Linking family planning with HIV/AIDS interventions: a systematic review of the evidence

Spaulding, Alicen B; Brickley, Deborah Bain; Kennedy, Caitlin E.; Almers, Lucy; Packel, Laura; Mirjahangir, Joy; Kennedy, Gail; Collins, Lynn H.; Osborne, K; Mbizvo, Michael T.

doi:10.1097/01.aids.0000363780.42956.ff

Cited by 86 publications

(96 citation statements)

References 16 publications

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“…Our findings are consistent with the evidence base on facility-based FP/HIV African Journal of Reproductive Health June 2017; 21 (2): 79 integration models, which shows that linkages between FP and HTC can facilitate HTC uptake 3,21 , and also indicates improvements in contraceptive use through various combinations of FP and HIV services 3,4 . Although somewhat limited, the available literature does not provide evidence of negative effects from potentially increased staff time with clients as a result of integrating services, and effects on the quality of FP counseling when adding HTC are reported as positive or mixed 3,21 . The challenges we observed with the delivery of integrated messages echo process evaluation data from several studies on facility-based integration of FP into HIV services, which showed that provision of contraceptive counseling, while improved, was not systematic and was in some cases lower than expected 4 .…”

Section: Discussionsupporting

confidence: 88%

“…Research and programmatic experience have shown that integrated FP/HIV service delivery is a worthwhile strategy to comprehensively address clients' sexual and reproductive health needs [3][4][5] . This is especially the case in settings with high unmet need for FP and high HIV prevalence, like subSaharan Africa 6 .…”

Section: Introductionmentioning

confidence: 99%

“…This is especially the case in settings with high unmet need for FP and high HIV prevalence, like subSaharan Africa 6 . Although conclusions are complicated by the heterogeneity of interventions, settings, and studies, research has demonstrated that linkages between FP and HIV services increased uptake of services and held promise for promoting dual method use [3][4][5] . Completed research on integrated HIVreproductive health services has been conducted almost exclusively in health facilities 3,4 .…”

Section: Introductionmentioning

confidence: 99%

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Integrating Family Planning and HIV Services at the Community Level: Formative Assessment with Village Health Teams in Uganda

Brunie

Mucheri²,

Akol³

et al. 2017

Afr J Reprod Health

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Little is known on integrating HIV and family planning (FP) services in community settings. Using a cluster randomized controlled design, we conducted a formative assessment in two districts in Uganda where community health workers, called VHTs, already offered FP. Thirty-six trained VHTs also provided HIV testing and counseling (HTC) during the intervention. We surveyed all 36 VHTs and 256 FP clients, and reviewed service statistics. In the intervention group, VHTs tested 80% of surveyed clients for HIV, including 76% they already saw for FP and 22% who first came to them for HTC before receiving FP. Comparing clients' experiences in the intervention and control groups, adding HTC does not appear to have negatively affected FP service quality. VHTs reported more monthly clients, but rated their workload as easy to manage. This integrated model seems feasible and beneficial for both VHTs and clients, while not resulting in any negative effects. This study was registered with ClinicalTrials.gov, number [NCT02244398]. (Afr J Reprod Health 2017; 21[2]: 73-80).Keywords: family planning, HIV, community health workers, integration, Uganda RésuméPeu d'informations sont disponibles sur l'intégration des services de planification familiale (PF) et du VIH dans les milieux communautaires. En utilisant un plan randomisé contrôlé par grappes, nous avons mené une évaluation formative dans deux districts en Ouganda dans lesquels les agents de santé communautaire qui sont appelés VHT offraient déjà des services de PF. Trente-six VHT formés ont également fourni des services de conseil et dépistage du VIH (CDV). Nous avons enquêté les 36 ASC et 256 clientes PF, et nous avons examiné les statistiques sur les services. Dans le groupe d'intervention, les VHT ont testé 80% des clients enquêtées pour le VIH, y compris 76% que les VHT voyaient déjà pour la PF et 22% qui sont d'abord venus pour le CDV avant avant de recevoir la PF. En comparant les expériences des clientes dans les groupes avec et sans intervention, l'ajout du CDV ne semble pas avoir affecté négativement la qualité des services PF. Les VHT ont signalé plus de clients mensuellement, mais ont évalué leur charge de travail comme étant aussi facile à gérer. Ce modèle intégré semble faisable et bénéfique pour les VHT et les clients, et sans entraîner d'effet négatif. Cette étude a été enregistrée auprès de ClinicalTrials.gov, numéro [NCT02244398]. (Afr J Reprod Health 2017; 21[2]: 73-80).

