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Table 1 Family planning counseling for HIV positive women—final study description

From: Family planning counseling for women living with HIV: a systematic review of the evidence of effectiveness on contraceptive uptake and pregnancy incidence, 1990 to 2011

Study Setting Population characteristics Intervention description Study design Key outcomes reported
Allen et al., 1993 Rwanda Pregnant/childbearing women presenting at antenatal or pediatric clinics HIV testing; 35 minute AIDS educational video, followed by a group discussion. Condoms and spermicide were distributed at no charge. In-depth counseling provided for HIV-infected women, including discussion of family planning measures for those who requested. Time series study design. Assessments at baseline (N = 1458), 12 months (N = 1254), and 24 months (N = 1352). Stratified random sampling from a consecutive sample of women presenting to prenatal and pediatric clinics. Hormonal contraception use
Kigali Age Range: 18-35 years Baseline: 23%
12 months: 16% (significance not reported)
Brou et al., 2009 Ivory Coast Pregnant women presenting for PMTCT HIV testing. Offered post-test and post-partum family planning during follow up visits, as well as information on sexually transmitted infections (STIs), including HIV/AIDS, and condom use. Postpartum free access to modern contraceptive methods (injectable contraceptives, contraceptive pills, and condoms) from first month. Time series study design. Assessments at baseline (N = 980) and at 3, 6, 12, 18 and 24 months post-partum Non-random selection of study participants. Modern contraception use:
Abidjan Age: Overall Median Age: 26 years (IQR: 22-30 years) Baseline: 46%
12 months: 65%
24 months: 52% (significance not reported)
Chibwesha et al., 2011 Zambia Women living with HIV on ART Trained 109 peer counselors to deliver standardized counseling message in context of clinical care, emphasizing dual methods. Referral to separate, on-site family planning department or surgical facility for permanent methods Before/after study design with no control group. Not clear how long was period from baseline to follow up. Non-random selection of study participants. Modern contraception use:
Lusaka Age: Overall Median Age: 34.6 years (IQR: 29.9-39.7) Baseline: 59%
Post counseling: 9.8% non-users want contraception; 61.% of these access FP services in 90 days
Hoffman et al., 2008 Malawi Women living with HIV Pregnancy testing, VCT, and FP counseling. Before/after study design with no control group. Participants were followed for 1 year, with assessments at baseline (N = 227), 1 week, and 1, 3, 6, 9 and 12 months after VCT. N = 200 at study completion. Non-random selection of study participants. All contraceptive use:
Lilongwe Age: Overall Median Age: 26 years (IQR: 23 to 30 years) Baseline: 38%
12 months: 46% ns
Pregnancy incidence:
Post only: 14.5 per 100 py
Homsy et al., 2009 Uganda Women living with HIV on ART Home Based AIDS Care with referral to government family planning clinic for counseling and contraceptive options. Weekly home visits to manage treatment adherence, monitor clinical signs and refer to clinics as needed. Prospective cohort design study to compare reproductive intentions, identifying risk factors of pregnancy, contraceptive use, incidence of pregnancy among HIV + women on ART. Assessment at baseline (N = 708) and at 3, 6, 9, 12, 15, 18, 21, 24 (N = 656) and 27 months. Non-random selection of study participants. All contraceptive use:
Tororo and Busia Districts Median Age: 37 years 18 months: 75.7%
24 months: 68.6%
King et al., 1995 Rwanda Women attending pediatric and prenatal clinics VCT followed by a 15 minute educational video on contraceptive methods and group discussion. Contraceptive pills, injectable progestins, and Norplant provided free of charge to women who chose to enroll in the FP program. Before/after study design with no control group. Assessments at baseline (N = 502) and every 3 months following the intervention (the mean length of follow-up was 161 day for hormonal contraceptive use and 363 days for incident pregnancy). Non-random selection of study participants. Hormonal contraceptive use:
Kigali Age Range: 20-44 years Baseline: 16%
Follow up: 24%
Pregnancy incidence:
Before: 22%
After: 9% (significant)
Kosgei et al., 2011 Kenya HIV + women in AIDS care (39% on ART) FP services integrated into HIV care in one clinical team; nurses experienced in offering FP services relocated to HIV clinical team; on site delivery of all FP methods except surgical Retrospective cohort study. Mean (SD) of follow up: 342 days (155) for integrated family planning and 361 day (147) for routine care Comparing intensified FP to regular care: new condom use: 16.7% increase, new FP use including condoms: 12.9% increase;
Eldoret Age: mean 32.7, SD 7.2 new FP use excluding condoms: 3.8% decrease; (all significant),
New pregnancies: 0.1% increase (ns)
Ngure et al., 2009 Kenya Women in HIV serodiscordant relationships Free contraceptive methods [oral contraceptive pills, injectables, implants, and intrauterine devices (IUDs)], contraceptive appointment cards to avoid lapses in hormonal contraception, couples and individual contraceptive counseling sessions during routine study visits Non-randomized trial comparing intervention to comparison group, stratifying by HIV serostatus. Assessments at baseline (N = 1429) and 3-months (N not reported). Non-random selection of study participants (cluster sampling). Non condom contraception use:
Thika (Intervention Site) and Eldoret Nairobi, Kisumu-(Comparison Sites) Age: Overall ages not reported Baseline: 31.5% visits
Follow up: 64.7% visits
Pregnancy incidence:
Intervention pre: 13.5 per 100 py
Intervention post: 8.7 per 100 py (sig)
HIV negative comparison pre: 21.1 per 100 py
HIV- comparison post: 11.0 per 100 py (sig)
(Increased in both groups at other sites without intensive intervention)
Stephenson et al., 2011 Zambia Serodiscordant couples and concordant positive couples. cohabiting for at least 12 months Two different video-based family planning interventions: information on contraceptive methods, with emphasis on IUD and implant; motivational video modeling desirable future planning behaviours, including pregnancy prevention; on-site access to most methods Group randomized trial to one of four arms: control, methods only, motivation only, motivation plus methods, No time specified for pre and post intervention follow up Motivational and method arm likely to adopt injectables than OCPs: RRR = 1.65 (CI 1.07-3.44); methods arm more likely to adopt injectables than OCPs: RRR = 1.55, CI 1.03-2.34). Pregnancy outcomes not studied
  Lusaka Ages: Men: 18-65, Women 18-45