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.

Keywords:

• Family planning
• HIV treatment
• male attitudes
• knowledge
• integration
• Kenya

Acknowledgments

We thank the Kenyan women and men who participated in this study. We acknowledge the important logistical support of the KEMRI-UCSF Collaborative Group and especially FACES. We gratefully acknowledge the Director of KEMRI, the Director of KEMRI’s Centre for Microbiology, and the Nyanza Provincial Ministries of Health and the provincial and district reproductive health coordinators for their support in conducting this research. We also thank Pauline Wekesa, Wanjiku King’ori, Gorrety Ongundi, Janet Opiyo, Phoebe Adhiambo, Christine Oray, Mercy Wanjiku, Violet Nasenya, and George Ochieng’ for their important contributions to this research.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by The Bill & Melinda Gates Foundation (http://www.gatesfoundation.org/) [grant number OPPGH5361] and the Tides Africa Fund (http://www.gatesfoundation.org/http://www.tides.org/impact/fund-initiative-spotlight/tides-africa-fund/) [grant number TFR10 – 01364], [grant number TFR08 – 02986]. Dr Newmann was supported by the National Center for Advancing Translational Sciences, National Institutes of Health through UCSF-CTSI [grant number KL2TR000143].