Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial
Unwanted pregnancies remain a burden for women living with HIV (WLWH). Family planning prevents unplanned pregnancies while promoting longer birth intervals, key strategies to eliminate perinatal transmission of HIV and promote maternal and child health. We evaluated the effect of a family planning...
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| creator | Atukunda, Esther C Mugyenyi, Godfrey R Obua, Celestino Atuhumuza, Elly B Lukyamuzi, Edward J Kaida, Angela Agaba, Amon G Matthews, Lynn T |
| description | Unwanted pregnancies remain a burden for women living with HIV (WLWH). Family planning prevents unplanned pregnancies while promoting longer birth intervals, key strategies to eliminate perinatal transmission of HIV and promote maternal and child health. We evaluated the effect of a family planning voucher, inclusive of immediate postpartum counseling, on uptake, early initiation, and continuation of modern contraceptive methods among recently postpartum WLWH delivering at a publicly funded regional referral hospital in rural, southwestern Uganda.
We performed a randomized controlled trial between October, 2016 and June, 2018 at a referral hospital in southwestern Uganda. This interim analysis includes adult WLWH randomized and enrolled equally to receive a family planning voucher or standard of care (control). Enrolled postpartum WLWH completed an interviewer-administered questionnaire at enrollment and 6 months postpartum. Our primary outcome of interest for this analysis is initiation of a modern family planning method within 8 weeks postpartum. Secondary outcomes included family planning initiation at 12, 14, 16, and 20 weeks postpartum, family planning discontinuation and/or change, pregnancy incidence, and mean time without contraception. The trial was registered with clinicaltrials.gov (NCT02964169). At enrollment, half of the women in both the voucher (N = 87, 55%) and control (N = 86, 54%) groups wanted to have a child in 2 years postpartum. Over 80% of referent pregnancies in the voucher (N = 136, 86%) and control (N = 128, 81%) groups were planned. All women were accessing ART. The mean CD4 count was 396 cells/mm3 (SD = 61) for those enrolled in the control group versus 393 cells/mm3 (SD = 64) in the family planning voucher group. By 8 weeks postpartum, family planning was initiated in 144 (91%) participants in the voucher group and 83 (52%) participants in the control group (odds ratio [OR] 9.42; CI 4.67-13.97, P < 0.001). We also found high family planning uptake rates for both groups, with higher rates among the intervention group at 12 weeks (OR 5.66; CI 2.65-12.12, P < 0.001), 14 weeks (OR 2.51; CI 1.31-4.79, P < 0.001), 16 weeks (OR 4.02; CI 1.66-9.77, P = 0.001), and 20 weeks (OR 3.65; CI 1.40-9.47, P = 0.004) postpartum. The average time to family planning initiation was reduced to 5.9 weeks (SD = 2.4) for those in the voucher group compared to 9.3 weeks (SD = 5) in the control (P < 0.001). One pregnancy was recorded in the group receivi |
| doi_str_mv | 10.1371/journal.pmed.1002832 |
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We performed a randomized controlled trial between October, 2016 and June, 2018 at a referral hospital in southwestern Uganda. This interim analysis includes adult WLWH randomized and enrolled equally to receive a family planning voucher or standard of care (control). Enrolled postpartum WLWH completed an interviewer-administered questionnaire at enrollment and 6 months postpartum. Our primary outcome of interest for this analysis is initiation of a modern family planning method within 8 weeks postpartum. Secondary outcomes included family planning initiation at 12, 14, 16, and 20 weeks postpartum, family planning discontinuation and/or change, pregnancy incidence, and mean time without contraception. The trial was registered with clinicaltrials.gov (NCT02964169). At enrollment, half of the women in both the voucher (N = 87, 55%) and control (N = 86, 54%) groups wanted to have a child in 2 years postpartum. Over 80% of referent pregnancies in the voucher (N = 136, 86%) and control (N = 128, 81%) groups were planned. All women were accessing ART. The mean CD4 count was 396 cells/mm3 (SD = 61) for those enrolled in the control group versus 393 cells/mm3 (SD = 64) in the family planning voucher group. By 8 weeks postpartum, family planning was initiated in 144 (91%) participants in the voucher group and 83 (52%) participants in the control group (odds ratio [OR] 9.42; CI 4.67-13.97, P < 0.001). We also found high family planning uptake rates for both groups, with higher rates among the intervention group at 12 weeks (OR 