It’s a simple idea that surprisingly, hasn’t been implemented or seriously studied and tested, until now: full integration of the most effective family planning services with HIV care and treatment to increase contraception use and reduce unwanted, and often risky, pregnancies among women living with HIV.
That’s what physicians Daniel Grossman and Craig Cohen of the University of California, San Francisco, examined when their team conducted a cluster-randomized trial in the Nyanza Province of western Kenya, where overall HIV/AIDS prevalence is 15 percent, 18 percent among women, and approaching 30 percent in communities located along Lake Victoria.
At a briefing with health advocates today, hosted by the Center for Health and Gender Equity, Grossman and Cohen said that even though studies indicate that among HIV-infected women in the region, 62-93 percent of pregnancies are unintended, family planning and HIV services are often segregated in many health settings in sub-Saharan Africa.
“Unintended pregnancies have serious impacts on patients, including economic and health impacts, like unsafe abortions,” Cohen said.
Their study aimed to determine if integrating family planning services into HIV care and treatment improved the uptake of more effective contraceptive methods, which include oral and injectable hormonal contraceptives, IUDs, and sub-dermal implants. A secondary aim was to see if integration had an impact on pregnancy rates.
They worked with the Kenyan Medical Research Institute to enroll 18 public sector HIV care and treatment sites in four districts, and provided training and mentoring on administering family planning methods to all staff at 12 sites, and left 6 sites as control groups where HIV patients were referred to family planning sites instead of receiving contraceptives at their HIV clinic.
While the study did not supply contraceptive commodities themselves, researchers did work to improve commodity security to prevent stock outs.
After a year, women at the 12 integrated sites were 81 percent more likely to use effective family planning methods compared to those at control sites, and after two years, when the original control sites had adopted full integration, the former control sites saw an even larger uptake of effective family planning use, and researchers saw an overall 20 percent reduction in pregnancy rates. The study also showed that integrating family planning with HIV services is sustainable, as the program was handed off to the Ministry of Health after one year, yet a follow up study a year later showed progress was the same.
When asked if they’re pushing for the World Health Organization to change their guidelines to include integrated family planning and HIV services, Cohen and Grossman said right now their focus is on working with country level leaders to implement greater integration. “Local country leadership at all levels is critical,” Cohen said.
He added that they had gotten feedback from the Office of the Global AIDS Coordinator that although PEPFAR does not fund family planning commodities, PEPFAR countries have been told to verify where their family planning commodities will come from in the next round of country operational plans.
Watch this video on how effective the “one-stop shop” approach to family planning and HIV care and treatment has been in Kenya.