title: Integrating family planning and prevention of mother to child HIV transmission in Zimbabwe.
abstract: OBJECTIVE
  The objective was to integrate enhanced family planning (FP) and prevention of mother-to-child HIV transmission services in order to help HIV-positive Zimbabwean women achieve their desired family size and spacing as well as to maximize maternal and child health.
  
  
  METHODS
  HIV-positive pregnant women were enrolled into a standard-of-care (SOC, n=33) or intervention (n=65) cohort, based on study entry date, and followed for 3 months postpartum. The intervention cohort received education sessions aimed at increasing FP use and negotiation power. Both groups received care from nurses with enhanced FP training. Outcomes included FP use, FP knowledge and HIV disclosure, and were assessed with Fisher's Exact Tests, binomial tests and t tests.
  
  
  RESULTS
  The intervention cohort reported increased control over condom use (p=.002), increased knowledge about IUDs (p=.002), increased relationship power (p=.01) and increased likelihood of disclosing their HIV status to a partner (p=.04) and having that partner disclose to them (p=.04) when compared to the SOC cohort. Long-acting reversible contraception (LARC) use in both groups increased from ~2% at baseline to >80% at 3 months postpartum (p<.001).
  
  
  CONCLUSIONS
  FP and sexual negotiation skills and knowledge, as well as HIV disclosure, increased significantly in the intervention cohort. LARC uptake increased significantly in both the intervention and SOC cohorts, likely because both groups received care from nurses with enhanced FP training. Successful service integration models are needed to maximize health outcomes in resource-constrained environments; this intervention is such a model that should be replicable in other settings in sub-Saharan Africa and beyond.
  
  
  CONCLUSIONS
  This study provides a rigorously evaluated intervention to integrate FP education into ante- and postnatal care for HIV-positive women and also to train providers on FP. Results suggest that this intervention had significant effects on contraception use and communication with sexual partners. This intervention should be adaptable to other areas.
authors: Stanford University School of Medicine, Division of Pediatric Infectious Diseases, Menlo Park, CA, 94205, USA. Electronic address: cleas@stanford.edu.
authors: Clea C
authors: CC
authors: Sarnquist
authors: University of Zimbabwe-University of California San Francisco Collaborative Research Programme, Belgravia, Harare, Zimbabwe.
authors: Precious
authors: P
authors: Moyo
authors: University of Zimbabwe-University of California San Francisco Collaborative Research Programme, Belgravia, Harare, Zimbabwe; University of Zimbabwe, College of Health Sciences, Parirenyatwa General Hospital, Harare, Zimbabwe.
authors: Lynda
authors: L
authors: Stranix-Chibanda
authors: University of Zimbabwe-University of California San Francisco Collaborative Research Programme, Belgravia, Harare, Zimbabwe; University of Zimbabwe, College of Health Sciences, Parirenyatwa General Hospital, Harare, Zimbabwe.
authors: Tsungai
authors: T
authors: Chipato
authors: Stanford University School of Medicine, Division of Pediatric Infectious Diseases, Menlo Park, CA, 94205, USA.
authors: Jennifer L
authors: JL
authors: Kang
authors: Stanford University School of Medicine, Division of Pediatric Infectious Diseases, Menlo Park, CA, 94205, USA.
authors: Yvonne A
authors: YA
authors: Maldonado
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017280:Condoms; D003267:Contraception / Q000379:methods; D030881:Disclosure; D005193:Family Planning Services / Q000193:education / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007434:Intrauterine Devices; D008297:Male; D010353:Patient Education as Topic; D011181:Postnatal Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D011295:Prenatal Care; D012747:Sexual Partners; D015030:Zimbabwe
keywords: Contraception; HIV/AIDS; Intervention; Maternal child health; Prevention education; Provider training