Abstract
BackgroundIn 2011, family planning (FP) services were integrated at Martin Preuss Centre (MPC), in urban Lilongwe, Malawi. To date, no previous study evaluated pregnancy rates among HIV-positive women after the integration of FP services into HIV care at the facility. In this study, we investigated whether integration of FP services into HIV clinical care led to increased use of contraceptives and decreased pregnancy rates.MethodsThis was a retrospective cohort analysis of HIV-positive women from 15 to 49 years of age who accessed antiretroviral therapy (ART) services at MPC. Ascertainment of FP needs, contraceptive methods and pregnancy status were done at ART initiation, and at each ART follow-up visit. Women were offered a wide range of contraceptive methods. Outcomes of interest were contraceptive use and rate of pregnancy. Incident pregnancy was ascertained through patient self-reports during clinic consultation. Trends of contraceptive use and pregnancy rates were analyzed using chi-square (χ2).ResultsA total of 10,472 women were included in the analysis and contributed 15,700 person-years of observation. Contraceptive use among all women receiving ART increased from 28% in 2012 to 62% in 2016 (p < 0.001). A total of 501 pregnancies occurred, including 13 multiple pregnancies, resulting in an overall pregnancy rates of 3.2 per 100 person-years. Rates of pregnancy decreased from 6.8 per 100 person-years in 2012 to 1.3 per 100 person-years in 2016 (p < 0.001).ConclusionIntegration of FP services into HIV care resulted in increased contraceptive use and, subsequently, decreased pregnancy rates in women receiving ART. HIV programs should consider offering FP services to women who are receiving ART.
Highlights
In 2011, family planning (FP) services were integrated into HIV care at Martin Preuss Centre (MPC) in urban Lilongwe, Malawi
We analyzed data collected during antiretroviral therapy (ART) patient visits at the HIV clinic
The study demonstrated that integrating family planning services into HIV care led to an
Summary
In 2011, family planning (FP) services were integrated at Martin Preuss Centre (MPC), in urban Lilongwe, Malawi. No previous study evaluated pregnancy rates among HIV-positive women after the integration of FP services into HIV care at the facility. We investigated whether integration of FP services into HIV clinical care led to increased use of contraceptives and decreased pregnancy rates. One-quarter of women in sub-Saharan Africa do not use modern contraceptives [3]. In Malawi, the total fertility rate is 4.4 births per woman; about 41% of pregnancies are unintended [4]. Among HIV-positive women, unintended pregnancy increases the risk of vertical transmission of HIV [5], HIV-related maternal morbidity [6] and mental health problems [7]. Some gains have been made to prevent unintended pregnancy, HIV-positive women still face challenges in accessing family planning (FP) services. FP services are mostly provided in clinics that are not connected to HIV clinics, HIVpositive women typically visit separate HIV clinics and reproductive health clinics to access both services
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
