Integrating family planning services into HIV care: use of a point-of-care electronic medical record system in Lilongwe, Malawi

Abstract

Background: Integrating family planning (FP) services into human immunodeficiency virus (HIV) clinical care helps improve access to contraceptives for women living with HIV. However, high patient volumes may limit providers’ ability to counsel women about pregnancy risks and contraceptive options. Objectives: To assess trends in the use of contraceptive methods after implementing an electronic medical record (EMR) system with FP questions and determine the reasons for non-use of contraceptives among women of reproductive age (15–49 years) receiving antiretroviral therapy (ART) at the Martin Preuss Center clinic in Malawi. Methods: In February 2012, two FP questions were incorporated into the ART EMR system (initial FP EMR module) to prompt providers to offer contraceptives to women. In July 2013, additional questions were added to the FP EMR module (enhanced FP EMR) to prompt providers to assess risks of unintended pregnancies, solicit reasons for non-use of contraceptives and offer contraceptives to non-pregnant women . We conducted a retrospective, longitudinal cohort study using the EMR routinely collected data. The primary outcome was the use of any modern contraceptive method. Descriptive statistics were used to describe the study population and report trends in contraceptive use during the initial and enhanced study periods. Results: Between February 2012 and December 2016, in HIV clinics, 20,253 women of reproductive age received ART, resulting in 163,325 clinic visits observations. The proportion of women using contraceptives increased significantly from 18% to 39% between February 2012 and June 2013, and from 39% to 67% between July 2013 and December 2016 (chi-square for trend p < 0.001). Common reasons reported for the non-use of contraceptives among those at risk of unintended pregnancy were: pregnancy ambivalence (n = 234, 51%) and never thought about it (n = 133, 29%). Conclusion: Incorporating the FP EMR module into HIV clinical care prompted healthcare workers to encourage the use of contraceptives.

Longitudinal patterns of unmet need for contraception among women living with HIV on antiretroviral therapy in South Africa

“…More succinct measures of fertility intentions, such as those used to inform this study’s assessment of unmet need, are demonstrably reliable in predicting pregnancy outcomes [8,17,41] and may be more readily integrated into clinical practice to evaluate the immediate family planning needs of women living with HIV. In one high-volume facility in Malawi, integration of a short family planning assessment using an electronic medical record-based tool prompted healthcare workers to more routinely offer contraceptives during HIV care visits, increasing contraceptive prevalence over a four-year period [42].…”

Pregnancy intention and contraceptive use among HIV-positive Malawian women at 4-26 weeks post-partum: A nested cross-sectional study

“…Pilot studies in Malawi, Kenya, Tanzania, Swaziland, Nigeria, South Africa, and Uganda have shown that this is acceptable, feasible and cost-effective [12–16]. In 2011, the Malawi HIV programme integrated family planning into HIV care and treatment services in all ART facilities [17,18]. However, the integrated system is challenged by insufficient policy enforcement, infrastructure, funding and leadership [18].…”

“…In 2011, the Malawi HIV programme integrated family planning into HIV care and treatment services in all ART facilities [17,18]. However, the integrated system is challenged by insufficient policy enforcement, infrastructure, funding and leadership [18].…”

HIV Status and Contraceptive Utilization among Women in Cameroon

“…Women living with HIV theoretically should have ongoing contact with their health care system, and this routine engagement may improve access to contraception counseling and services, resulting in increased contraceptive utilization. 37,38 Previous studies (as well as this study) have found evidence in support of coupling HIV treatment services and contraception counseling 37,38 ; however, the benefits and challenges of comprehensive women's health care in global settings are not fully understood and warrant further examination. For example, a recent study from South Africa found women living with HIV (these are women who are likely to be engaged in health care) were more likely to have an unplanned pregnancy than their uninfected peers, which is both surprising and worrisome.…”