Impact of integrating family planning services into HIV care on reproductive health
Abstract
Background: HIV-infected patients like their uninfected counterparts are faced with
reproductive health needs including family planning (FP). FP has been shown to
play a role in primary and secondary prevention of HIV virus transmission including
prevention of mother-to-child transmission of HIV/AIDS. Despite this, FP uptake is
low among HIV-infected women. This is attributed, in part to the vertical nature of FP
and HIV care programs. To address this challenge, the United States Agency for
International Development - Academic Model Providing Access To Healthcare
(USAID-AMPATH) partnership integrated FP services into one of its HIV clinics.
Objectives: Among HIV-infected women attending the USAID-AMPATH HIV Care
clinic with and without integrated FP services, to: 1) determine and compare the
incidence of new users of modern FP methods, 2) determine and compare the
incidence of pregnancy and 3) determine the correlation between incidence of new
use of modern FP methods and incidence of pregnancies with socio-demographic
variables.
Methods: This was a retrospective cohort study carried out in the Eldoret clinic of
the USAID-AMPATH partnership, Western Kenya. The primary outcome measures,
incidence of new use of modern FP method and pregnancy were compared between
HIV-infected women attending the HIV care module with integrated FP services
(exposed group) and HIV-infected women attending HIV care modules which had
not yet integrated FP services (unexposed group). The exposed and unexposed
were matched by age on a ratio of 1:2 respectively. The secondary outcome
measures were the correlations of these incidences with socio-demographic
variables that were significant in the univariate analysis.
Results: Between October 2007 and February 2009, 4,138 patients met the
eligibility criteria (1,498 were exposed to the integrated module and 2,640 were
unexposed). There was a 10.8% (p<0.001; 95% CI: 7.3%, 14.3%) increase in new
condom use; 7.1% (p<0.001; 95% CI: 3.6%, 10.6%) increase in new FP methods
use other than condoms and 1.3% (p=0.24; 95% CI: -3.4%, 0.8%) decrease in the
incidence of pregnancy among the exposed group. The incidence rate of new use of
modern FP methods was 46.6 per 100 person years (95% CI: 44.0, 49.3) and 36.6
per 100 person years (95% CI: 34.7, 38.5) for the exposed and the unexposed
respectively. The patients exposed to the integrated model were 27 times more likely
to use modern FP methods than the unexposed (RR=1.27; 95% CI: 1.14, 1.41). The
incidence rate of pregnancy was 8.69 per 100 person years (95% CI: 7.31, 10.31)
and 8.37per 100 person years (95% CI: 7.34, 9.53) for the exposed and the
unexposed respectively. There was no significant difference in likelihood of
pregnancy between the exposed and the unexposed (RR=1.04; 95% CI: 0.83, 1.30).
Disclosure to partner, sex within the last 6 months and more years of schooling was
associated with an increased incidence of modern FP method use. More years of
schooling, higher age at enrollment and having more children living with the patient
were associated with a reduction in the incidence of pregnancy.
Conclusion: Integrating FP services into HIV care and treatment programs is
associated with a significant increase in the incidence of new condom and FP
method other than condoms use of 10.8% and 7.1% respectively and a none
statistical but clinical reduction in the incidence of pregnancy of 1.3%. Funding
agencies and programs should consider integrating FP services into HIV care and
treatment programs. There is need for further studies on strategies to increase FP
uptake by HIV-infected patients.
Sponsorhip
University of NairobiPublisher
Institute of Tropical and Infectious Diseases, College of Health Sciences, University of Nairobi