Fp hiv integration-Integrating FP & HIV Services | Family Planning

This systematic review adds to the knowledge base by characterizing the range of models used to integrate FP into HIV care and treatment, and synthesizing the evidence on integration outcomes among women living with HIV. Fourteen studies met our inclusion criteria, eight of which were published after the last systematic review on the topic in Overall, integration was associated with higher modern method contraceptive prevalence and knowledge, although there was insufficient evidence to evaluate its effects on unintended pregnancy or achieving safe and healthy pregnancy. Evidence for change in unmet need for FP was limited, although two of the three evaluations that measured unmet need suggested possible improvements associated with integrated services. However, improving access to FP services through integration was not always sufficient to increase the use of more effective noncondom modern methods among women who wanted to prevent pregnancy.

Fp hiv integration

Fp hiv integration

Service ratio of referrals from HIV treatment centers increased by 3. Open in inntegration separate window. South Korea. Advance Family Planning. However, improving access to FP services through integration was not always sufficient Fp hiv integration increase the use of more effective noncondom modern methods among women who wanted to prevent pregnancy. Partner Find business and funding opportunities. None of the five Fl evaluating Fp hiv integration outcomes demonstrated a significant difference associated with Boy crotch watcher bulge. None of the evaluations described services or referrals for infertility. Providers were trained in FP as described below.

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Supreme Court decision and makes explicit that the prostitution and sex trafficking policy requirement does not apply to U. The legal requirements are implemented through USAID's standard provisions inserted in all grants, cooperative agreements, and contracts that include family planning activities. Family planning use should always be a F, made freely and voluntarily, independent of the person's HIV status. Sincesix international Fp hiv integration and a number of international convocations have resolved to promote integration see Table 1. The World Health Organization, Older version internet explorer download, and other collaborators have published guidelines to help policymakers and program managers pursue integration in a strategic and cost-effective manner. A majority of studies showed improvements in indicators of health as well as in overall quality of services, providing further support for fast-tracking integration. Reynolds, M. Share This Page. Integration is integraton for the client and the health system that is Fp hiv integration to co-locate services. Integrtaion planning is a key but greatly underutilized HIV prevention strategy.

PEPFAR funds are often used to incorporate and integrate other health services, including family planning.

  • This article highlights five good reasons why integration is a sound investment that will pay multiple dividends for individuals, communities, societies, and health systems.
  • PEPFAR funds are often used to incorporate and integrate other health services, including family planning.
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Integration improves health outcomes by offering comprehensive sexual and reproductive services to women and couples who are affected by HIV and at risk for unintended pregnancy.

Delivering these services separately results in a missed opportunity that may weaken their effectiveness and quality and stall progress toward achieving key health outcomes and safeguarding human rights.

Continue reading to learn about the benefits of integrating family planning and HIV services:. Meets client desires and demand. Integration allows for a one-stop, comprehensive health care service where clients can receive family planning services at the same place where they access HIV services.

Supports clients to achieve their fertility intentions. Integrating family planning services and HIV services can increase access to contraception among clients of HIV services who wish to delay, space, or limit their pregnancies.

Integration can also help to ensure a safe and healthy pregnancy and delivery for those who wish to have a child. Improves HIV prevention. For women living with HIV who do not wish to become pregnant, family planning is an evidence-based, cost-effective strategy for preventing unintended pregnancies and for reducing new pediatric HIV infections. Protects human rights. By increasing access to care and enabling women and couples to achieve their fertility intentions, high-quality and comprehensive integration of these services protects human rights and fosters gender equality.

Service integration is just one component of this broad human rights-based approach. Additional eLearning courses that address the intersection of family planning and HIV services include the following:. Below is a selection of peer-reviewed articles on contraceptive technology innovations and related topics.

This commentary discusses the integral role that family planning FP plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. Studies in Family Planning. This systematic review adds to the knowledge base by characterizing the range of models used to integrate FP into HIV care and treatment, and synthesizing the evidence on integration outcomes among women living with HIV. Integration efforts, particularly in contexts where contraceptive use is low, must address community-wide and HIV-specific barriers to using effective FP methods alongside improving access to information, commodities, and services within routine HIV care.

This study sought to determine if integration of family planning FP and HIV services led to increased use of more effective contraception and decreased pregnancy rates.

Integration of FP services into HIV clinics led to a sustained increase in the use of more effective contraceptives and decrease in pregnancy incidence 24 months following implementation of the integrated service model. The authors apply a SRHR lens to HIV prevention by highlighting the critical relationship between unintended pregnancy and HIV, and seek to expand on earlier debates that prevention of HIV and prevention of unintended pregnancy are inextricably linked, complementary activities with interrelated and common goals.

