Pregnancy & STI prevention in a cluster randomized trial: Where does LARC for teens and young women leave us?

The American College of Obstetricians and Gynecologists and American Academy of Pediatrics have come out in support of IUDs and implants as first-line contraceptives for teens and young women. These age groups are also at highest risks of STIs, however. Past studies have shown decreased condom use with long-acting methods. Our research question was whether an intervention to integrate IUDs and implants into contraceptive care would compromise STI prevention. We randomized 40 Planned Parenthood health centers throughout the U.S. to the training intervention or control. We recruited and followed for 1 year 1,500 sexually-active women aged 18-25 who did not desire pregnancy. Main trial results showed women were more likely to learn about and choose IUDs and implants in intervention. In this pre-specified sub-analysis, we assessed dual use (IUD, implant or other hormonal) with condoms, as well as STI incidence, by arm. For dual use, we used generalized estimating equations for clustering, and for STI incidence, survival analysis with shared frailty. The trial was registered with ClinicalTrials.gov and reporting followed CONSORT guidelines. Results showed overall condom use at last sex at 12 months to be equivalent by arm (30% v. 31%).  Likewise, dual condom use at last sex at 12 months was equivalent, albeit low (14% v. 14%, OR=1.0 [95%CI 0.7-1.4]). There were no differences in STI incidence (HR=1.2, 95% CI: 0.9-1.7). These findings show that a provider training intervention to integrate IUDs and implants into care did not compromise condom use nor increase STI incidence among young women.