Integrating family planning and HIV services in western Kenya: the impact on HIV-infected patients’ knowledge of family planning and male attitudes toward family planning

Abstract

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.

Integration of Family Planning Services into HIV Care and Treatment Services: A Systematic Review

“…), the average FP awareness score increased significantly between the pre‐ and post‐intervention periods among women at both the integrated and usual care sites, but awareness at endline was no higher among women attending the clinics with integrated FP compared to regular sites (Onono et al. ). This nondifferential improvement across sites might be attributable to the training providers received at comparison sites.…”

“…The evaluation of the randomized trial in Kenya found a favorable improvement in the attitude of men attending HIV care programs at the integrated sites, with a 12 percent decline in men's agreement with the statement that FP is “women's business” that was statistically significantly different from the men at the usual care sites (Onono et al. ). HIV care and treatment may be an opportune environment to engage men in FP.…”

“…Integrated programs were evaluated in 12 countries with varying economic and sociopolitical contexts. Nine studies were conducted in sub-Saharan Africa (Chabikuli et al 2009;Chibwesha et al 2011;Kosgei et al 2011;McCarraher et al 2011;Church et al 2012; Grossman et al 2013;Shade et al 2013;Baumgartner et al 2014;Hoke et al 2014;Sarnquist et al 2014;Church et al 2015;Onono et al 2015;Wanyenze et al 2015;Phiri et al 2016), two in Europe (Coyne, Hawkins, and Desmond 2007;Wielding and Flynn 2015) and one in Asia (Thyda et al 2015) (Appendix Table A1). The integration settings represent the World Bank categories for economic development: low-income (Cambodia, Malawi, Tanzania, Uganda, and Zimbabwe), lower middle-income (Kenya, Nigeria, Swaziland, and Zambia), upper middle-income (South Africa), and high income (England and Scotland).…”

The Current Status of Research on the Integration of Sexual and Reproductive Health and HIV Services

“…More research is required to understand how improved gender equity might be leveraged to increase access to HIV testing and treatment, contraceptive use, and other reproductive health outcomes (Hawkes and Buse ; Onono et al. ; Ghanotakis et al. ; Newmann et al.…”

PrEP as Peri-conception HIV Prevention for Women and Men

“…Because many individuals may not be able to disclose HIV status and/or bring their partner to clinic, sexual and reproductive health and HIV prevention programs need to cater to individual-level as well as couples-based consultation [73]. Male-friendly environments may promote male health-seeking behaviors, including engaging in pre-conception care [74]. …”