5.66; CI 2.65-12.12, P < 0.001), 14 weeks (OR 2.51; CI 1.31-4.79, P < 0.001), 16 weeks (OR 4.02; CI 1.66-9.77, P = 0.001), and 20 weeks (OR 3.65; CI 1.40-9.47, P = 0.004) postpartum. The average time to family planning initiation was reduced to 5.9 weeks (SD = 2.4) for those in the voucher group compared to 9.3 weeks (SD = 5) in the control (P < 0.001). One pregnancy was recorded in the group receiving standard of care; none were reported in the voucher group. Method mix did not differ by group: injectables were selected by most women (N = 150, 50%), and 52% of this proportion were in the experimental arm, with <10% in each arm selecting condoms, oral contraception, or intrauterine devices (IUDs). Similar proportions of women changed contraceptive methods over the 6-month follow-up in the voucher and control groups (N = 8, 5% versus N = 5, 4%; P = 0.467). More women in the control group discontinued contraception for 1 to 2 weeks (N = 19, 13% versus N = 7, 5%; P = 0.008) or more than 4 weeks (N = 15, 10% versus N = 3, 2%; P = 0.002) compared to those given a family planning voucher. The main limitation of this study is that its findings may not be generalized to settings without improved availability of contraceptives in publicly funded facilities.
These findings indicate that a well-structured, time-bound family planning voucher program appeared to increase early postpartum contraceptive uptake and continuation in a setting in which users are faced with financial, knowledge, and structural barriers to contraceptive services. Further work should clarify the role of vouchers in empowering WLWH to avoid unintended pregnancies over time.
ClinicalTrials.gov NCT02964169.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1002832</identifier><identifier>PMID: 31226123</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abortion ; Adult ; Antiretroviral therapy ; Biology and Life Sciences ; Birth control ; CD4 antigen ; Child health ; Clinical trials ; Condoms ; Contraception ; Contraception Behavior - trends ; Contraceptives ; Contraceptives industry ; Disease transmission ; Engineering and Technology ; Evaluation ; Family ; Family planning ; Family planning services ; Family Planning Services - methods ; Family Planning Services - trends ; Female ; Follow-Up Studies ; Funding ; Health ; Health facilities ; HIV ; HIV Infections - epidemiology ; HIV Infections - prevention & control ; HIV Infections - transmission ; HIV patients ; Hospitals ; Hospitals, Teaching - methods ; Hospitals, Teaching - trends ; Human immunodeficiency virus ; Humans ; Intrauterine devices ; IUD ; Maternal & child health ; Medicine and Health Sciences ; Methods ; Oral contraceptives ; People and Places ; Postnatal care ; Postnatal Care - methods ; Postnatal Care - trends ; Postpartum ; Pregnancy ; Pregnancy, Unplanned ; Public health ; Randomization ; Reproductive health ; Rural areas ; Social Sciences ; Studies ; Uganda - epidemiology ; Womens health</subject><ispartof>PLoS medicine, 2019-06, Vol.16 (6), p.e1002832-e1002832</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication: https://creativecommons.org/publicdomain/zero/1.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c764t-be432853dfa5fbe47f0080eda7ab4f6d53bfd8c84d533d25d2bf1f06b963de2f3</citedby><cites>FETCH-LOGICAL-c764t-be432853dfa5fbe47f0080eda7ab4f6d53bfd8c84d533d25d2bf1f06b963de2f3</cites><orcidid>0000-0001-6167-6328 ; 0000-0002-0045-0138</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588214/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588214/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31226123$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Todd, Catherine Suzanne</contributor><creatorcontrib>Atukunda, Esther C</creatorcontrib><creatorcontrib>Mugyenyi, Godfrey R</creatorcontrib><creatorcontrib>Obua, Celestino</creatorcontrib><creatorcontrib>Atuhumuza, Elly B</creatorcontrib><creatorcontrib>Lukyamuzi, Edward J</creatorcontrib><creatorcontrib>Kaida, Angela</creatorcontrib><creatorcontrib>Agaba, Amon G</creatorcontrib><creatorcontrib>Matthews, Lynn T</creatorcontrib><title>Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>Unwanted pregnancies remain a burden for women living with HIV (WLWH). Family planning prevents unplanned pregnancies while promoting longer birth intervals, key strategies to eliminate perinatal transmission of HIV and promote maternal and child health. We evaluated the effect of a family planning voucher, inclusive of immediate postpartum counseling, on uptake, early initiation, and continuation of modern contraceptive methods among recently postpartum WLWH delivering at a publicly funded regional referral hospital in rural, southwestern Uganda.
