Women living with HIV (WLHIV) in sub-Saharan Africa continue to experience high rates of unplanned pregnancies. Ready access to family planning (FP) within HIV treatment programs allows women to make informed fertility choices. We implemented an enhanced model of integrating FP and HIV services at 6 health facilities in Lusaka, Zambia aimed at increasing contraceptive uptake among WLHIV wanting to avoid pregnancy and to improve safer conception counseling for those desiring a pregnancy.
The model included: training HIV clinic staff in FP service delivery; offering a full range of FP methods within the HIV clinic; improving FP documentation within HIV monitoring systems; and introducing facilitated referral to community-based distributors to support FP use between HIV treatment visits. For the evaluation, systematic, independent samples of WLHIV aged ≥16 years were interviewed pre and post-intervention about their fertility desires and FP use, and clinical data was abstracted from their medical charts. Differences between pre and post-intervention participants were tested using Pearson Chi-square tests. Unadjusted and adjusted logistic regression models were used to examine differences in self-reported FP uptake between the two time periods.
A total of 629 WLHIV were interviewed pre-intervention and 684 post-intervention. During the pre-intervention period, only 38% of women not desiring a pregnancy reported currently using an effective FP method compared to 49% post-intervention (p=.003, Table 1). Uptake by method at the two time points was: pills (10% vs. 8%, p>.05), injectables (15% vs. 25%, p<.0001), implants (5% vs. 8%, p>.05), and intrauterine devices (IUDs, 1% vs. 1%, p>.05). The percent of women reporting dual method use increased from 9% to 18% (P=.0003); while, unmet need for FP decreased from 59% to 46% (P=.0003). Among women wanting to get pregnant, receipt of safer pregnancy counseling increased from 27% to 39%. The total intervention cost was estimated at $83,293 (2018 USD) over the 12-month period including labor (40%), supplies (26%), training (14%) and administration (20%).
Our model of FP/HIV integration was associated with a significant increase in the number of WLHIV reporting use of an effective FP method and a met need for FP. These results support continued efforts to integrate FP and HIV services to improve women’s access to these services.