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.