OBJECTIVES: Thrombophilia is associated with an elevated risk of thrombosis, which may be further elevated with use of hormonal contraception. Our objective was to update a previously published systematic review on thrombosis risk with use of hormonal contraception among women with thrombophilia. STUDY DESIGN: We conducted a systematic review of five databases from database inception through December 8, 2022. We searched for articles that examined risk of venous thromboembolism (VTE) or arterial thromboembolism (ATE) in women with thrombophilia using hormonal contraception compared with women using non-hormonal or no contraception. We assessed risk of bias for each study and certainty of evidence for all outcomes. RESULTS: Eighteen articles met inclusion criteria; four had moderate risk of bias and 14 had high risk of bias. Odds of VTE in women with factor V Leiden (FVL) mutation or prothrombin (PT) gene mutation were elevated in combined oral contraception (COC) users vs non-users. Odds of VTE were elevated in COC users with FVL mutation, PT gene mutation, both FVL and PT mutations, antithrombin (AT) deficiency, or protein C deficiency compared with non-users without the mutation. Odds of stroke were elevated in COC users with FVL mutation compared with non-users without the mutation. Evidence was mixed on whether risk was elevated in women with protein S deficiency using COC compared with non-use. One study found elevated odds of VTE in women with FVL mutation but not women with PT gene mutation using progestin-only contraception (POC), compared with non-users without the mutation. CONCLUSIONS: Overall, studies found elevated odds of VTE and ATE in women with thrombophilia using COC compared with non-users without thrombophilia. The certainty of evidence for all outcomes is low. Evidence is also limited by small numbers of women and minimal evidence on use of patch, ring, or POC, and is insufficient to assess differential risk by all thrombophilia types. IMPLICATIONS: Use of estrogen-containing hormonal contraception might further elevate risk of thrombosis among women with thrombophilia. Further study is needed on safety of POC use in women with thrombophilia.

Adolescent girls and young women (AGYW) in sub-Saharan Africa remain at high risk for HIV, yet limited data exist on implementation of HIV pre-exposure prophylaxis (PrEP) for this group. We examined PrEP uptake among AGYW using a retrospective cohort enrolled in the Determined Resilient Empowered AIDS-free Mentored Safe (DREAMS) initiative in Zambia between October 2020 and March 2022. Consent was obtained from eligible AGYW at substantial risk for HIV, and they voluntarily participated in PrEP. Multivariable logistic regression was used to examine factors associated with PrEP refills following initiation. Of 4,162 HIV-negative AGYW, 3,233 (77%) were at substantial risk and initiated on PrEP. Overall, 68% of AGYW had at least one refill, but this differed significantly by age group and district. DREAMS was successful at reaching AGYW with PrEP services. More evidence is needed to assess reasons for discontinuation and to improve persistence for those with sustained HIV risk.