Impact of integrated family planning and HIV care services on contraceptive use and pregnancy outcomes: A retrospective cohort study

Rose J. Kosgei, Kizito M. Lubano, Changyu Shen, Kara Wools-Kaloustian, Beverly S. Musick, Abraham M. Siika, Hillary Mabeya, E. Jane Carter, Ann Mwangi, James Kiarie

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objective: To determine the impact of routine care (RC) and integrated family planning (IFP) and HIV care service on family planning (FP) uptake and pregnancy outcomes. Design: Retrospective cohort study conducted between October 10, 2005, and February 28, 2009. Setting: United States Agency for International Development-Academic Model Providing Access To Healthcare (USAID-AMPATH) in western Kenya. Subjects: Records of adult HIV-infected women. Intervention: Integration of FP into one of the care teams. Primary Outcomes Measures: Incidence of FP methods and pregnancy. Results: Four thousand thirty-one women (1453 IFP; 2578 RC) were eligible. Among the IFP group, there was a 16.7% increase (P < 0.001) [95% confidence interval (CI): 13.2% to 20.2%] in incidence of condom use, 12.9% increase (P < 0.001) (95% CI: 9.4% to 16.4%) in incidence of FP use including condoms, 3.8% reduction (P < 0.001) (95% CI: 1.9% to 5.6%) in incidence of FP use excluding condoms, and 0.1% increase (P = 0.9) (95% CI:-1.9% to 2.1%) in incidence of pregnancies. The attributable risk of the incidence rate per 100 person-years of IFP and RC for new condom use was 16.4 (95% CI: 11.9 to 21.0), new FP use including condoms was 13.5 (95% CI: 8.7 to 18.3), new FP use excluding condoms was-3.0 (95% CI:-4.6 to-1.4) and new cases of pregnancies was 1.2 (95% CI:-0.6 to 3.0). Conclusions: Integrating FP services into HIV care significantly increased the use of modern FP methods but no impact on pregnancy incidence. HIV programs need to consider integrating FP into their program structure.

Original languageEnglish
JournalJournal of Acquired Immune Deficiency Syndromes
Volume58
Issue number5
DOIs
StatePublished - Dec 15 2011

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Family Planning Services
Pregnancy Outcome
Contraceptive Agents
Cohort Studies
Retrospective Studies
HIV
Condoms
Confidence Intervals
Incidence
Pregnancy
United States Agency for International Development
Kenya

Keywords

  • HIV care
  • integrating family planning services
  • retrospective cohort study
  • USAID-AMPATH partnership

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Impact of integrated family planning and HIV care services on contraceptive use and pregnancy outcomes : A retrospective cohort study. / Kosgei, Rose J.; Lubano, Kizito M.; Shen, Changyu; Wools-Kaloustian, Kara; Musick, Beverly S.; Siika, Abraham M.; Mabeya, Hillary; Carter, E. Jane; Mwangi, Ann; Kiarie, James.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 58, No. 5, 15.12.2011.

Research output: Contribution to journalArticle

Kosgei, Rose J. ; Lubano, Kizito M. ; Shen, Changyu ; Wools-Kaloustian, Kara ; Musick, Beverly S. ; Siika, Abraham M. ; Mabeya, Hillary ; Carter, E. Jane ; Mwangi, Ann ; Kiarie, James. / Impact of integrated family planning and HIV care services on contraceptive use and pregnancy outcomes : A retrospective cohort study. In: Journal of Acquired Immune Deficiency Syndromes. 2011 ; Vol. 58, No. 5.
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abstract = "Objective: To determine the impact of routine care (RC) and integrated family planning (IFP) and HIV care service on family planning (FP) uptake and pregnancy outcomes. Design: Retrospective cohort study conducted between October 10, 2005, and February 28, 2009. Setting: United States Agency for International Development-Academic Model Providing Access To Healthcare (USAID-AMPATH) in western Kenya. Subjects: Records of adult HIV-infected women. Intervention: Integration of FP into one of the care teams. Primary Outcomes Measures: Incidence of FP methods and pregnancy. Results: Four thousand thirty-one women (1453 IFP; 2578 RC) were eligible. Among the IFP group, there was a 16.7{\%} increase (P < 0.001) [95{\%} confidence interval (CI): 13.2{\%} to 20.2{\%}] in incidence of condom use, 12.9{\%} increase (P < 0.001) (95{\%} CI: 9.4{\%} to 16.4{\%}) in incidence of FP use including condoms, 3.8{\%} reduction (P < 0.001) (95{\%} CI: 1.9{\%} to 5.6{\%}) in incidence of FP use excluding condoms, and 0.1{\%} increase (P = 0.9) (95{\%} CI:-1.9{\%} to 2.1{\%}) in incidence of pregnancies. The attributable risk of the incidence rate per 100 person-years of IFP and RC for new condom use was 16.4 (95{\%} CI: 11.9 to 21.0), new FP use including condoms was 13.5 (95{\%} CI: 8.7 to 18.3), new FP use excluding condoms was-3.0 (95{\%} CI:-4.6 to-1.4) and new cases of pregnancies was 1.2 (95{\%} CI:-0.6 to 3.0). Conclusions: Integrating FP services into HIV care significantly increased the use of modern FP methods but no impact on pregnancy incidence. HIV programs need to consider integrating FP into their program structure.",
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AU - Shen, Changyu

AU - Wools-Kaloustian, Kara

AU - Musick, Beverly S.

AU - Siika, Abraham M.

AU - Mabeya, Hillary

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AU - Kiarie, James

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N2 - Objective: To determine the impact of routine care (RC) and integrated family planning (IFP) and HIV care service on family planning (FP) uptake and pregnancy outcomes. Design: Retrospective cohort study conducted between October 10, 2005, and February 28, 2009. Setting: United States Agency for International Development-Academic Model Providing Access To Healthcare (USAID-AMPATH) in western Kenya. Subjects: Records of adult HIV-infected women. Intervention: Integration of FP into one of the care teams. Primary Outcomes Measures: Incidence of FP methods and pregnancy. Results: Four thousand thirty-one women (1453 IFP; 2578 RC) were eligible. Among the IFP group, there was a 16.7% increase (P < 0.001) [95% confidence interval (CI): 13.2% to 20.2%] in incidence of condom use, 12.9% increase (P < 0.001) (95% CI: 9.4% to 16.4%) in incidence of FP use including condoms, 3.8% reduction (P < 0.001) (95% CI: 1.9% to 5.6%) in incidence of FP use excluding condoms, and 0.1% increase (P = 0.9) (95% CI:-1.9% to 2.1%) in incidence of pregnancies. The attributable risk of the incidence rate per 100 person-years of IFP and RC for new condom use was 16.4 (95% CI: 11.9 to 21.0), new FP use including condoms was 13.5 (95% CI: 8.7 to 18.3), new FP use excluding condoms was-3.0 (95% CI:-4.6 to-1.4) and new cases of pregnancies was 1.2 (95% CI:-0.6 to 3.0). Conclusions: Integrating FP services into HIV care significantly increased the use of modern FP methods but no impact on pregnancy incidence. HIV programs need to consider integrating FP into their program structure.

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