They discuss the intersecting pathways between HIV prevention and unintended pregnancy prevention and build a case for contraception to be placed at the center of the HIV prevention agenda. Skip to content. Are you in a hurry? You can skip ahead to the quick summary. Click through the menu below to explore messages, research, and educational resources related to this topic. Countries with the greatest burden of HIV also have high levels of unmet need for family planning. Both are driven by poverty, poor access to health care, gender inequality, and social marginalization of vulnerable populations.

Evidence suggests that linking family planning with HIV services is feasible, beneficial, and cost-effective. Take a Course. Review the Evidence. Return to all topics.

Supreme Court decision and makes explicit that the prostitution and sex trafficking policy requirement does not apply to U. PEPFAR funds are often used to incorporate and integrate other health services, including family planning. Act Learn how you can get involved and lend a hand. Reynolds, M. Government requirements and uphold the principles of voluntarism and informed choice. All individuals have a right to choose the number, timing, and spacing of their children, as well as decide on the use of family planning methods, regardless of their HIV status. Partner Find business and funding opportunities.

Fp hiv integration

Fp hiv integration

Fp hiv integration

Fp hiv integration

Fp hiv integration. Search Fusion

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Integration of Family Planning Services into HIV Care and Treatment Services: A Systematic Review

This systematic review adds to the knowledge base by characterizing the range of models used to integrate FP into HIV care and treatment, and synthesizing the evidence on integration outcomes among women living with HIV. Fourteen studies met our inclusion criteria, eight of which were published after the last systematic review on the topic in Overall, integration was associated with higher modern method contraceptive prevalence and knowledge, although there was insufficient evidence to evaluate its effects on unintended pregnancy or achieving safe and healthy pregnancy.

Evidence for change in unmet need for FP was limited, although two of the three evaluations that measured unmet need suggested possible improvements associated with integrated services. However, improving access to FP services through integration was not always sufficient to increase the use of more effective noncondom modern methods among women who wanted to prevent pregnancy. Like all women of reproductive age, women living with HIV have diverse fertility intentions that change over time and are influenced by interrelated factors at the individual, couple, family, and community levels.

The problems associated with unmet need for contraception and unintended pregnancy are not limited by region. The global survey on the SRHR priorities of women living with HIV, the largest to date, led by and conducted among women living with HIV, found that 60 percent of respondents had at least one unplanned pregnancy and that less than half had ever obtained family planning FP services Salamander Trust The consequences of unintended pregnancies can be profound; safe abortion is not universally available, and, without optimal treatment, women living with HIV are at greater risk of death during the pregnancy and postpartum period than women without HIV Calvert and Ronsmans Family planning for women living with HIV has the dual goals of preventing unintended pregnancies and facilitating safe and healthy pregnancy among women who want to become pregnant.

The inclusion of both GBV prevention and the elimination of stigma as essential components of FP services acknowledges that strengthening service access or quality may not suffice to improve health outcomes in the absence of a safe and supportive environment. Wilcher and colleagues found that integration was positively associated with contraceptive uptake.

Furthermore, suboptimal implementation in the context of health systems constraints, measured by inconsistent FP service provision and inadequate provider knowledge, may have led to the more modest effect demonstrated in the routine compared to clinical trial settings. To inform the development of the World Health Organization WHO consolidated guideline on the sexual and reproductive health and rights of women living with HIV, we conducted a systematic review of the evidence on the integration of FP services into HIV care and treatment programs, building on and updating the prior systematic reviews.

We sought to 1 characterize the range of models of integration of FP into HIV care and treatment that have been evaluated, and 2 synthesize the evidence on the positive and negative outcomes of such integration.

We considered a program to have enhanced referrals to FP services if one or more written policies were in place to facilitate the referral e. We did not restrict the search by language or location of the study. Primary outcomes of interest for the review were unmet FP need, contraceptive use, and unintended pregnancy. Primary outcomes were limited to women living with HIV; however, knowledge about and attitudes toward FP among men living with HIV were included, where available, given the role of partner attitudes in decisionmaking for FP.

Finally, we conducted secondary reference searching on all studies included in our review to identify any remaining articles we might have missed. Titles, abstracts, citation information, and descriptor terms of citations identified through the search were screened by two members of the study staff. Differences were resolved through consensus. For each study included in the review, data were extracted using standardized forms and included information on geographic location, study design, sample size, study setting, target group, integration model, findings on process indicators and fidelity, outcomes measured, and results.

One study from the Spaulding and colleagues review of articles published prior to met the inclusion criteria and was added to the current review. Integration settings, populations, and approaches varied. The settings for integration reflected the diverse levels of facilities where HIV care is delivered, ranging from small health centers to large tertiary hospitals.

