Table 3.
Evidence to support interventions for promoting the sexual and reproductive health of women living with HIV/AIDS, by study
| Intervention | Outcomes | Reference | Country | G* | Description |
|---|---|---|---|---|---|
| Contraception/ FP as part of routine HIV services and vice versa |
Increase condom, contraceptive and dual method use, avert unintended pregnancies, increase VCT |
[17] | Zambia | II | FP^ education and offer of contraceptives available on site rather than by referral. |
| [18] | South Africa | II | Integrated routine discussion of HIV risk and prevention, dual method use and increased counselling and testing in FP services. | ||
| [19] | Haiti | III | Rapid HIV testing performed on all pregnant women. After testing, all HIV-positive, pregnant women informed of their status, counselled and referred to ANC clinic. Voluntary counselling and testing (VCT), sexually transmitted infections (STIs), family planning (FP) services and TB screening and treatment integrated into one central HIV clinic. | ||
| [20] | Kenya | III | Trained staff on contraceptive methods with job aids to use with clients; provision of free contraceptive methods; appointment cards; discussions with couples; involvement of male partners in discussions; and discussions of unintended pregnancies. | ||
| [21] | Kenya | III | Provider-initiated testing and counselling with updated guidelines to discuss HIV transmission, conduct risk assessment, discuss dual protection, and offer testing and counselling. Staff training included contraception, HIV, reproductive rights, informed choice, safe sex, values clarification, risk assessment and reduction, record keeping and logistics. | ||
| [22] | Nigeria | III | Integration of FP and HIV services, with strengthened referral links, provider training, co-located services, same staff and parallel supply chain management systems and strong monitoring and evaluation. | ||
| [23] | Uganda | III | FP was integrated into HIV treatment, using an integrated training curriculum. Short-term contraceptives were available on site with referral for long-term and permanent methods. | ||
| [24] | Uganda | IV | Access to contraception and linking FP services for women on HAART. | ||
| [25] | Uganda | V | Easy access to FP services for HIV-positive women accessing HAART services | ||
| [26] | Malawi | V | Providing on-site FP services to women participating in HIV-related research studies. | ||
| [27] | South Africa | V | Women initiating ART also counselled on effective contraception, provided through referral to a nearby primary care clinic. | ||
| Early postpartum visits that include FP and HIV information and services | Increased condom use, contraceptive use, HIV testing and treatment, reduced unintended pregnancy | [38] | Swaziland | III | One week postpartum visit for HIV-positive mothers, with provider training on FP. |
| [39] | Kenya | III | Postpartum follow up for HIV-positive women, with referral for contraceptive counselling and services. The women were counselled antenatally to initiate contraception postpartum and dual protection. | ||
| [40] | Cote d'Ivoire | III | Women tested for HIV prenatally were followed up for two years following delivery. At each postpartum visit, women received FP counselling and free contraception. | ||
| Providing clinic services that are youth-friendly | Increased use of reproductive health service, including counselling and testing | [41] | Multi-country | III | A review of HIV prevention interventions among youth from 80 developing countries. |
| [42] | Mozambique | III | Youth-friendly clinical services as part of a multidisciplinary approach that include no-cost FP counselling and contraceptives and HIV counselling and testing. | ||
| [43] | Madagascar | III | Offer of confidential, convenient and affordable HIV testing, FP and STI treatment services by non-judgmental providers. Promotion of the clinics through mass media, face-to-face communication and mobile outreach. | ||
| Providing information and skills-building support for HIV-positive people | Reduce unprotected sex | [44] | USA | I | A meta-analytic review of 12 trials in the US. All interventions provided information with nine interventions providing skill building through live demonstrations, role plays or practice, such as correct use of condoms, coping or interpersonal skills, such as communication about safer sex or disclosing serostatus. Interventions were delivered by healthcare providers, counsellors or trained HIV-positive peers. Effective interventions were delivered on a one-to-one basis by providers or counsellors with at least 10 intervention sessions for at least three months. No studies which met the meta-analytic criteria were found for developing country contexts. |
| [45] | Multi-country | I | A meta-analysis found that the most effective interventions included skills-building and motivated participants. | ||
| [46] | Multi- country | III | A review of interventions for "prevention for positives" included: individually delivered intervention sessions; group sessions, including a focus on gender and sexual orientation; attention to negative consequences of unsafe sex for the HIV-positive person; interactive group sessions and social networking. Addressing provider attitudes and providing training to providers was found to be critical. | ||
| [47] | Zambia | V | Focus group sessions for women with skills training on HIV prevention and transmission, communication, conflict resolution and sexual negotiation. | ||
| Supporting disclosure | Increase condom use among discordant couples | [48] | South Africa | IV | To assess outcomes associated with disclosure, including safer sexual behaviour. |
| [49] | Uganda | Abs | A programme by The AIDS Support Organization (TASO) to provide support that resulted in sero-disclosure. | ||
| [50] | Caribbean Region | Abs | Assessed disclosure and relevant outcomes, including condom use. | ||
| Providing ARVs | Increase prevention behaviours, including condom use | [53] | Uganda | III | Study participants were followed in a home-based ART programme that included prevention counselling, VCT for cohabitating partners and condom provision. |
| [54] | Uganda | III | A prospective cohort of HIV-negative household members of HIV-positive patients on ART receiving home-based care. | ||
| [55] | Kenya | III | A comparative study of people living with HIV or AIDS on HAART and those receiving preventative therapy (PT), including such outcomes as condom use. | ||
| [56] | Uganda | III | Condom use among ART patients compared with non-ART patients. | ||
| [57] | Multi-country | III | To assess outcomes among ART patients compared with non-ART patients, including condom use. | ||
| [58] | Rwanda and Zambia | IV | A study of longitudinal data from sero-discordant couples, including unprotected sex, condom use and pregnancy. | ||
| [59] | Brazil, South Africa and Uganda | IV | Analysis of survey data of HIV-positive women in three countries, including HAART and condom use. | ||
| [60] | Mozambique | IV | A survey of HIV care clinic attendees from initiation to treatment, including condom use. | ||
| Promising | |||||
| Cervical cancer screening integrated into HIV care | Reduce morbidity and mortality in women living with HIV | [63] | Zambia | V | A programme for cervical cancer for both HIV-positive and HIV-negative women that screened more than 20,000 women and linked cervical cancer prevention services with HIV care and treatment services. Cervical cancer using visual inspection with acetic acid (VIA) provided on-the-spot results, which were then linked with same-visit cryotherapy. Peer educators reduced loss to follow up. Community women were trained on conducting community-based cervical health promotion talks. Women who wanted more information were directed to the cervical cancer prevention clinics. To minimize stigma, screening clinics were co-located in government-operated public health clinics near to but not directly within the HIV clinic. |
| [64] | NA | V | A new, rapid HPV test is underway and may be the best option considering the difficulties associated with Pap smears, visual inspection and HPV tests in low-resource countries. Questions remain on effectiveness in HIV-positive women. | ||
| Promoting condom use for contraception | Make condom use more acceptable and easier to negotiate | [65] | Ethiopia | III | A study that included assessment of use of condoms and reasons for condom use among sex workers. |
| Total | 35 | ||||
* G = Gray Scale Rating of the Strength of the Evidence (see Table 1)
^ FP = family planning
Abs = abstract