We performed a randomized controlled trial between October, 2016 and June, 2018 at a referral hospital in southwestern Uganda. This interim analysis includes adult WLWH randomized and enrolled equally to receive a family planning voucher or standard of care (control). Enrolled postpartum WLWH completed an interviewer-administered questionnaire at enrollment and 6 months postpartum. Our primary outcome of interest for this analysis is initiation of a modern family planning method within 8 weeks postpartum. Secondary outcomes included family planning initiation at 12, 14, 16, and 20 weeks postpartum, family planning discontinuation and/or change, pregnancy incidence, and mean time without contraception. The trial was registered with clinicaltrials.gov (NCT02964169). At enrollment, half of the women in both the voucher (N = 87, 55%) and control (N = 86, 54%) groups wanted to have a child in 2 years postpartum. Over 80% of referent pregnancies in the voucher (N = 136, 86%) and control (N = 128, 81%) groups were planned. All women were accessing ART. The mean CD4 count was 396 cells/mm3 (SD = 61) for those enrolled in the control group versus 393 cells/mm3 (SD = 64) in the family planning voucher group. By 8 weeks postpartum, family planning was initiated in 144 (91%) participants in the voucher group and 83 (52%) participants in the control group (odds ratio [OR] 9.42; CI 4.67-13.97, P < 0.001). We also found high family planning uptake rates for both groups, with higher rates among the intervention group at 12 weeks (OR 5.66; CI 2.65-12.12, P < 0.001), 14 weeks (OR 2.51; CI 1.31-4.79, P < 0.001), 16 weeks (OR 4.02; CI 1.66-9.77, P = 0.001), and 20 weeks (OR 3.65; CI 1.40-9.47, P = 0.004) postpartum. The average time to family planning initiation was reduced to 5.9 weeks (SD = 2.4) for those in the voucher group compared to 9.3 weeks (SD = 5) in the control (P < 0.001). One pregnancy was recorded in the group receiving standard of care; none were reported in the voucher group. Method mix did not differ by group: injectables were selected by most women (N = 150, 50%), and 52% of this proportion were in the experimental arm, with <10% in each arm selecting condoms, oral contraception, or intrauterine devices (IUDs). Similar proportions of women changed contraceptive methods over the 6-month follow-up in the voucher and control groups (N = 8, 5% versus N = 5, 4%; P = 0.467). More women in the control group discontinued contraception for 1 to 2 weeks (N = 19, 13% versus N = 7, 5%; P = 0.008) or more than 4 weeks (N = 15, 10% versus N = 3, 2%; P = 0.002) compared to those given a family planning voucher. The main limitation of this study is that its findings may not be generalized to settings without improved availability of contraceptives in publicly funded facilities.
These findings indicate that a well-structured, time-bound family planning voucher program appeared to increase early postpartum contraceptive uptake and continuation in a setting in which users are faced with financial, knowledge, and structural barriers to contraceptive services. Further work should clarify the role of vouchers in empowering WLWH to avoid unintended pregnancies over time.
