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Little information exists on the impact of integrating family planning (FP) services into HIV care and treatment on patients’ familiarity with and attitudes toward FP. We conducted a cluster-randomized trial in 18 public HIV clinics with twelve randomized to integrated FP and HIV services and six to the standard referral-based system where patients are referred to an FP clinic. Serial cross-sectional surveys were done before (n=488 women, 486 men) and after (n=479 women, 481 men) the intervention to compare changes in familiarity with FP methods and attitudes toward FP between integrated and non-integrated sites. We created an FP familiarity score based on the number of more effective FP methods patients could identify (score range: 0-6). Generalized estimating equations were used to control for clustering within sites. An increase in mean familiarity score between baseline (mean=5.16) and post-intervention (mean=5.46) occurred with an overall mean change of 0.26 (95%CI= 0.09, 0.45; p=0.003) across all sites. At endline, there was no difference in increase of mean FP familiarity scores at intervention versus control sites (mean=5.41 vs. 5.49, p=0.94). We observed a relative decrease in the proportion of males agreeing that FP was “women’s business” at integrated sites (baseline 42% to endline 30%; reduction of 12%) compared to males at non-integrated sites (baseline 35% to endline 42%; increase of 7%); aOR=0.43; 95%CI=0.22, 0.85). Following FP-HIV integration, familiarity with FP methods increased but did not differ by study arm. Integration was associated with a decrease in negative attitudes toward FP among men.

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Background The United States HIV care workforce is shrinking, which could complicate service delivery to people living with HIV (PLWH). In this study, we examined the impact of practice transformations, defined as efficiencies in structures and delivery of care, on demonstration project sites within the Workforce Capacity Building Initiative, a Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program Special Projects of National Significance (SPNS). Methods and findings Data were collected at 14 demonstration project sites in 7 states and the District of Columbia. Organizational assessments were completed at sites once before and 4 times after implementation. They captured 3 transformation approaches: maximizing the HIV care workforce (efforts to increase the number of existing healthcare workforce members involved in the care of PLWH), share-the-care (team-based care giving more responsibility to midlevel providers and staff), and enhancing client engagement in primary HIV care to reduce emergency and inpatient care (e.g., care coordination). We also obtained Ryan White HIV/AIDS Program Services Reports (RSRs) from sites for calendar years (CYs) 2014-2016, corresponding to before, during, and after transformation. The RSR include data on client retention in HIV care, prescription of antiretroviral therapy (ART), and viral suppression. We used generalized estimating equation (GEE) models to analyze changes among sites implementing each practice transformation approach. The demonstration projects had a mean of 18.5 prescribing providers (SD = 23.5). They reported data on more than