title: Providing family planning in Ethiopian voluntary HIV counseling and testing facilities: client, counselor and facility-level considerations.
abstract: BACKGROUND
  Governments and donors encourage the integration of family planning into voluntary HIV counseling and testing (VCT) services. We aimed to determine whether VCT counselors could feasibly offer family planning and whether clients would accept such services.
  
  
  METHODS
  We employed a quasi-experimental, pre and postintervention survey design, interviewing 4019 VCT clients attending eight Ethiopian public sector facilities and 4027 additional clients 18 months after introducing family planning services in the same facilities. We constructed sex-stratified multilevel models assessing three outcomes: whether clients received contraceptive counseling, whether clients obtained contraceptive methods during VCT and whether clients intended to use condoms consistently after VCT.
  
  
  RESULTS
  Clients demonstrated lower than expected immediate need for contraception. After intervention, only 29% of women had sex in the past 30 days, and 74% of these women were already using contraceptives. Despite the relatively low risk this population had for unwanted pregnancy, family planning counseling in VCT increased from 2 to 41% for women and from 3 to 29% for men (P < 0.01). Approximately, 6% of clients received contraceptive methods. However, sexually active men and women and those with more perceived HIV risk were more likely to obtain contraceptives and intend to use condoms consistently. Men attending facilities with higher client loads were 88% less likely to receive family planning information and 93% less likely to receive contraceptives than those attending facilities with lower client loads. Male and female clients whose counselors perceived contraceptive availability to be adequate were four and two times more likely, respectively, to receive contraceptive methods than those counseled by providers who felt supplies were inadequate (P < 0.01).
  
  
  CONCLUSIONS
  Integrating VCT and family planning services is likely to be an effective programmatic option, but populations at risk for HIV or unintended pregnancy should be targeted.
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Bradley
authors.forename: Duff
authors.initials: D
authors.lastname: Gillespie
authors.forename: Aklilu
authors.initials: A
authors.lastname: Kidanu
authors.forename: Yung-Ting
authors.initials: YT
authors.lastname: Bonnenfant
authors.forename: Sabrina
authors.initials: S
authors.lastname: Karklins
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005002:Ethiopia / Q000453:epidemiology; D005193:Family Planning Services / Q000458:organization & administration* / Q000600:supply & distribution; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D035141:Voluntary Programs / Q000458:organization & administration*; D055815:Young Adult