BackgroundFamily planning (FP) is an essential health service and an important part of comprehensive HIV care. However, there is limited information about the contraceptive needs of people living with HIV in sub-Saharan Africa, which in turn has hampered efforts to expand and integrate FP services into existing HIV programs.MethodsWe performed a cross-sectional survey to determine FP prevalence and predictors among HIV-positive women and men attending 18 public antiretroviral therapy (ART) clinics in Lusaka, Zambia. Trained peer counselors administered the 10-question survey to those seeking care for five days at each of the target sites.ResultsFrom February to April 2014, we surveyed 7,046 HIV-infected patients receiving routine HIV services. Use of modern contraception was reported by 69 % of female ART patients and 79 % of male ART patients. However, highly effective contraceptive use and dual method use were low among women (38 and 25 %, respectively) and men (19 and 14 %, respectively). HIV disclosure status (adjusted odds ratio (AOR) = 4.91, 95 % confidence interval (CI) = 3.32–7.24 for women, AOR = 3.58, 95 % CI = 2.39–5.38 for men) and sexual activity in the last 6 months (AOR = 5.80, 95 % CI = 4.51–7.47 for women, AOR = 6.24, 95 % CI = 3.51–11.08 for men) were associated with modern contraceptive use in multivariable regression. Most respondents said they would access FP services if made available within ART clinic.ConclusionsWhile FP-ART integration may be a promising strategy for increasing FP service uptake, such services must focus on assessing sexual activity and advocating for dual method use to increase effective contraceptive use and prevent unintended pregnancies.

Reducing the global unmet need for contraception is currently a priority for many governments, multi-lateral initiatives, non-governmental organizations, and donors. Evidence strongly suggests that the provision of quality family planning services can increase uptake, prevalence, and continuation of contraception. While an accepted framework to define the components of family planning service quality exists, translating this framework into assessment tools that are accessible, easily utilized, and valid for service providers has remained a challenge. We propose new approaches to improve the standardization and accessibility of family planning service quality assessment tools to simplify family planning service quality evaluation. With easier approaches to program evaluation, quality improvements can be performed more swiftly to help increase uptake and continuation of contraception to improve the health of women and their families.

The aim of this study was to evaluate the HIV-1 RNA pooled nucleic acid amplification testing (NAAT) strategy to screen pregnant women in the 'window period' of acute HIV infection (AHI) in rural South Africa. MethodsIn 2007 and 2008, 750 consecutive pregnant women on their first antenatal care visit to a primary health care clinic were tested anonymously for HIV infection. HIV-1 RNA pooled NAAT was performed on HIV antibody-negative samples. All positive pools were tested individually and positive samples were classified as incident cases to calculate HIV incidence. ResultsThe overall HIV prevalence was 37.3% [95% confidence interval (CI) 34.3-41.3]. Of the 467 HIV antibody-negative samples, four (0.9%) were HIV-1 RNA-positive. The mean viral load in the four samples was 386 260 HIV-1 RNA copies/mL (range 64 200-1 228 130). The HIV incidence was 11.2% per year (95% CI 0.3-22.1) and all women with AHI were 21 years of age. ConclusionsIdentifying AHI in pregnancy is important for health interventions to reduce perinatal and heterosexual transmission of HIV, and to estimate HIV incidence for epidemiological surveillance. IntroductionEpidemiological screening for HIV infection using standard antibody tests is crucial to understand and monitor the spread of HIV and to provide care and treatment for those who are infected [1]. In countries with generalized epidemics where heterosexual transmission is dominant, HIV seroprevalence surveys among pregnant women are frequently used. These surveys identify individuals with latent or advanced HIV disease and miss individuals with 'window-period' acute HIV infection (AHI), who are more likely to transmit HIV due to high viral concentrations in the blood and genital tract [2,3]. Sensitive, validated and well-calibrated assays for HIV-1 RNA and p24 antigen, and the fourth-generation assays for the simultaneous detection of HIV antibodies and p24 antigen, have been used with increasing frequency to diagnose AHI [4][5][6][7][8]. These tests have been used in cross-sectional studies to estimate HIV incidence [5,6] and are useful to understand HIV transmission dynamics and assess the impact of public health interventions [9]. The objective of this study was to evaluate the HIV-1 RNA pooled nucleic acid amplification testing (NAAT) strategy to screen pregnant women for 'window-period' AHI and estimate HIV incidence. Methods Study setting and populationThe study population comprised pregnant women attending seven public sector primary health care clinics in Vulindlela, a rural community about 150 km west of HIV testing procedureHIV antibody testing on serum samples was carried out using Enzygnost* Anti-HIV-1/2 Plus (Dade Behring, Marburg, Germany), an ELISA for the detection of antibodies to HIV-1, HIV-2 and HIV-1 (subtype O) antigens. Plasma from all ELISA-negative samples were batched and tested using the pooled NAAT strategy [5,6]. Each master pool comprised 10 samples, consisting of 100 mL from each sample to a total volume of 1000 mL, and tested with qualitative HIV-1 RNA pol...