title: Integrating family planning and HIV services in western Kenya: the impact on HIV-infected patients' knowledge of family planning and male attitudes toward family planning.
abstract: Little information exists on the impact of integrating family planning (FP) services into HIV care and treatment on patients' familiarity with and attitudes toward FP. We conducted a cluster-randomized trial in 18 public HIV clinics with 12 randomized to integrated FP and HIV services and 6 to the standard referral-based system where patients are referred to an FP clinic. Serial cross-sectional surveys were done before (n = 488 women, 486 men) and after (n = 479 women, 481 men) the intervention to compare changes in familiarity with FP methods and attitudes toward FP between integrated and nonintegrated (NI) sites. We created an FP familiarity score based on the number of more effective FP methods patients could identify (score range: 0-6). Generalized estimating equations were used to control for clustering within sites. An increase in mean familiarity score between baseline (mean = 5.16) and post-intervention (mean = 5.46) occurred with an overall mean change of 0.26 (95% confidence intervals [CI] = 0.09, 0.45; p = 0.003) across all sites. At end line, there was no difference in increase of mean FP familiarity scores at intervention versus control sites (mean = 5.41 vs. 5.49, p = 0.94). We observed a relative decrease in the proportion of males agreeing that FP was "women's business" at integrated sites (baseline 42% to end line 30%; reduction of 12%) compared to males at NI sites (baseline 35% to end line 42%; increase of 7%; adjusted odds ration [aOR] = 0.43; 95% CI = 0.22, 0.85). Following FP-HIV integration, familiarity with FP methods increased but did not differ by study arm. Integration was associated with a decrease in negative attitudes toward FP among men.
authors: a Kenya Medical Research Institute (KEMRI), Family AIDS Care and Education Services (FACES) , Kisumu , Kenya.
authors: Maricianah
authors: M
authors: Onono
authors: Mary A
authors: MA
authors: Guzé
authors: Daniel
authors: D
authors: Grossman
authors: Rachel
authors: R
authors: Steinfeld
authors: Elizabeth A
authors: EA
authors: Bukusi
authors: Starley
authors: S
authors: Shade
authors: Craig R
authors: CR
authors: Cohen
authors: Sara J
authors: SJ
authors: Newmann
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003268:Contraception Behavior / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003657:Decision Making; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D012737:Sex Factors
chemical_list: D019380:Anti-HIV Agents
keywords: Family planning; HIV treatment; Kenya; integration; knowledge; male attitudes
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