Integrating family planning into HIV care in western Kenya: HIV care providers’ perspectives and experiences one year following integration

ABSTRACT

With high rates of unintended pregnancy in sub-Saharan Africa, integration of family planning (FP) into HIV care is being explored as a strategy to reduce unmet need for contraception. Perspectives and experiences of healthcare providers are critical in order to create sustainable models of integrated care. This qualitative study offers insight into how HIV care providers view and experience the benefits and challenges of providing integrated FP/HIV services in Nyanza Province, Kenya. Sixteen individual interviews were conducted among healthcare workers at six public sector HIV care facilities one year after the implementation of integrated FP and HIV services. Data were transcribed and analyzed qualitatively using grounded theory methods and Atlas.ti. Providers reported a number of benefits of integrated services that they believed increased the uptake and continuation of contraceptive methods. They felt that integrated services enabled them to reach a larger number of female and male patients and in a more efficient way for patients compared to non-integrated services. Availability of FP services in the same place as HIV care also eliminated the need for most referrals, which many providers saw as a barrier for patients seeking FP. Providers reported many challenges to providing integrated services, including the lack of space, time, and sufficient staff, inadequate training, and commodity shortages. Despite these challenges, the vast majority of providers was supportive of FP/HIV integration and found integrated services to be beneficial to HIV-infected patients. Providers' concerns relating to staffing, infrastructure, and training need to be addressed in order to create sustainable, cost-effective FP/HIV integrated service models.

KEYWORDS:

• HIV
• family planning services
• integrated
• delivery of health care
• healthcare provider
• Kenya

Acknowledgements

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 Research, and the Nyanza Provincial Ministries of Health for their support in conducting this research. We thank the providers who generously gave their time to participate in this study and Sophie Otticha for her important contribution to this research. The contents of the manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The study was funded by the Bill & Melinda Gates Foundation. Dr. Newmann was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI [grant number KL2TR000143].