You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Efficacy of a Culturally Adapted Intervention for Youth Living with HIV in Uganda
Abstract 1:
This study examined whether a culturally adapted version of a previously evaluated efficacious HIV prevention program reduced sexual risk behaviors of youth living with HIV ( YLH ) in Ug and a. YLH , 14 to 21 years , were r and omized to  intervention ( N = 50 ) or control  ( N = 50 ) conditions . Significantly more YLH in the intervention used condoms consistently and decreased their number of sexual partners in comparison to the control condition . Western interventions can be culturally adapted to retain efficacy in reducing the sexual risk behavior of YLH


Title 2:
Improved access increases postpartum uptake of contraceptive implants among HIV-positive women in Rwanda
Abstract 2:
Background Long-acting reversible contraceptives ( LARCs ) and sterilisation are the most cost-effective methods of contraception but are rarely used in sub-Saharan Africa partly due to limited access . Study design HIV-positive pregnant women attending two urban clinics in Rw and a were followed prospect ively in a perinatal HIV transmission cohort study . Women attending one clinic were referred to public family planning ( FP ) services for all contraceptive methods ( Site A ) and women attending the other clinic ( Site B ) were offered implants and intrauterine devices ( IUDs ) on-site . Results Fifty three percent of the pregnant women reported an intention to use a LARC or to be sterilised after delivery . The uptake of implants was significantly higher at Site B ( 38 % ) than at Site A ( 6 % ) . The IUD uptake was extremely low at both sites ( 2 % ) . Twenty-eight of the 39 women at Site B who had intended to start using a LARC actually did so as compared to only one of 23 at Site A. Conclusion When access to LARC was provided , a substantial number of HIV-positive women started using hormonal implants , but not IUDs , in the postpartum period . HIV and FP services should consider improving access to implants to reduce the number of unintended pregnancies


Title 3:
Successful increase in contraceptive uptake among Kenyan HIV-1-serodiscordant couples enrolled in an HIV-1 prevention trial
Abstract 3:
Objective : To evaluate a multipronged approach to promote dual  contraceptive  use by women within heterosexual HIV-1-serodiscordant partnerships . Methods : For 213 HIV-1-serodiscordant couples in Thika , Kenya , participating in an HIV-1 prevention clinical trial , contraceptive promotion was initiated through a multipronged intervention that included staff training , couples family planning sessions , and free provision of hormonal contraception on-site .  Contraceptive use and pregnancy incidence were compared between two time periods ( before versus after June 2007 , when the intervention was initiated ) and between Thika and other Kenyan trial sites ( Eldoret , Kisumu , and Nairobi ) . Generalized estimating equations and And ersen – Gill proportional hazards modeling were used . Results : Nonbarrier contraceptive use increased after implementation of the intervention : from 31.5 to 64.7 % of visits among HIV-1-seropositive women [ odds ratio 4.0 , 95 % confidence interval ( CI ) 3.0–5.3 ] and from 28.6 to 46.7 % of visits among HIV-1-seronegative women ( odds ratio 2.2 , 95 % CI 1.4–3.5 ) . In comparison , at the other Kenyan sites , where the intervention was not implemented , contraceptive use changed minimally , from 15.6 to 22.3 % of visits for HIV-1-seropositive women and from 13.6 to 12.7 % among HIV-1-seronegative women . Self-reported condom use remained high during follow-up . Pregnancy incidence at the Thika was significantly lower after compared with before June 2007 ( hazard ratio 0.2 , 95 % CI 0.1–0.6 ) and was approximately half that at other Kenyan sites during the intervention period ( hazard ratio 0.5 , 95 % CI 0.3–0.8 ) . Conclusion : A multipronged family planning intervention can lead to high nonbarrier contraceptive uptake and reduced pregnancy incidence among women in HIV-1-serodiscordant partnerships


Title 4:
Messages about dual contraception in areas of high HIV prevalence are not heeded.
Abstract 4:
BACKGROUND Dual protection is recommended for prevention of unwanted pregnancies and protection against sexually transmitted infections , including HIV . It is critical for HIV-negative women to prevent seroconversion and HIV transmission to their infants during pregnancy and breastfeeding . METHODS Women were followed up after delivery , monthly for the first 9 months and then 3-monthly to 24 months , in a cohort study investigating postnatal HIV transmission . Study nurses discussed family planning , including condom use , at each visit . Contraceptive methods used since the last visit were recorded . All women knew their HIV status , and most women breastfed for a minimum of 6 months . RESULTS Among 1,137 HIV-positive and 1 220 HIV-negative women the most common contraceptive method was the hormonal injectable ; few women used  condoms alone  or as dual contraception  ( 0 - 3 months 6.8 % ; 7 - 12 months 16.3 % ; 19 - 24 months 14.4 % ) . Compared with uninfected women , HIV-positive women were more likely to use condoms in years 1 and 2 after delivery ( adjusted odds ratio ( AOR ) 1.72 , 95 % confidence interval ( CI ) 1.38 - 2.14 , p<0.001 ; AOR 1.61 , 95 % CI 1.15 - 2.25 , p=0.006 respectively ) . Compared with women with a flush toilet , those with a pit latrine were less likely to use condoms in years 1 and 2 ( AOR 0.22 , 95 % CI 01.7 - 0.28 , p<0.001 ; AOR 0.27 , 95 % CI 0.19 - 0.39 , p<0.001 ) . Older women were more likely to use condoms in the first postpartum year ( AOR 1.78 , 95 % CI 1.03 - 3.09 , p=0.040 ) . CONCLUSIONS More creative ways of promoting condoms and dual contraception need to be found if new HIV infections , in women and children , are to be prevented
We found little innovation in the behavioral interventions .
Since some of these studies were conducted , improvements in HIV treatment have influenced the fertility intentions of HIV-positive people .