Integrating family planning services into HIV care and treatment clinics in Tanzania: evaluation of a facilitated referral model

Baumgartner, Joy Noel; Green, Mackenzie; Weaver, Mark A.; Mpangile, Gottlieb S.; Kohi, Thecla W.; Mujaya, Stella; Lasway, Christine

doi:10.1093/heapol/czt043

Cited by 35 publications

(59 citation statements)

References 31 publications

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“…60–71,98,99 One study reported morbidity, 61 whereas 12 studies reported prevention of HIV transmission. 60–71 In addition, 2 studies reported the costs associated with providing FP services.…”

Section: Resultsmentioning

confidence: 99%

Integrating Prevention Interventions for People Living With HIV Into Care and Treatment Programs

Medley

Bachanas

Grillo

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction This review assesses the impact of prevention interventions for people living with HIV on HIV-related mortality, morbidity, retention in care, quality of life, and prevention of ongoing HIV transmission in resource-limited settings (RLSs). Methods We conducted a systematic review of studies reporting the results of prevention interventions for people living with HIV in RLS published between January 2000 and August 2014. Standardized methods of searching and data abstraction were used. Results Ninety-two studies met the eligibility criteria: 24 articles related to adherence counseling and support, 13 on risk reduction education and condom provision, 19 on partner HIV testing and counseling, 14 on provision of family planning services, and 22 on assessment and treatment of other sexually transmitted infections. Findings indicate good evidence that adherence counseling and sexually transmitted infection treatment can have a high impact on morbidity, whereas risk reduction education, partner HIV testing and counseling, and family planning counseling can prevent transmission of HIV. More limited evidence was found to support the impact of these interventions on retention in care and quality of life. Most studies did not report cost information, making it difficult to draw conclusions about the cost-effectiveness of these interventions. Conclusions This evidence suggests that these prevention interventions, if brought to sufficient scale and coverage, can help support and optimize the impact of core treatment and prevention interventions in RLS. Further operational research with more rigorous study designs, and ideally with biomarkers and costing information, is needed to determine the best model for providing these interventions in RLS.

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Section: Resultsmentioning

confidence: 99%

Integrating Prevention Interventions for People Living With HIV Into Care and Treatment Programs

Medley

Bachanas

Grillo

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Indeed, the unmet needs for family planning among west-African women irrespective of their HIV status is as high as 30% (9, 30). It has been pointed out that integrating family planning services into HIV care is an important shortcoming to reduce unintended pregnancy rates among HIV-infected women and eliminate the vertical risk of HIV transmission (1, 31, 32). …”

Section: Discussionmentioning

confidence: 99%

Incidence of Pregnancy After Antiretroviral Therapy Initiation and Associated Factors in 8 West African Countries

Burgos-Soto

Balestre

Minga³

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction This study aimed at estimating the incidence of pregnancy after antiretroviral therapy (ART) initiation in eight West African countries over a 10-year period. Methods A retrospective analysis was conducted within the international database of the IeDEA West Africa Collaboration. All HIV-infected women aged <50 years and starting ART for their own health between 1998 and 2011 were eligible. Pregnancy after ART initiation was the main outcome and was based on clinical reporting. Poisson regression analysis accounting for country heterogeneity was computed to estimate first pregnancy incidence post-ART and to identify its associated factors. Pregnancy incidence rate ratios were adjusted on country, baseline CD4 count and clinical stage, haemoglobin, age, first ART regimen and calendar year. Results Overall 29,425 HIV-infected women aged 33 years in median [Inter Quartile Range: 28–38] contributed for 84,870 women-years of follow-up to this analysis. The crude incidence of first pregnancy (2,304 events) was 2.9 per 100 women-years [95% confidence interval [CI]: 2.7–3.0], the highest rate being reported among women aged 25–29 years: 4.7 per 100 women-years; 95% CI: 4.3–5.1. The overall Kaplan-Meier probability of pregnancy occurrence by the fourth year on ART was 10.9% (95% CI: 10.4–11.4) and as high as 28.4% (95% CI: 26.3–30.6) among women aged 20–29 years at ART initiation. Conclusion The rate of pregnancy occurrence after ART initiation among HIV-infected women living in the West Africa region was high. Family planning services tailored to procreation needs should be provided to all HIV-infected women initiating ART and health consequences carefully monitored in this part of the world.

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“…Indeed, the government of Rwanda has prioritized an integration strategy wherein providers are cross-trained 11–13 ; however, given the time and training limitations often faced by providers, 30 referral system strengthening is a potentially less expensive integration method shown to increase linkages between HIV and FP services and decrease unmet need for those services. 31,32 Strengthening referrals may also allay concerns about message dilution if HIV and FP services are integrated in certain settings, as expressed by 1 stakeholder. Interestingly however, none of our stakeholders raised the idea of referral system strengthening, perhaps reflecting the current government stance on physical integration.…”

Section: Discussionmentioning

confidence: 99%

Rwandan stakeholder perspectives of integrated family planning and HIV services

Wall

Bayingana

Ingabire

et al. 2018

Health Planning & Management

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SummaryThe purpose of this qualitative study was to understand the knowledge, attitudes, and practices among key Rwandan policymakers and stakeholders related to family planning (FP) and integrated HIV/FP services. Motivational in-depth interview format and content was developed after an extensive policy review. A convenience sample of 10 high-level HIV and FP Rwandan policymakers and stakeholders completed the interview. Stakeholders demonstrated strong foundational knowledge of HIV and FP. Given the choice, stakeholders would allocate more monies to FP and less to HIV than currently distributed. Respondents felt that improved FP method knowledge, especially long-acting reversible contraception, among clients/couples and providers, was needed to address myths, misconceptions, and biases. The most often cited way to integrate HIV/FP services was development of integrated tools (eg, training materials, data collection tools, and advocacy and policy guidance). We recommend strategies for policy advancement supportive of HIV/FP service integration inclusive of couples and long-acting reversible contraception methods.

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Integrating family planning services into HIV care and treatment clinics in Tanzania: evaluation of a facilitated referral model

Cited by 35 publications

References 31 publications

Integrating Prevention Interventions for People Living With HIV Into Care and Treatment Programs

Integrating Prevention Interventions for People Living With HIV Into Care and Treatment Programs

Incidence of Pregnancy After Antiretroviral Therapy Initiation and Associated Factors in 8 West African Countries

Rwandan stakeholder perspectives of integrated family planning and HIV services

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