“Our Choice” improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches
Abstract Background 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 u...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-04-01
|
| Series: | Implementation Science |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13012-021-01109-z |
| _version_ | 1818327622367576064 |
|---|---|
| author | Glenn J. Wagner Rhoda K. Wanyenze Jolly Beyeza-Kashesya Violet Gwokyalya Emily Hurley Deborah Mindry Sarah Finocchario-Kessler Mastula Nanfuka Mahlet G. Tebeka Uzaib Saya Marika Booth Bonnie Ghosh-Dastidar Sebastian Linnemayr Vincent S. Staggs Kathy Goggin |
| author_facet | Glenn J. Wagner Rhoda K. Wanyenze Jolly Beyeza-Kashesya Violet Gwokyalya Emily Hurley Deborah Mindry Sarah Finocchario-Kessler Mastula Nanfuka Mahlet G. Tebeka Uzaib Saya Marika Booth Bonnie Ghosh-Dastidar Sebastian Linnemayr Vincent S. Staggs Kathy Goggin |
| author_sort | Glenn J. Wagner |
| collection | DOAJ |
| description | Abstract Background 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. Conclusions More intensive provider training and more frequent supervision leads to greater adoption of complex SCM behaviors and is more cost-effective than the standard low intensity implementation approach. Trial registration Clinicaltrials.gov, NCT03167879 ; date registered May 23, 2017. |
| first_indexed | 2024-12-13T12:19:12Z |
| format | Article |
| id | doaj.art-f7a347907f39424d8e55fb323bc9a0b2 |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-12-13T12:19:12Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-f7a347907f39424d8e55fb323bc9a0b22022-12-21T23:46:37ZengBMCImplementation Science1748-59082021-04-0116111310.1186/s13012-021-01109-z“Our Choice” improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approachesGlenn J. Wagner0Rhoda K. Wanyenze1Jolly Beyeza-Kashesya2Violet Gwokyalya3Emily Hurley4Deborah Mindry5Sarah Finocchario-Kessler6Mastula Nanfuka7Mahlet G. Tebeka8Uzaib Saya9Marika Booth10Bonnie Ghosh-Dastidar11Sebastian Linnemayr12Vincent S. Staggs13Kathy Goggin14RAND CorporationSchool of Public Health, College of Health Sciences, Makerere UniversityDepartment of Reproductive Medicine, Mulago Specialised Women and Neonatal HospitalDepartment of Disease Control and Environmental Health, Makerere University School of Public HealthChildren’s Mercy Research Institute, Children’s Mercy Kansas City, University of Missouri - Kansas City School of MedicineUniversity of California Global Health Institute, Center for Women’s Health and EmpowermentDepartment of Family Medicine & Community Health, University of Kansas Medical CenterThe AIDS Support OrganizationPardee RAND Graduate SchoolPardee RAND Graduate SchoolRAND CorporationRAND CorporationRAND CorporationChildren’s Mercy Research Institute, Children’s Mercy Kansas City, University of Missouri - Kansas City School of MedicineChildren’s Mercy Research Institute, Children’s Mercy Kansas City, University of Missouri - Kansas City School of MedicineAbstract Background 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. Conclusions More intensive provider training and more frequent supervision leads to greater adoption of complex SCM behaviors and is more cost-effective than the standard low intensity implementation approach. Trial registration Clinicaltrials.gov, NCT03167879 ; date registered May 23, 2017.https://doi.org/10.1186/s13012-021-01109-zHIVSafer conception counselingContraceptionFamily planningUgandaSerodiscordant couples |
| spellingShingle | Glenn J. Wagner Rhoda K. Wanyenze Jolly Beyeza-Kashesya Violet Gwokyalya Emily Hurley Deborah Mindry Sarah Finocchario-Kessler Mastula Nanfuka Mahlet G. Tebeka Uzaib Saya Marika Booth Bonnie Ghosh-Dastidar Sebastian Linnemayr Vincent S. Staggs Kathy Goggin “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 HIV Safer conception counseling Contraception Family planning Uganda Serodiscordant couples |
| title | “Our Choice” improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches |
| title_full | “Our Choice” improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches |
| title_fullStr | “Our Choice” improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches |
| title_full_unstemmed | “Our Choice” improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches |
| title_short | “Our Choice” improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches |
| title_sort | our choice improves use of safer conception methods among hiv serodiscordant couples in uganda a cluster randomized controlled trial evaluating two implementation approaches |
| topic | HIV Safer conception counseling Contraception Family planning Uganda Serodiscordant couples |
| url | https://doi.org/10.1186/s13012-021-01109-z |
| work_keys_str_mv | AT glennjwagner ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT rhodakwanyenze ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT jollybeyezakashesya ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT violetgwokyalya ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT emilyhurley ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT deborahmindry ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT sarahfinocchariokessler ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT mastulananfuka ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT mahletgtebeka ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT uzaibsaya ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT marikabooth ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT bonnieghoshdastidar ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT sebastianlinnemayr ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT vincentsstaggs ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches AT kathygoggin ourchoiceimprovesuseofsaferconceptionmethodsamonghivserodiscordantcouplesinugandaaclusterrandomizedcontrolledtrialevaluatingtwoimplementationapproaches |