Reviewer ’s report  
 
Title: Modern Contraceptive Use among Postpartum Women l iving with HIV Attending Mother 
Baby Care Points in Kabarole District, Uganda  
 
Version: 2 Date: 06 Aug 2018  
 
Reviewer: Nancy Padian  
 
Reviewer's report:  
 
It's clear that the authors w orked hard to address the comments.  Still, my fundamental concern 
from the last version still remains.  As I mentioned in my last review, the significance of the 
study is diminished by the fact that uptake of modern methods was associated with method 
availability and whether counseling occurred; factors entirely driven by supply and not choices 
made by the women themselves.   This seems a bit circular and uninformative (i.e. determinants 
of uptake might better be limited to women with equal access).  For e xample, in this revised 
version (Line 10: p 215), they consider the opportunity women had to "find" contraceptive at 
care sites.  Isn't this a de facto necessity?  That access to modern contraceptives repeatedly 
comes up as a significant predictor of use, still seems very self -evident.  Are there other ways 
women could have accessed FP methods outside of these care visits?  As it stands, that access to 
methods is associated with use, seems axiomatic and therefor unenlightening  
 
 
Three other supply related i ssues are:   
 
p. 16, line 335: isn't the hypothesis that integration of family planning and reproductive health 
with HIV services would increase uptake of both?  In this case, contraceptive uptake was lower 
among HIV -infected post -partum women who had integrated services compared to women living 
with HIV in general  
 
p. 17: par beginning on line 345: Injectables were likely most used because they were most 
offered. Again, this would have nothing to do with individual choice.   
 
The comparison re condom uptake in PLWHIV in general compared to post -partum, infected 
women may not be apt because in the former, condoms may have been promoted more for HIV 
prevention rather  than family planning.  More specifically, condoms could simply have been 
more widely available in HIV clinics. Similarly, given well -known limitations with self -report of 
condom use, the text comparing prevalence of condom use in different samples may not  be 
warranted  
 
 
Timing and opportunities for uptake of modern method:  
 
They are examining women 2 -18 mos. post -partum - time, yet, women &gt; 7 most post -partum 
are more likely to be using modern methods of contraception.  Perhaps this means that the 
women s hould not be pooled - (this is one of the problems of a cross -sectional survey) - indeed, 
it's possible that some of the women who delivered more recently may in fact adopt a modern 
method later on —still, this supports the need as they point out, for targeti ng women for FP soon 
after delivery women  
 
Similarly, ( P. 7, line 140):  I wonder if it was wise to exclude those women  seeking immediate 
care or attention from the healthcare worker - isn't it possible that they might receive FP 
counseling and methods d uring this visit?  Likewise, on p.8, line 165:  the authors note that 
interviews were conducted, prior to receipt of the routine healthcare. Here too, might it be 
possible that women received FP counseling and access to methods during the health care part of 
the visit and so this would be missed?  
 
 
Measurement:  
 
P. 9, line 182: were women only asked about specific contraceptive methods if they first 
answered yes to using modern contraceptives or was the list of methods posed to all participants.  
Asking the whole list for everyone would be more rigorous, and then, if a woman answers no to 
all the methods, they could then be categorized as not having used a modern method  
 
P. 10 &lt; line 2017:  categorization of the period of time since child birth seems to hav e been 
made post -hoc based -on analyses that revealed differences in uptake by months since birth.  This 
seems somewhat circular  
 
Line 209: characterization of previous users of modern methods was assessed by ever use of a 
modern such a method pre -pregnancy . Does this mean that frequency of use of these methods is 
irrelevant?  
 
Line 217: its important to point out that information regarding the male partners was ascertained 
by self -report from the women, at least I think this is the case.  
 
p 13, line 266: wha t is the rationale for dichotomizing the time they learned their serostatus as 3 
years prior to the study?  
 
P.4, line 70: how was risky sex defined and measured?  
 
 
Analysis:   
 
p. 11, line 232; I believe that use of a modern method was the dependent and not  independent 
outcome of interest  
 
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 control s? 
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
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 o f written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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