title: Does integrating family planning into HIV care and treatment impact intention to use contraception? Patient perspectives from HIV-infected individuals in Nyanza Province, Kenya.
abstract: OBJECTIVE
  To evaluate whether HIV-infected women and men in HIV care and not using highly effective methods of contraception thought they would be more likely to use contraception if it were available at the HIV clinic.
  
  
  METHODS
  A face-to-face survey assessing family-planning knowledge, attitudes, and practices was conducted among 976 HIV-infected women and men at 18 public-sector HIV clinics in Nyanza, Kenya. Data were analyzed using logistic regression and generalized estimating equations.
  
  
  RESULTS
  The majority of women (73%) and men (71%) thought that they or their partner would be more likely to use family planning if it were offered at the HIV clinic. In multivariable analysis, women who reported making family-planning decisions with their partner (adjusted odds ratio [aOR] 3.22; 95% confidence interval [CI], 1.53-6.80) and women aged 18-25 years who were not currently using family planning (aOR 4.76; 95% CI, 2.28-9.95) were more likely to think they would use contraception if integrated services were available. Women who perceived themselves to be infertile (aOR 0.07; 95% CI, 0.02-0.31) and had access to a cell phone (aOR 0.40; 95% CI, 0.25-0.63) were less likely to think that integrated services would change their contraceptive use. Men who were not taking antiretroviral medications (aOR 3.30; 95% CI, 1.49-7.29) were more likely, and men who were unsure of their partner's desired number of children (aOR 0.36; 95% CI, 0.17-0.76), were not currently using family planning (aOR 0.40; 95% CI, 0.22-0.73), and were living in a peri-urban setting (aOR 0.46; 95% CI, 0.21-0.99) were less likely to think their partner would use contraception if available at the HIV clinic.
  
  
  CONCLUSIONS
  Integrating family planning into HIV care would probably have a broad impact on the majority of women and men accessing HIV care and treatment. Integrated services would offer the opportunity to involve men more actively in the contraceptive decision-making process, potentially addressing 2 barriers to family planning: access to contraception and partner uncertainty or opposition.
authors.affiliation: Bixby Center for Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA. Electronic address: newmanns@obgyn.ucsf.edu.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Newmann
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossman
authors.forename: Cinthia
authors.initials: C
authors.lastname: Blat
authors.forename: Maricianah
authors.initials: M
authors.lastname: Onono
authors.forename: Rachel
authors.initials: R
authors.lastname: Steinfeld
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Starley
authors.initials: S
authors.lastname: Shade
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003267:Contraception / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003625:Data Collection; D003657:Decision Making; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D007630:Kenya; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care; D012747:Sexual Partners; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Contraception; Decision making; Family planning; HIV; Integration