Integration of family planning services into HIV care clinics: Results one year after a cluster randomized controlled trial in Kenya.
OBJECTIVE
To determine if integration of family planning (FP) and HIV services led to increased use of more effective contraception (i.e. hormonal and permanent methods, and intrauterine devices) and decreased pregnancy rates.


METHODS
Cohort analysis following cluster randomized trial, when the Kenya Ministry of Health led integration of the remaining control (delayed integration) sites and oversaw integrated services at the original intervention (early integration) sites.


METHODS
Eighteen health facilities in Kenya.


METHODS
Women aged 18-45 receiving care: 5682 encounters at baseline, and 11628 encounters during the fourth quarter of year 2.


METHODS
"One-stop shop" approach to integrating FP and HIV services.


METHODS
Use of more effective contraceptive methods and incident pregnancy across two years of follow-up.


RESULTS
Following integration of FP and HIV services at the six delayed integration clinics, use of more effective contraception increased from 31.7% to 44.2% of encounters (+12.5%; Prevalence ratio (PR) = 1.39 (1.19-1.63). Among the twelve early integration sites, the proportion of encounters at which women used more effective contraceptive methods was sustained from the end of the first to the second year of follow-up (37.5% vs. 37.0%). Pregnancy incidence including all 18 integrated sites in year two declined in comparison to the control arm in year one (rate ratio: 0.72; 95% CI 0.60-0.87).


CONCLUSIONS
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.


BACKGROUND
ClinicalTrials.gov NCT01001507.
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
Craig R
CR
Cohen
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.|Ibis Reproductive Health, Oakland, California, United States of America.
Daniel
D
Grossman
Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Maricianah
M
Onono
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
Cinthia
C
Blat
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
Sara J
SJ
Newmann
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
Rachel L
RL
Burger
Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
Starley B
SB
Shade
Department of Reproductive Health, Ministry of Health, Kisumu, Kenya.
Norah
N
Bett
Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Elizabeth A
EA
Bukusi
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003267:Contraception / Q000379:methods; D003268:Contraception Behavior; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007630:Kenya; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic; D012736:Sex Education / Q000379:methods; D055815:Young Adult