Outcomes were assessed among women receiving HIV care and treatment. See the intervention descriptions in Appendix Table A1 for additional detail on integration models. Half of the studies relied on clinical records, audits, or routine monitoring and evaluation data for the ascertainment of outcomes and covariates, which enabled them to include a large proportion of the target population of women of reproductive age receiving HIV care.

The assessment of study rigor is presented in Appendix Table A2. The threat of selection bias was minimized in nine studies by defining the sample using routine data as described above, or by following a systematic method to screen women attending the clinic for eligibility, most often screening everyone in attendance over the enrollment period.

Half of the reports evaluated integration within a network of clinics, providing examples of the scalability of integration. Other models added FP information to a provider checklist to cover during the clinical visit; some specified that the topic was included in individual counseling sessions; and still others did not specify how the information was provided.

In theory, ongoing assessments could better capture changes in pregnancy intentions. The training of clinic staff or peer educators in the provision of FP services for women living with HIV was highlighted as an important component of integration in all the evaluations. None of the evaluations described services or referrals for infertility.

There was limited detail on counseling and practical support provided for safer conception. Findings from each study are presented in Appendix Table A1 and are summarized below by type of outcome. Contraceptive prevalence was the most commonly measured outcome, reported in 12 studies, but defined in multiple ways. Modern method use was defined in most studies as including hormonal injectables, oral contraceptives, IUDs, implants, female or male sterilization, and consistent use of male or female condoms.

The prevalence of dual method use, the concurrent use of male or female condoms for barrier protection with a more effective method of contraception, was measured in only a few studies. Contraceptive prevalence was reported among all women with HIV of reproductive age in some studies, and was measured among a subset of nonpregnant women who were sexually active in others.

This corresponds to an increase in more effective method use from For example, in Eldoret, Kenya the incidence of more effective FP after integration was lower in integration programs compared with usual care clinics 4.

In contrast, the uptake of condoms was significantly greater in the intervention group, leading to a significant difference in modern method initiation among women in the intervention compared to the control site Interestingly, the evaluation reported that prior to the integration, all sites had been providing condoms and counseling on their use for transmission prevention, suggesting that messaging in an integrated setting about the effectiveness of correct and consistent condom use for the purpose of pregnancy prevention encouraged uptake.

Only three evaluations reported comparative results for dual method use, and all found potential associations in a promising direction. Dual method use also increased slightly, although not significantly, from 11 percent to Whereas increases in contraceptive prevalence, in the context of informed choice and voluntary use, suggest that some need for contraception has been met, it does not account for fertility intentions.

Therefore, unmet need for FP, which considers fertility intentions and the ability to become pregnant, more directly measures the intended outcome of FP services for women wanting to prevent pregnancy. Only three studies evaluated the effects of integration on unmet need. None of the five studies evaluating pregnancy outcomes demonstrated a significant difference associated with integration.

Likewise, in the integration program in Eldoret, Kenya no significant difference in incident pregnancy between integrated and control clinics was found 8. Given that an increase in desired pregnancies facilitated by FP integration is a good outcome, while an increase in unintended pregnancies indicates a poor outcome, changes in total pregnancies are hard to interpret. However, just the one small study from Scotland reported comparative data on the unplanned pregnancy rate; it declined from 5.

Overall, knowledge and awareness about contraceptive methods and their appropriateness for women living with HIV improved with integration. This nondifferential improvement across sites might be attributable to the training providers received at comparison sites. Women participating in HIV care in Cambodia also had significantly improved knowledge about IUDs, injections, and male and female sterilization after integration, although knowledge of emergency contraception and female condoms remained low and there was a residual misconception among Women participating in a program to prevent perinatal HIV transmission in Zimbabwe with exposure to the peer intervention had significantly improved knowledge of the IUD compared with the group without this exposure However, not all integrated programs demonstrated improvements in knowledge.

The increased knowledge about the safety of voluntary sterilization improved women's ability to make informed choices but did not translate into changes in potential demand, as clients were no more likely to consider undergoing sterilization in the future after integration Attitudes also changed after FP services were introduced. Despite the improvement, the agreement among the majority of women with a statement that contravenes the reproductive choice and rights of women living with HIV suggests that the component on reproductive rights was insufficient.

HIV care and treatment may be an opportune environment to engage men in FP. Comparative data on client satisfaction was limited. While there was significant demand across all sites for more services related to FP, including STI services 48 percent , FP services The same evaluation found that the number of FP services received since diagnosis was not consistently higher among women attending the integrated sites, and that while women attending an integrated site were more likely to have been counseled on FP and safe pregnancy, they were no less likely to have unmet need for contraception.

