Reviewer ’s report  
 
Title: Modern Cont raceptive Use among Postpartum Women l iving with HIV Attending Mother 
Baby Care Points in Kabarole District, Uganda  
 
Version: 1 Date: 12 Feb 2018  
 
Reviewer: Nancy Padian  
 
Reviewer's report:  
 
GENERAL COMMENTS:   
 
This is a tidy paper with well -defined methods and analyses.  The significance of the study 
however, is diminished by the fact that uptake of modern methods was associated with method  
availability and whether counseling occurred.   This seems a bit circular and uninformative (ie 
determinants of uptake might better be limited to women with equal and wide access).  Related 
to this was the finding that uptake was greater among PLWHIV and the hypothesis that more (or 
perhaps better?) counseling is offered at ART clinics than in post -natal care.  Can't this be 
assessed empirically by examining SOPs at different types of clinics?  Finally, if some methods 
are contraindicated for HIV infected women, it seems odd that this is not addressed in 
counseling.  These limitations highlight the fact that determinants of uptake might be more 
closely related to supply factors and health care delivery, rather than individual choice.  
 
Another general comme nt is that from the outset, they need to say how modern contraception is 
defined.  This affects measurement of the type of contraceptives at the time of the study: for 
example, as condoms were included, how was frequency of use taken into account?  Similar ly 
given well -known limitations with self -report of condom use, the text comparing prevalence of 
condom use in different samples may not be warranted.  A more important concern is that 
combining methods that require wildly different methods of adherence ma y severely confound 
results  
 
 
SPECIFIC COMMENTS:  
 
Second and third pars in background have a lot of repetition and also, it's not clear here and 
throughout the paper which references are for global estimates and which are more regional or 
local  
 
What are the criteria for lactation amenorrhea?  
 
Although sample size parameters are clearly defined, it would be helpful to know the 
denominator of eligible women from which the 369 were selected:   
 
How was fecundity assessed?  
Did they know the proportion of married or  consensual union partners that were also the fathers 
of the babies considered in this study?  
 
Were the women farmers or were their husbands?  
 
In comparisons to other women in Uganda, did they control for age and parity  
 
More information about period of time since birth would also be interesting, rather than 
considering the cut point of 6 or 7 months, it would be interesting to look at mothers closer to 18 
most post -delivery.  
 
Data on ART adherence among the mothers could be an important independent predictor  
The finding that uptake was higher among those in wanting to space pregnancy rather than stop 
needs unpacking  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, fees, funding, or salary 
from an  organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the p ublication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that  I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I have no competing interests  
 
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