ClinicalTrials.gov NCT02964169.</description><subject>Abortion</subject><subject>Adult</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>Birth control</subject><subject>CD4 antigen</subject><subject>Child health</subject><subject>Clinical trials</subject><subject>Condoms</subject><subject>Contraception</subject><subject>Contraception Behavior - trends</subject><subject>Contraceptives</subject><subject>Contraceptives industry</subject><subject>Disease transmission</subject><subject>Engineering and Technology</subject><subject>Evaluation</subject><subject>Family</subject><subject>Family planning</subject><subject>Family planning services</subject><subject>Family Planning Services - methods</subject><subject>Family Planning Services - trends</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Funding</subject><subject>Health</subject><subject>Health facilities</subject><subject>HIV</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - prevention & control</subject><subject>HIV Infections - transmission</subject><subject>HIV patients</subject><subject>Hospitals</subject><subject>Hospitals, Teaching - methods</subject><subject>Hospitals, Teaching - trends</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Intrauterine devices</subject><subject>IUD</subject><subject>Maternal & child health</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Oral contraceptives</subject><subject>People and Places</subject><subject>Postnatal care</subject><subject>Postnatal Care - methods</subject><subject>Postnatal Care - trends</subject><subject>Postpartum</subject><subject>Pregnancy</subject><subject>Pregnancy, Unplanned</subject><subject>Public health</subject><subject>Randomization</subject><subject>Reproductive health</subject><subject>Rural areas</subject><subject>Social Sciences</subject><subject>Studies</subject><subject>Uganda - 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trends</topic><topic>Contraceptives</topic><topic>Contraceptives industry</topic><topic>Disease transmission</topic><topic>Engineering and Technology</topic><topic>Evaluation</topic><topic>Family</topic><topic>Family planning</topic><topic>Family planning services</topic><topic>Family Planning Services - methods</topic><topic>Family Planning Services - trends</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Funding</topic><topic>Health</topic><topic>Health facilities</topic><topic>HIV</topic><topic>HIV Infections - epidemiology</topic><topic>HIV Infections - prevention & control</topic><topic>HIV Infections - transmission</topic><topic>HIV patients</topic><topic>Hospitals</topic><topic>Hospitals, Teaching - methods</topic><topic>Hospitals, Teaching - trends</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Intrauterine devices</topic><topic>IUD</topic><topic>Maternal & child health</topic><topic>Medicine and Health Sciences</topic><topic>Methods</topic><topic>Oral contraceptives</topic><topic>People and Places</topic><topic>Postnatal care</topic><topic>Postnatal Care - methods</topic><topic>Postnatal Care - trends</topic><topic>Postpartum</topic><topic>Pregnancy</topic><topic>Pregnancy, Unplanned</topic><topic>Public health</topic><topic>Randomization</topic><topic>Reproductive health</topic><topic>Rural areas</topic><topic>Social Sciences</topic><topic>Studies</topic><topic>Uganda - epidemiology</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Atukunda, Esther C</creatorcontrib><creatorcontrib>Mugyenyi, Godfrey R</creatorcontrib><creatorcontrib>Obua, Celestino</creatorcontrib><creatorcontrib>Atuhumuza, Elly B</creatorcontrib><creatorcontrib>Lukyamuzi, Edward J</creatorcontrib><creatorcontrib>Kaida, Angela</creatorcontrib><creatorcontrib>Agaba, Amon G</creatorcontrib><creatorcontrib>Matthews, Lynn T</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Atukunda, Esther C</au><au>Mugyenyi, Godfrey R</au><au>Obua, Celestino</au><au>Atuhumuza, Elly B</au><au>Lukyamuzi, Edward J</au><au>Kaida, Angela</au><au>Agaba, Amon G</au><au>Matthews, Lynn T</au><au>Todd, Catherine Suzanne</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2019-06-21</date><risdate>2019</risdate><volume>16</volume><issue>6</issue><spage>e1002832</spage><epage>e1002832</epage><pages>e1002832-e1002832</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>Unwanted pregnancies remain a burden for women living with HIV (WLWH). Family planning prevents unplanned pregnancies while promoting longer birth intervals, key strategies to eliminate perinatal transmission of HIV and promote maternal and child health. We evaluated the effect of a family planning voucher, inclusive of immediate postpartum counseling, on uptake, early initiation, and continuation of modern contraceptive methods among recently postpartum WLWH delivering at a publicly funded regional referral hospital in rural, southwestern Uganda.