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Integrating Family Planning and HIV Services at the Community Level: Formative Assessment with Village Health Teams in Uganda

Brunie

Mucheri²,

Akol³

et al. 2017

Afr J Reprod Health

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“…Potential benefits of integrating these services have been previously described and include increasing uptake of health services and prevention of unintended pregnancies, STIs including HIV, as well as of mother-to-child transmission of HIV and infant abandonment among HIV-infected females. 40,41 A recent review of programs linking family planning and HIV services found that integration was generally feasible and effective. 40 For street youth in Ukraine, community-based programs utilizing skilled outreach workers are critical to successfully reach and serve this high-risk and transient youth population.…”

Section: Discussionmentioning

confidence: 99%

“…40,41 A recent review of programs linking family planning and HIV services found that integration was generally feasible and effective. 40 For street youth in Ukraine, community-based programs utilizing skilled outreach workers are critical to successfully reach and serve this high-risk and transient youth population. Fortunately, there are several existing evidence-based HIV prevention programs for homeless youth 42,43 that could be easily adapted to integrate pregnancy prevention, as most already aim to reduce HIV-related sexual behaviors (e.g., reduction of multiple sex partners or unprotected sex) that also reduce pregnancy risk.…”

Section: Discussionmentioning

confidence: 99%

Multi-City Assessment of Lifetime Pregnancy Involvement among Street Youth, Ukraine

et al. 2011

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Although street youth are at increased risk of lifetime pregnancy involvement (LPI), or ever becoming or getting someone pregnant, no reports to date describe the epidemiology of LPI among systematically sampled street youth from multiple cities outside of North America. The purpose of our assessment was to describe the prevalence of and risk factors associated with LPI among street youth from three Ukrainian cities. We used modified time-location sampling to conduct a cross-sectional assessment in Odesa, Kyiv, and Donetsk that included citywide mapping of 91 public venue locations frequented by street youth, random selection of 74 sites, and interviewing all eligible and consenting street youth aged 15-24 years found at sampled sites (n=929). Characteristics of youth and prevalence of LPI overall and by demographic, social, sexual, and substance use risk factors, were estimated separately for males and females. Adjusted odds ratios (AORs) were calculated with multivariable logistic regression and effect modification by gender was examined. Most (96.6%) eligible youth consented to participate. LPI was reported for 41.7% of females (93/223) and 23.5% of males (166/706). For females, LPI was significantly elevated and highest (970%) among those initiating sexual activity at ≤12 years and for those reporting lifetime anal sex and exchanging sex for goods. For males, LPI was significantly elevated and highest (940%) among those who reported lifetime anal sex and history of a sexually transmitted infection. Overall, risk factors associated with LPI were similar for females and males. Among the total sample (females and males combined), significant independent risk factors with AORs ≥2.5 included female gender, being aged 20-24 years, having five to six total adverse childhood experiences, initiating sex at age ≤12 or 13-14 years, lifetime anal sex, most recent sex act unprotected, and lifetime exchange of sex for goods. Among street youth with LPI (n=259), the most recent LPI event was reported to be unintended by 63.3% and to have ended in abortion by 43.2%. In conclusion, our assessment documented high rates of LPI among Ukrainian street youth who, given the potential for negative outcomes and the challenges of raising a child on the streets, are in need of community-based pregnancy prevention programs and services. Promising preventive strategies are discussed, which are likely applicable to other urban populations of street-based youth as well.

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Integration of HIV/AIDS services with maternal, neonatal and child health, nutrition, and family planning services

Lindegren

Kennedy

Bain-Brickley

et al. 2012

Cochrane Database of Systematic Reviews

109

110

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Linking family planning with HIV/AIDS interventions: a systematic review of the evidence

Abstract: Interventions linking family planning and HIV services were generally considered feasible and effective, though overall evaluation rigor was low.

Cited by 86 publications

References 16 publications

Integrating Family Planning and HIV Services at the Community Level: Formative Assessment with Village Health Teams in Uganda

Integrating Family Planning and HIV Services at the Community Level: Formative Assessment with Village Health Teams in Uganda

Multi-City Assessment of Lifetime Pregnancy Involvement among Street Youth, Ukraine

Integration of HIV/AIDS services with maternal, neonatal and child health, nutrition, and family planning services

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