Effect of improving family planning services in the context of HIV care and treatment in Kenya
With colleagues at University of California, San Francisco, and the Kenya Medical Research Institute, we performed a cluster randomized trial in Nyanza Province, Kenya, to determine if integrating family planning services into HIV care and treatment increases contraceptive prevalence and reduces rates of unintended pregnancy compared to the standard practice of referring women to a separate family planning clinic. Twelve sites were randomized to an intervention in which family planning services were integrated into HIV care and treatment, while six sites continued to refer patients at the HIV clinic to the family planning clinic. We conducted a baseline assessment of the barriers to providing integrated services, which included interviews with clinic staff and surveys of the family planning knowledge, attitudes, and practices of clients at HIV clinics, as well as their interest in obtaining family planning services at an HIV clinic. We performed training at all sites on contraceptive counseling and method provision with a focus on long-acting methods (Jadelle implant and copper IUD). We collected data on contraceptive use and unintended pregnancy at all 18 sites over one year. We also performed interviews with 500 women and 500 men from the HIV clinic to examine changes in knowledge, attitudes, and behavior related to contraception. We also completed a study on the costs of family planning provision in both models.
Results show that integrating family planning services into HIV care and treatment increases uptake and use of more effective contraceptive methods such as hormonal methods, IUDs, and sterilization, compared to the standard practice of referring women to a separate family planning clinic. We also found that, despite their high effectiveness for preventing pregnancy and potential for decreasing mother-to-child transmission of HIV, many providers and women have misinformation or limited knowledge about LARC and their safety for HIV-positive women. Another finding was that integration was associated with high levels of satisfaction among clients, as well as a reduction in negative attitudes toward family planning among men. We showcased the findings of this study and other intervention models and research at the Integration for Impact Conference organized by the study team that took place in Nairobi in September 2012, where the results were shared with researchers, government officials, and community groups, and at a policy briefing in Washington, DC, in December 2013.