Reviewer's report
Title:Use of HIV counseling and testing and family planning services among
postpartum women in Kenya: a multicentre, non-randomised trial
Version:2Date:26 May 2015
Reviewer: maricianah atieno onono
Reviewer's report:
Overall, I thought this was a nice study that avoided over-interpretation of the
results.
Major compulsory revisions
1. It is unclear what the precise Integra studied when compared to the standard
of care. The Kenya national guidelines for post natal care outline the same visit
schedule and promote PITC and counselling for FP with the exception of the 6
week visit. These create substantial opportunity for contamination, which are not
described anywhere in the text
2. A clearer statement of the study aim needs to be given. The final sentence of
the introduction tells a reader that the study was designed to assess “the
feasibility of integrating HIV PITC and FP services into PNC services and its
effect on the use of PITC and FP services among new mothers attending
postnatal care in public health facilities in Kenya”. This is alright, as far as it goes,
but greater precision and specificity regarding these aims, as well as the ultimate
potential impact of such changes (e.g. reduction of unintended pregnancy or
vertical transmission due to women not being re-tested). Related to this point is
that the rationale for the study, while it can be gleaned from the manuscript,
should be more clearly and explicitly stated.
3. Although the methods for the larger Integra project are reported elsewhere, for
this paper
I. Provide a justification for the sample size and the actual number of participants
included
II. Briefly explain why randomisation of the sites was not done (as mentioned in
the limitations section)
III. Inherently, there are limitations to cluster designs, but the statistical methods
used to control for this are not well described in this paper.
4. It is not clear if the baseline participants are the same as the endline
participants - in fact my understanding is that they are different. While the
methods say that this is a prospective cohort, further in the discussion, they
mention that the study was cross-sectional. Can the authors explain/justify why a
cross sectional rather than a cohort approach was chosen
5. Additionally, in the methods section a closer description of the covariates
included in the model is needed. The dependent variable should be explicitly
stated as such. It would also be helpful to know the correlation structure
6. Baseline tables should contain p-values where testing was conducted
7. Table 1: There is no justification for discrepancy in the number of participants
in each arm. While it is acceptable, there needs to be a justification
8. In reporting the multivariate analysis results, I would like to see the 95%
confidence intervals reported together with the Odds Ratios
9. In stating limitations – it would be great for the authors to comment on how
those limitations could affect the validity and generalizability of the results and
how they attempted to mitigate them
10. Discussion: Greater nuance is needed in interpreting the findings, however,
particularly in relation to impact, or lack thereof, on clinical and population health
outcomes including vertical transmission of HIV and unwanted pregnancy in the
immediate postnatal period
Discretionary revisions
There is an entire section that justifies consenting women less than 18 years of
age that is very lengthy and could be considerably shortened to provide room to
address some of the issues raised above
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests