Integration of family planning services into HIV care clinics: Results one year after a cluster randomized controlled trial in Kenya

Craig R Cohen, Daniel Grossman, Maricianah Onono, Cinthia Blat, Sara J Newmann, Rachel L Burger, Starley B Shade, Norah Bett, Elizabeth A Bukusi, Craig R Cohen, Daniel Grossman, Maricianah Onono, Cinthia Blat, Sara J Newmann, Rachel L Burger, Starley B Shade, Norah Bett, Elizabeth A Bukusi

Abstract

Objectives: To determine if integration of family planning (FP) and HIV services led to increased use of more effective contraception (i.e. hormonal and permanent methods, and intrauterine devices) and decreased pregnancy rates.

Design: Cohort analysis following cluster randomized trial, when the Kenya Ministry of Health led integration of the remaining control (delayed integration) sites and oversaw integrated services at the original intervention (early integration) sites.

Setting: Eighteen health facilities in Kenya.

Subjects: Women aged 18-45 receiving care: 5682 encounters at baseline, and 11628 encounters during the fourth quarter of year 2.

Intervention: "One-stop shop" approach to integrating FP and HIV services.

Main outcome measures: Use of more effective contraceptive methods and incident pregnancy across two years of follow-up.

Results: Following integration of FP and HIV services at the six delayed integration clinics, use of more effective contraception increased from 31.7% to 44.2% of encounters (+12.5%; Prevalence ratio (PR) = 1.39 (1.19-1.63). Among the twelve early integration sites, the proportion of encounters at which women used more effective contraceptive methods was sustained from the end of the first to the second year of follow-up (37.5% vs. 37.0%). Pregnancy incidence including all 18 integrated sites in year two declined in comparison to the control arm in year one (rate ratio: 0.72; 95% CI 0.60-0.87).

Conclusions: Integration of FP services into HIV clinics led to a sustained increase in the use of more effective contraceptives and decrease in pregnancy incidence 24 months following implementation of the integrated service model.

Trial registration: ClinicalTrials.gov NCT01001507.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Trial profile.
Fig 1. Trial profile.
Fig 2. Proportion of encounters on which…
Fig 2. Proportion of encounters on which women used more effective contraceptive methods.

References

    1. UNAIDS (2014) The Gap Report. pp. 127.
    1. World Health Organization, United Nations Population Fund (2006) Sexual and reproductive health of women living with HIV/AIDS: Guidelines on care, treatment and support for women living with HIV/AIDS and their children in resource-constrained settings. Geneva.
    1. Schwartz SR, Rees H, Mehta S, Venter WD, Taha TE, et al. (2012) High incidence of unplanned pregnancy after antiretroviral therapy initiation: findings from a prospective cohort study in South Africa. PLoS One 7: e36039 10.1371/journal.pone.0036039
    1. Rochat TJ, Richter LM, Doll HA, Buthelezi NP, Tomkins A, et al. (2006) Depression among pregnant rural South African women undergoing HIV testing. JAMA 295: 1376–1378. 10.1001/jama.295.12.1376
    1. Homsy J, Bunnell R, Moore D, King R, Malamba S (2009) Reproductive Intentions and Outcomes among Women on Antiretroviral therapy in Rural Uganda: A Prospective Cohort Study. PLoS ONE 4: e4149 10.1371/journal.pone.0004149
    1. United Nations Population Fund (2004) The Glion Call to Action on Family Planning and HIV/AIDS in Women and Children
    1. Duerr A, Hurst S, Kourtis AP, Rutenberg N, Jamieson DJ (2005) Integrating family planning and prevention of mother-to-child HIV transmission in resource-limited settings. The Lancet 366: 261–263.
    1. Brocklehurst P, French R (1998) The association between maternal HIV infection and perinatal outcome: a systematic review of the literature and meta-analysis. Br J Obstet Gynaecol 105: 836–848.
    1. Global report: UNAIDS report on the global AIDS epidemic 2013. Joint United Nations Programme on HIV/AIDS.
    1. Mutiso SM, Kinuthia J, Qureshi Z (2008) Contraceptive use among HIV infected women attending Comprehensive Care Centre. East Afr Med J 85: 171–177.
    1. Wilcher R, Petruney T, Reynolds H, Cates W (2008) From effectiveness to impact: contraception as an HIV prevention intervention. Sexually Transmitted Infections 84: ii54–60. 10.1136/sti.2008.030098
    1. Grossman D, Onono M, Newmann SJ, Blat C, Bukusi EA, et al. (2013) Integration of family planning services into HIV care and treatment in Kenya: a cluster-randomized trial. AIDS 27 Suppl 1: S77–85.
    1. Newmann SJ, Grossman D, Blat C, Onono M, Steinfeld R, et al. (2013) Does integrating family planning into HIV care and treatment impact intention to use contraception? Patient perspectives from HIV-infected individuals in Nyanza Province, Kenya. Int J Gynaecol Obstet 123 Suppl 1: e16–23.
    1. Newmann SJ, Mishra K, Onono M, Bukusi EA, Cohen CR, et al. (2013) Providers' Perspectives on Provision of Family Planning to HIV-Positive Individuals in HIV Care in Nyanza Province, Kenya. AIDS Res Treat 2013: 915923 10.1155/2013/915923
    1. Steinfeld RL, Newmann SJ, Onono M, Cohen CR, Bukusi EA, et al. (2013) Overcoming Barriers to Family Planning through Integration: Perspectives of HIV-Positive Men in Nyanza Province, Kenya. AIDS Res Treat 2013: 861983 10.1155/2013/861983
    1. Patel R, Baum S, Grossman D, Steinfeld R, Onono M, et al. (2014) HIV-Positive Men's Experiences with Integrated Family Planning and HIV Services in Western Kenya: Integration Fosters Male Involvement. AIDS Patient Care STDS 28: 418–424. 10.1089/apc.2014.0046
    1. Tao AR, Onono M, Baum S, Grossman D, Steinfeld R, et al. (2015) Providers' perspectives on male involvement in family planning in the context of a cluster-randomized controlled trial evaluating integrating family planning into HIV care in Nyanza Province, Kenya. AIDS Care 27: 31–37. 10.1080/09540121.2014.954982
    1. Newmann SJ, Zakaras JM, Tao AR, Onono M, Bukusi EA, et al. Integrating family planning into HIV care in western Kenya: HIV care providers’ perspectives and experiences one year following integration. AIDS Care In Press.
    1. Shade SB, Kevany S, Onono M, Ochieng G, Steinfeld RL, et al. (2013) Cost, cost-efficiency and cost-effectiveness of integrated family planning and HIV services. AIDS 27 Suppl 1: S87–92.
    1. Tsui AO, McDonald-Mosley R, Burke AE (2010) Family planning and the burden of unintended pregnancies. Epidemiol Rev 32: 152–174. 10.1093/epirev/mxq012
    1. Antelman G, Medley A, Mbatia R, Pals S, Arthur G, et al. (2015) Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania. J Fam Plann Reprod Health Care 41: e1 10.1136/jfprhc-2013-100784
    1. Mak J, Birdthistle I, Church K, Friend-Du Preez N, Kivunaga J, et al. (2013) Need, demand and missed opportunities for integrated reproductive health-HIV care in Kenya and Swaziland: evidence from household surveys. AIDS 27 Suppl 1: S55–63.
    1. Cherutich P, Kaiser R, Galbraith J, Williamson J, Shiraishi RW, et al. (2012) Lack of knowledge of HIV status a major barrier to HIV prevention, care and treatment efforts in Kenya: results from a nationally representative study. PLoS One 7: e36797 10.1371/journal.pone.0036797
    1. Cohen MS, Gay CL (2010) Treatment to prevent transmission of HIV-1. Clin Infect Dis 50 Suppl 3: S85–95.

Source: PubMed

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