We performed a randomized controlled trial between October, 2016 and June, 2018 at a referral hospital in southwestern Uganda. This interim analysis includes adult WLWH randomized and enrolled equally to receive a family planning voucher or standard of care (control). Enrolled postpartum WLWH completed an interviewer-administered questionnaire at enrollment and 6 months postpartum. Our primary outcome of interest for this analysis is initiation of a modern family planning method within 8 weeks postpartum. Secondary outcomes included family planning initiation at 12, 14, 16, and 20 weeks postpartum, family planning discontinuation and/or change, pregnancy incidence, and mean time without contraception. The trial was registered with clinicaltrials.gov (NCT02964169). At enrollment, half of the women in both the voucher (N = 87, 55%) and control (N = 86, 54%) groups wanted to have a child in 2 years postpartum. Over 80% of referent pregnancies in the voucher (N = 136, 86%) and control (N = 128, 81%) groups were planned. All women were accessing ART. The mean CD4 count was 396 cells/mm3 (SD = 61) for those enrolled in the control group versus 393 cells/mm3 (SD = 64) in the family planning voucher group. By 8 weeks postpartum, family planning was initiated in 144 (91%) participants in the voucher group and 83 (52%) participants in the control group (odds ratio [OR] 9.42; CI 4.67-13.97, P < 0.001). We also found high family planning uptake rates for both groups, with higher rates among the intervention group at 12 weeks (OR 5.66; CI 2.65-12.12, P < 0.001), 14 weeks (OR 2.51; CI 1.31-4.79, P < 0.001), 16 weeks (OR 4.02; CI 1.66-9.77, P = 0.001), and 20 weeks (OR 3.65; CI 1.40-9.47, P = 0.004) postpartum. The average time to family planning initiation was reduced to 5.9 weeks (SD = 2.4) for those in the voucher group compared to 9.3 weeks (SD = 5) in the control (P < 0.001). One pregnancy was recorded in the group receiving standard of care; none were reported in the voucher group. Method mix did not differ by group: injectables were selected by most women (N = 150, 50%), and 52% of this proportion were in the experimental arm, with <10% in each arm selecting condoms, oral contraception, or intrauterine devices (IUDs). Similar proportions of women changed contraceptive methods over the 6-month follow-up in the voucher and control groups (N = 8, 5% versus N = 5, 4%; P = 0.467). More women in the control group discontinued contraception for 1 to 2 weeks (N = 19, 13% versus N = 7, 5%; P = 0.008) or more than 4 weeks (N = 15, 10% versus N = 3, 2%; P = 0.002) compared to those given a family planning voucher. The main limitation of this study is that its findings may not be generalized to settings without improved availability of contraceptives in publicly funded facilities.
These findings indicate that a well-structured, time-bound family planning voucher program appeared to increase early postpartum contraceptive uptake and continuation in a setting in which users are faced with financial, knowledge, and structural barriers to contraceptive services. Further work should clarify the role of vouchers in empowering WLWH to avoid unintended pregnancies over time.
ClinicalTrials.gov NCT02964169.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31226123</pmid><doi>10.1371/journal.pmed.1002832</doi><orcidid>https://orcid.org/0000-0001-6167-6328</orcidid><orcidid>https://orcid.org/0000-0002-0045-0138</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1549-1676 |
| ispartof | PLoS medicine, 2019-06, Vol.16 (6), p.e1002832-e1002832 |
| issn | 1549-1676 1549-1277 1549-1676 |
| language | eng |
| recordid | cdi_plos_journals_2258795684 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central |
| subjects | Abortion Adult Antiretroviral therapy Biology and Life Sciences Birth control CD4 antigen Child health Clinical trials Condoms Contraception Contraception Behavior - trends Contraceptives Contraceptives industry Disease transmission Engineering and Technology Evaluation Family Family planning Family planning services Family Planning Services - methods Family Planning Services - trends Female Follow-Up Studies Funding Health Health facilities HIV HIV Infections - epidemiology HIV Infections - prevention & control HIV Infections - transmission HIV patients Hospitals Hospitals, Teaching - methods Hospitals, Teaching - trends Human immunodeficiency virus Humans Intrauterine devices IUD Maternal & child health Medicine and Health Sciences Methods Oral contraceptives People and Places Postnatal care Postnatal Care - methods Postnatal Care - trends Postpartum Pregnancy Pregnancy, Unplanned Public health Randomization Reproductive health Rural areas Social Sciences Studies Uganda - epidemiology Womens health |
| title | Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial |
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