Table 3 Evidence to support interventions for promoting the sexual and reproductive health of women living with HIV/AIDS, by study

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