Effect of behavioral interventions on contraceptive use among women living with HIV: Systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Contraceptive use is a cost-effective public health strategy to prevent unplanned pregnancy, maternal mortality and morbidity, and reduce vertical HIV transmission. However, contraceptive use remains low among women living with HIV. Reviews examining effect of behavioral interventions on contraceptive use among women living with HIV using randomized controlled trials are limited. We evaluated the effect of behavioral interventions on contraceptive use among women living with HIV using randomized controlled trials. METHODS: We conducted a systematic literature search across PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov and the Cochrane Central Register of Control Trials from their inception to 09/15/2025. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-2020) guidelines were followed in conducting this review. Peer reviewed and published randomized controlled trials (RCTs) focusing on behavioral interventions were included. Effect estimates (odds ratios) were pooled using a random-effects model (REM). Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: The search yielded 853 records. Five trials involving 5903 women living with HIV and published between 2009 and 2021 were included in this review. Across the trials, structured contraceptive counseling was the most common intervention implemented while others included provision of family planning vouchers, client outreaches and education and counseling on safe sex, and social support. Two of the studies were conducted in Uganda, two in Kenya and one in the United States. Two of the studies reported 100% antiretroviral therapy use with mean duration ranging 4.1 years (SD = 3.33) to 7.8 years (SD = 7.1), while one study reported 83.9% viral suppression among their sample. Across the trials, behavioral interventions were significantly associated with greater odds of contraceptive use among women living with HIV with pooled odds ratio, 3.61 (95% CI: 1.15, 11.32), p = 0.04 compared to controls. CONCLUSIONS: The findings underscore the efficacy of behavioral interventions in enhancing contraceptive use among women living with HIV. Leveraging behavioral interventions could offer an opportunity to increase contraceptive use and improve the reproductive health outcomes for women living with HIV.