Higher contraceptive uptake in HIV treatment centers offering integrated family planning services: A national survey in Kenya
| Autor: | John Kinuthia, Yilin Chen, Christine J. McGrath, Grace John-Stewart, Wangui Muthigani, Lucy Ng’ang’a, Emily R. Begnel, Benson Singa, Agnes Langat, Joel Gondi, Alison L. Drake, Dunstan Achwoka |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Human immunodeficiency virus (HIV) HIV Infections medicine.disease_cause Article 03 medical and health sciences 0302 clinical medicine Contraceptive Agents medicine Antiretroviral treatment Humans 030212 general & internal medicine Dual method Hiv treatment 030219 obstetrics & reproductive medicine High prevalence business.industry Obstetrics and Gynecology Kenya Contraception Cross-Sectional Studies Contraceptive use Reproductive Medicine Family planning Family Planning Services Family medicine Who guidelines Female business |
| Zdroj: | Contraception |
| ISSN: | 0010-7824 |
| DOI: | 10.1016/j.contraception.2020.04.003 |
| Popis: | Objectives Integrating family planning (FP) into routine HIV care and treatment are recommended by WHO guidelines to improve FP access among HIV-infected individuals in sub-Saharan Africa. This study sought to assess factors that influence the delivery of integrated FP services and the impact of facility-level integration of FP on contraceptive uptake among women living with HIV (WLWH). Study design A national cross-sectional study was conducted among WLWH at HIV Care and Treatment centers with >1000 antiretroviral treatment (ART) clients per year. A mobile team visited 108 HIV Care and Treatment centers and administered surveys to key informants regarding facility attributes and WLWH regarding FP at these centers between June and September 2016. We classified facilities offering FP services within the same facility as ‘integrated’ facilities. Results 4805 WLWH were enrolled at 108 facilities throughout Kenya. The majority (73%) of facilities offered integrated FP services. They were more likely to be offered in public than private facilities (Prevalence Ratio [PR]: 1.86, 95% Confidence Interval [CI]: 1.11–3.11; p = 0.02] and were more common in the Nyanza region than the Nairobi region (77% vs 35% respectively, p = 0.06). Any contraceptive use (89% vs 80%), use of modern contraception (88% vs 80%), dual method use (40% vs 30%), long-acting reversible contraception (LARC) (28% vs 20%), and non-barrier short-term methods (34% vs 27%) were all significantly higher in facilities with integrated FP services (p Conclusions The majority of high volume facilities integrated FP services into HIV care. Integrating FP services may increase modern contraceptive use among WLWH. Implications Integration of FP services was associated with higher modern contraceptive use, lower unmet need for modern methods and higher use of long-acting, reversible contraception (LARC), and non-barrier short-term methods among women living with HIV. Despite high prevalence of integration of FP services, organizational challenges remain at integrated clinics. |
| Databáze: | OpenAIRE |
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