Abstract: We identified four studies that met the inclusion criteria: three randomized controlled trials and a pilot study for one of the included trials. The interventions differed markedly: computer-delivered, individually tailored sessions; phone counseling added to clinic counseling; and case management plus a peer-leadership program. The latter study, which addressed multiple risks, showed an effect on contraceptive use. Compared to the control group, the intervention group was more likely to report consistent dual-method use, i.e., oral contraceptives and condoms. The reported relative risk was 1.58 at 12 months (95% CI 1.03 to 2.43) and 1.36 at 24 months (95% CI 1.01 to 1.85). The related pilot study showed more reporting of consistent dual-method use for the intervention group compared to the control group (reported P value = 0.06); the investigators used a higher alpha (P < 0.10) for this pilot study. The other two trials did not show any significant difference between the study groups in reported dual-method use or in test results for pregnancy or STIs at 12 or 24 months. We found few behavioral interventions for improving dual-method contraceptive use and little evidence of effectiveness. A multifaceted program showed some effect but only had self-reported outcomes. Two trials were more applicable to clinical settings and had objective outcomes measures, but neither showed any effect. The included studies had adequate information on intervention fidelity and sufficient follow-up periods for change to occur. However, the overall quality of evidence was considered low. Two trials had design limitations and two had high losses to follow up, as often occurs in contraceptive trials. Good quality studies are still needed of carefully designed and implemented programs or services.

Plain-language summary: Through January 2014, we did computer searches for studies of programs to improve use of dual-methods. We wrote to researchers to find missing data. Studies examined a behavioral intervention for improving dual-method use. The educational program had to address preventing pregnancy and HIV/STI by using condoms plus another modern contraceptive. The intervention was compared with a different program, usual care, or no intervention. We only found four studies to include. Three were randomized trials and the fourth was a pilot study for one of the included trials. The programs differed from one another. They included computer-delivered sessions tailored for each person; phone counseling added to clinic counseling; and case management plus a peer-leadership program. In the latter study, more women in the intervention group reported regular use of dual methods, namely birth control pills plus condoms, than the control group. The pilot study reported a trend toward more regular dual-method use for the intervention group compared to the control group. The other two trials did not show any major difference between the study groups in reported use of dual methods or in test results for pregnancy or STIs. We found few programs to improve use of dual methods, and only one showed an effect. The reports gave enough information on how the interventions were conducted. The studies had adequate follow-up periods of 12 to 24 months. However, the overall quality of results was low, mainly due to study design and losing many women to follow up.