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Integration of family planning services into HIV care clinics: Results one year after a cluster randomized controlled trial in Kenya.

Integration of family planning services into HIV care clinics: Results one year after a cluster randomized controlled trial in Kenya.
Author Information (click to view)

Cohen CR, Grossman D, Onono M, Blat C, Newmann SJ, Burger RL, Shade SB, Bett N, Bukusi EA,


Cohen CR, Grossman D, Onono M, Blat C, Newmann SJ, Burger RL, Shade SB, Bett N, Bukusi EA, (click to view)

Cohen CR, Grossman D, Onono M, Blat C, Newmann SJ, Burger RL, Shade SB, Bett N, Bukusi EA,

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PloS one 2017 03 2212(3) e0172992 doi 10.1371/journal.pone.0172992

Abstract
OBJECTIVES
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.

DESIGN
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.

SETTING
Eighteen health facilities in Kenya.

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

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

MAIN OUTCOME MEASURES
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.

TRIAL REGISTRATION
ClinicalTrials.gov NCT01001507.

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