS AND CONTRACEPTIVE DISCONTINUATION FG MHLANGA MTN ANNUAL MEETING 20 MARCH 2018
BLEEDING PATTERNS AND CONTRACEPTIVE DISCONTINUATION FG MHLANGA MTN ANNUAL MEETING 20 MARCH 2018 Introduction Bleeding with contraception may lead to discontinuation and possible unintended pregnancy What
More informationDisclosures CONTRACEPTION COUNSELING IN MEDICALLY COMPLEX ADOLESCENTS. Aletha Akers, MD, MPH and Lyndsey Benson, MD, MS
CONTRACEPTION COUNSELING IN MEDICALLY COMPLEX ADOLESCENTS Aletha Akers, MD, MPH and Lyndsey Benson, MD, MS Disclosures Aletha Akers Society of Family Planning Templeton Foundation National Institutes of
More informationDisclosures. Learning Objectives 4/18/2017 ADOLESCENT CONTRACEPTION UPDATE APRIL 28, Nexplanon trainer for Merck
ADOLESCENT CONTRACEPTION UPDATE APRIL 28, 2017 Brandy Mitchell, MN, RN, ANP BC, WHNP BC University of Iowa Hospitals and Clinics Obstetrics and Gynecology Iowa Association of Nurse Practitioners Spring
More information2. Studies of Cancer in Humans
346 IARC MONOGRAPHS VOLUME 72 2. Studies of Cancer in Humans 2.1 Breast cancer 2.1.1 Results of published studies Eight studies have been published on the relationship between the incidence of breast cancer
More informationprevalence was 13.8% among females
1 2 3 1. Woldeamanuel YW et al. Migraine affects 1 in 10 people worldwide featuring recent rise: a systematic review and meta-analysis of communitybased studies involving 6 million participants. J Neurol
More informationduring conception, pregnancy and lactation at 2 U.S. medical centers
Use of HIV preexposure prophylaxis during conception, pregnancy and lactation at 2 U.S. medical centers Dominika Seidman, MD Shannon Weber, Maria Teresa Timoney, Karishma Oza, Elizabeth Mullins, Rodney
More informationJean Anderson, MD Catherine Sewell, MD, MPH
Jean Anderson, MD Catherine Sewell, MD, MPH No Relevant Financial Relationships with Commercial Interests To review contraception in the setting of HIV infection and address controversies 33 yo P5015,
More informationImmunological Changes in the FRT During the Menstrual Cycle
Immunological Changes in the FRT During the Menstrual Cycle Charles R. Wira PhD Department of Physiology and Neurobiology Geisel School of Medicine at Dartmouth Lebanon, NH 03756 May 1, 2014 Anatomy and
More informationCoding for the Contraceptive Implant and IUDs
LARC Quick Coding Guide 2018 UPDATE Coding for the Contraceptive Implant and IUDs CORRECT CODING can result in more appropriate compensation for services and devices. To help practices receive appropriate
More informationManagement of Emergency Contraception (EC)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) Management of Emergency Contraception (EC) The risks and benefits of an IUD or oral EC should be discussed and documented (see appendix). Reasonable measures
More informationMDHHS: Coding and Billing for Contraceptive Services
1 The correct answer is B. A separate preventive E/M service was provided and a 25 modifier is necessary. The correct code is 99385 based on Lisa being new to the practice and being between 18 and 39 years
More informationMEDROXYPROGESTERONE ACETATE HAS MINIMAL IMPACT ON HIV-1 REPLICATION IN ECTOCERVICAL TISSUE EX VIVO. Hawa Mariko. BS, Towson University, 2013
MEDROXYPROGESTERONE ACETATE HAS MINIMAL IMPACT ON HIV-1 REPLICATION IN ECTOCERVICAL TISSUE EX VIVO by Hawa Mariko BS, Towson University, 2013 Submitted to the Graduate Faculty of the Graduate School of
More informationSexual transmission of HIV: a heterogeneous event
Sexual transmission of HIV: a heterogeneous event Deutsch-Österreichischer AIDS Kongress Wien 1.-4. June 2005 Pietro L. Vernazza, Infectious Diseases, KSSG St. Gallen, Switzerland Heterosexual Transmission
More informationEmergency Contraception THE FACTS
Emergency Contraception Quick Facts What is it? Emergency contraception is birth control that you use after you have had unprotected sex--if you didn t use birth control or your regular birth control failed.
More informationCROI 2016 Review: Immunology and Vaccines
Frontier AIDS Education and Training Center CROI 2016 Review: Immunology and Vaccines Meena Ramchandani MD MPH Acting Instructor, University of Washington March 2016 This presentation is intended for educational
More informationDynamic Vaginal Microbiota in Macaques Associated with Menstrual Cycle and Inflammation
Dynamic Vaginal Microbiota in Macaques Associated with Menstrual Cycle and Inflammation Nichole Klatt 1 st Microbiome Workshop NIH, Bethesda MD April 7 th 2015 University of Washington WaNPRC Department
More informationUCLA OB/GYN Clinic offers women. a comfortable, caring and confidential
OB/GYN Clinic UCLA OB/GYN Clinic offers women a comfortable, caring and confidential treatment center where they can receive comprehensive gynecologic and obstetric care. The clinic provides women and
More informationLearning objectives. Some fun facts. Presenter Disclosure Information. Become familiar with the newest contraceptive options available
8:45 9:30 am Advances and Options in Female Contraception SPEAKER Pelin Batur, MD, FACP, NCMP, CCD Presenter Disclosure Information The following relationships exist related to this presentation: Pelin
More informationWorld Health Organization Medical Eligibility for Contraceptive Use. Connie Kraus, PharmD, BCACP Professor (CHS) Director Office of Global Health
World Health Organization Medical Eligibility for Contraceptive Use Connie Kraus, PharmD, BCACP Professor (CHS) Director Office of Global Health Objectives After this session, learners should be able to:
More informationGlobal Contraception
Video Companion Guide Global Contraception Learning Objectives: By the end of the session, learners will be able to: Describe of all contraceptive methods. Develop a basic understanding of patient-centered
More informationFlow Cytometric Analysis of Gut Biopsies. Ian McGowan MD PhD FRCP University of Pittsburgh Pittsburgh, PA USA
Flow Cytometric Analysis of Gut Biopsies Ian McGowan MD PhD FRCP University of Pittsburgh Pittsburgh, PA USA Overview GALT flow cytometry GALT flow data from completed studies MTN studies Non-MTN studies
More informationUKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
SUMMARY TABLE SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION Cu-IUD = Copper-bearing intrauterine device; LNG-IUS = Levonorgestrel-releasing intrauterine system; IMP = Progestogen-only implant;
More informationArticle begins on next page
Association of cervical microglandular hyperplasia with exogenous progestin exposure Rutgers University has made this article freely available. Please share how this access benefits you. Your story matters.
More information