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

Abstract

Evidence on the feasibility, effectiveness, and cost‐effectiveness of integrating family planning (FP) and HIV services has grown significantly since the 2004 Glion Call to Action. This systematic review adds to the knowledge base by characterizing the range of models used to integrate FP into HIV care and treatment, and synthesizing the evidence on integration outcomes among women living with HIV. Fourteen studies met our inclusion criteria, eight of which were published after the last systematic review on the topic in 2013. Overall, integration was associated with higher modern method contraceptive prevalence and knowledge, although there was insufficient evidence to evaluate its effects on unintended pregnancy or achieving safe and healthy pregnancy. Evidence for change in unmet need for FP was limited, although two of the three evaluations that measured unmet need suggested possible improvements associated with integrated services. However, improving access to FP services through integration was not always sufficient to increase the use of more effective (noncondom) modern methods among women who wanted to prevent pregnancy. Integration efforts, particularly in contexts where contraceptive use is low, must address community‐wide and HIV‐specific barriers to using effective FP methods alongside improving access to information, commodities, and services within routine HIV care.

Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study

“…A single model of HIV and family planning integration is unlikely to reach all women, and considering alternative points of service access for multipronged, bidirectional approaches to integration and family planning service delivery may optimize coverage. 81,82 As for many working cisgender women, FSWs are often mothers with ongoing fertility desires. 83 Consequently, they would benefit from family planning services that are adaptive to changes in fertility intentions and contraceptive needs, including services for safer conception and pregnancy.…”

“…the availability of contraceptives is everywhere.”: Coordinated Family Planning Service Delivery in Rwanda Facilitates Integration into Other Health Services

“…Since CHWs provide a range of services to their fellow community members, in addition to FP, the CHW design naturally allows for easy integration of one service into another. The "one-stop-shop" model for integration, where many different health care services can be administered at the same time and space, has been shown to increase cost efficacy in Kenya, and was generally linked to higher levels of modern method contraceptive use and knowledge among women with HIV (12). The absence of transportation time and cost with CHWs amplifies the "one-stop-shop" integration experience.…”

“…Another route to expanding access to FP is via the integration of FP into other health services. There is accumulating evidence of successful FP integration into existing health services, including HIV care (11,12), maternal care (13), and child health (14).…”

Fertility desires of people living with HIV: Does the implementation of a sexual and reproductive health and HIV integration model change healthcare providers’ attitudes and clients’ desires?

“…People living with HIV (PLHIV) also have reproductive needs and require access to information and quality family planning services to prevent unintended pregnancies and to facilitate safe and healthy pregnancies (5). They require access to reliable contraception so that they can have only the number of children that they desire, and need support and access to perinatal mother-to-child transmission (PMTCT) services to minimize the chances of mother-to-child transmission (6).…”