Our Choice” improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Implementation Science
Abstract
Safer conception counseling (SCC) to promote the use of safer conception methods (SCM) is not yet
part of routine family planning or HIV care. Guidelines for the use of SCM have been published, but to date there
are no published controlled evaluations of SCC. Furthermore, it is unknown whether standard methods commonly
used in resource constrained settings to integrate new services would be sufficient, or if enhanced training and
supervision would result in a more efficacious approach to implementing SCC.
Methods: In a hybrid, cluster randomized controlled trial, six HIV clinics were randomly assigned to implement the
SCC intervention Our Choice using either a high (SCC1) or low intensity (SCC2) approach (differentiated by amount
of training and supervision), or existing family planning services (usual care). Three hundred eighty-nine HIV clients
considering childbearing with an HIV-negative partner enrolled. The primary outcome was self-reported use of
appropriate reproductive method (SCM if trying to conceive; modern contraceptives if not) over 12 months or until
pregnancy.
Results: The combined intervention groups used appropriate reproductive methods more than usual care [20.8%
vs. 6.9%; adjusted OR (95% CI)=10.63 (2.79, 40.49)], and SCC1 reported a higher rate than SCC2 [27.1% vs. 14.6%; OR
(95% CI)=4.50 (1.44, 14.01)]. Among those trying to conceive, the intervention arms reported greater accurate use of
SCM compared to usual care [24.1% vs. 0%; OR (95% CI)=91.84 (4.94, 1709.0)], and SCC1 performed better than
SCC2 [34.6% vs. 11.5%; OR (95% CI)=6.43 (1.90, 21.73)]. The arms did not vary on modern contraception use among
those not trying to conceive. A cost of $631 per person was estimated to obtain accurate use of SCM in SCC1,
compared to $1014 in SCC2
Description
Keywords
HIV, Safer conception counseling, Contraception, Family planning, Uganda, Serodiscordant couples
Citation
Wagner, G. J., Wanyenze, R. K., Beyeza-Kashesya, J., Gwokyalya, V., Hurley, E., Mindry, D., ... & Goggin, K. (2021). “Our Choice” improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches. Implementation Science, 16(1), 1-13.