They were, however, less likely to have received condoms than women attending the HIV standalone clinic, where condoms have been a mainstay of programs to prevent HIV transmission. Data are needed from more programs on the access, quality, and cost of FP services from the perspective of women attending care and treatment in HIV care and treatment settings with, compared to without, integrated FP services. Overall, the integration of FP into HIV care and treatment settings was associated with higher levels of modern method contraceptive use and knowledge among women living with HIV.

The diversity of integration models and their successful implementation across a range of settings suggests that such models are feasible. The effectiveness of the modern methods chosen differed by setting, however, with some improvements driven by higher condom use alone, whereas other sites demonstrated significant improvements in the use of LARCs or other highly effective methods. In many evaluations, the level of more effective FP use and dual method use remained low, even when it was higher relative to comparison groups.

More effective FP use excluding condom use alone remained below 20 percent in some settings. However, the level of unmet need was extremely high, even at the integrated sites, and points to the need for other interventions to reduce the gap between pregnancy intentions and contraceptive use. Integrated services improved the important intermediate outcomes of women's knowledge of the benefits and risks of contraceptive methods for women with HIV, but not uniformly, with some sites reporting mixed or negative results.

More research to understand variation in knowledge around specific types of contraception is recommended to ensure that rights to full information on the range of contraceptive choices are upheld and that provider training is sufficient. Commonalities emerged across programs, including the use of peer educators to deliver information about FP for women and couples living with HIV.

Although decentralized training by traveling trainers at the health facilities has the potential benefit of reaching more staff with potentially fewer service disruptions, the low baseline demand for the IUD in some settings makes it difficult for the providers to gain the practical experience needed to offer them to women reliably or to complete certification.

In some settings, bringing providers into hub facilities that have higher demand for the IUD for practical training could help build their proficiency before they return to sites where initial demand is low but may increase with improved availability and quality. All of the included studies focused more on FP services and outcomes among women wanting to prevent unintended pregnancy than among women who wanted to become pregnant.

Using a comprehensive definition of FP, the completed referrals to programs to prevent perinatal transmission could be one process indicator of successful linkage for women who would like to become pregnant, for example. Therefore, it is possible that women are benefiting from such programming, although they were not measured as outcomes of the integrated FP services.

Finally, input and leadership from women living with HIV have illuminated critical gaps in the delivery of FP services available in many settings, including attitudes and practices among health workers that do not support and in some cases violate the SRHR of women and couples living with HIV WHO and Harvard School of Public Health The view that HIV infection and safe pregnancy were often perceived as mutually exclusive before widespread availability of ART is still reflected in the attitudes and biases of some antenatal service providers treating women living with HIV, although these attitudes were not assessed by most of the evaluations.

Measures must be taken to ensure that the SRHR of women living with HIV are respected through gaining information about the full range of contraceptive options and being supported to make a fully informed, voluntary choice. There are several limitations to the evidence available.

Overall, the study designs and analyses that met our inclusion criteria did not adequately adjust for confounding and bias, and the majority of comparisons were of crude differences. While our review did not explicitly include outcomes among women and couples within serodiscordant relationships who were accessing integrated FP services at HIV care and treatment centers through the partner living with HIV, our search would have likely identified them.

Finally, as with all reviews, the bias toward publishing positive over null or negative evaluation results may lead to the inclusion of programs that are more likely to have positive outcomes, relative to all integrated programs.

However, the quality of the evidence of effectiveness is modest. Furthermore, some integration efforts demonstrate that improving access is not sufficient to improve the uptake of more effective contraceptive methods among women living with HIV who want to avoid pregnancy.

Integration, particularly in contexts where the use of effective contraception is low, must address the cultural and gender norms that impact women's decisionmaking regarding FP alongside improving access to FP information and services within routine HIV care. We thank Namratha Rao for assistance with citation screening. We also thank the authors of the previous systematic reviews and Hacsi Horvath for their collaborations on previous work that informed this review.

The 7 steps of the referral model included: 1 Screen clients for unintended pregnancy risk, 2 Provide informed choice counseling on contraceptive options or safer pregnancy, 3 Refer for services, if desired, using the CTC referral form, 4 Document the referral, 5 Staff member accompanies the client to the FP clinic, 6 CTC client accesses FP services in a timely manner, and 7 CTC and FP staff follow up on referrals and services through monthly meetings and tracking of completed referrals. The screening process was supposed to be initiated at every clinical visit for women of reproductive age.

Additional components : FP group education sessions, monitoring using national forms and registers; job aids. Training : For providers, followed by supportive supervision, 4 job aids at the FP clinics , 1 job aid at the ART clinic.

Fp hiv integration

Fp hiv integration