Impact of Integrated Family Planning and HIV Care Services on Contraceptive Use and Pregnancy Outcomes

Abstract

Objective To determine the impact of routine care (RC) and integrated family planning (IFP) and HIV care service on family planning (FP) uptake and pregnancy outcomes. Design Retrospective cohort study conducted between October 10, 2005, and February 28, 2009. Setting United States Agency for International Development—Academic Model Providing Access To Healthcare (USAID-AMPATH) in western Kenya. Subjects Records of adult HIV-infected women. Intervention Integration of FP into one of the care teams. Primary Outcomes Measures Incidence of FP methods and pregnancy. Results Four thousand thirty-one women (1453 IFP; 2578 RC) were eligible. Among the IFP group, there was a 16.7% increase (P < 0.001) [95% confidence interval (CI): 13.2% to 20.2%] in incidence of condom use, 12.9% increase (P < 0.001) (95% CI: 9.4% to 16.4%) in incidence of FP use including condoms, 3.8% reduction (P < 0.001) (95% CI: 1.9% to 5.6%) in incidence of FP use excluding condoms, and 0.1% increase (P = 0.9) (95% CI: −1.9% to 2.1%) in incidence of pregnancies. The attributable risk of the incidence rate per 100 person-years of IFP and RC for new condom use was 16.4 (95% CI: 11.9 to 21.0), new FP use including condoms was 13.5 (95% CI: 8.7 to 18.3), new FP use excluding condoms was −3.0 (95% CI: −4.6 to −1.4) and new cases of pregnancies was 1.2 (95% CI: −0.6 to 3.0). Conclusions Integrating FP services into HIV care significantly increased the use of modern FP methods but no impact on pregnancy incidence. HIV programs need to consider integrating FP into their program structure.

Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania

“…35 Other methods of contraception such as sterilisation, intrauterine devices (IUDs) and hormonal contraceptives are more effective, but do not protect against HIV transmission or acquisition of other sexually transmitted infections (STIs). Thus, using only condoms for dual protection against HIV/STIs and unintended pregnancy is not as reliable or effective as dual method use, 38 which combines consistent condom use with a highly effective contraceptive method. 36 However, studies indicate that fewer than 20% of PLHIV in sub-Saharan Africa report dual method use.…”

Women and Lung Disease. Sex Differences and Global Health Disparities

“…Diagnosing TB among pregnant women remains a challenge in Kenya. Kosgei and colleagues (47) found TB symptom screening questionnaires to be less useful than chest X-rays to identify TB suspects in both symptomatic and asymptomatic women. Physiological changes associated with pregnancy, as well as women living with HIV, may mask the symptoms of TB.…”

HIV-Positive Men's Experiences with Integrated Family Planning and HIV Services in Western Kenya: Integration Fosters Male Involvement

“…[19][20][21] Some cohort studies have documented that integrated services can decrease pregnancy rates 22 and increase uptake of hormonal contraceptive methods. 23,24 Most recently, the first cluster-randomized trial (CRT) of integrating FP into routine HIV care services, conducted in western Kenya, demonstrated an increase in more effective contraception use, from 17% at baseline to 37% one year after integration in the intervention arm. 16 The trial also found the intervention to be cost-effective.…”