The Effect of Integration of Family Planning Into HIV Services on Contraceptive Use Among Women Accessing HIV Services in Low and Middle-Income Countries: A Systematic Review

Abstract

There is substantial unmet need for family planning (FP) among women living with HIV (WLHIV), leading to unintended pregnancies and may contribute indirectly to increasing the risk of transmission of HIV. This review aims to determine whether integration of FP into HIV testing and care results in increased use of contraception, a reduction in unmet need for FP, improved use of safer conception methods and a reduction in unintended pregnancies in low and middle-income countries. A systematic review was undertaken incorporating studies from PubMed, EMBASE, CINAHL, Web of Science and Global Health, the International AIDS Society Abstract Archive, the World STI & HIV Congress Abstract Archive and the Conference on Retroviruses and Opportunistic Infections Abstract Archive published between 2016 and 2021, updating previous systematic reviews. After screening, 13 studies were included, 11 conducted in sub-Saharan Africa and 2 in India. The primary outcome of the review was contraceptive uptake and secondary outcomes included unmet need for FP, safer conception and unintended pregnancy. Integrated FP-HIV facilities were found to increase dual contraceptive use by at least 8% in five studies and modern contraceptive use by at least 8% in four studies. Findings from two studies suggested integration decreased the unmet need for contraception. Limited data prevented a conclusion from being drawn regarding whether integration increases safer conception. There was no evidence of integration reducing unintended pregnancies. The median quality score of studies was 3/9. Overall, integrated facilities have the potential of improving reproductive health of women accessing HIV services in LMICs. FP may be enhanced by including a safer conception component for WLHIV.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021251008, identifier: CRD42021251008.

Does family planning and HIV services integration increase contraceptive prevalence? A comparative analysis of modern contraceptive prevalence among HIV-positive and HIV-negative women of reproductive age in Tanzania-analysis of the 2016/17 Tanzania HIV impact survey

“…[22,23] Prior studies have demonstrated that service integration increases the uptake of modern contraceptives among HIV-positive women [16, 17,22]. A systematic review study by Grant-Maidment and colleagues reported 8% higher contraceptive use in integrated than on non-integrated facilities [17]. The difference in contraceptive prevalence in women on ART and those not in ART in this study is smaller than the expected impact of service integration observed elsewhere.…”

“…The increase in modern contraceptives may be attributed to family planning and HIV services integration and or reduced desire for more children following HIV diagnosis. [22,23] Prior studies have demonstrated that service integration increases the uptake of modern contraceptives among HIV-positive women [16, 17,22]. A systematic review study by Grant-Maidment and colleagues reported 8% higher contraceptive use in integrated than on non-integrated facilities [17].…”

“…Age distribution substantially differed among HIV-positive and negative women. Over 50% of HIV-positive women were older adults (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), while the majority of HIV-negative women (44%) were youth (15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Other characteristics differentiating the two groups were attainment of secondary education and above (HIV-positive = 13% vs HIV negative = 26%), living in urban areas (HIV-positive = 50% vs HIV-negative = 39%), and divorced/widow/separated marriage status (HIV-positive = 35% vs HIV-negative = 12%).…”

“…In a well-functional integrated program, HIVpositive women are expected to have higher modern contraceptive prevalence than other groups due to intensi ed family planning counselling, prescriptions and referrals. [16,17] Using data from a large household population-based HIV impact survey in Tanzania, we assessed this hypothesis by comparing modern contraceptive prevalence in women on ART (accessing integrated services) with HIV-positive women who are not on treatment and HIV-negative women. This assessment will provide information on the performance of the service integration strategy in Tanzania and the need for its evaluation.…”

Mobile solutions to Empower reproductive life planning for women living with HIV in Kenya (MWACh EMPOWER): Protocol for a cluster randomized controlled trial

“…Unmet need for contraception among WLWH remains high because of many intersecting individual [ 15 , 16 ], societal [ 17 ] and structural barriers [ 18 ]. These barriers include insufficient knowledge about family planning (FP), negative family planning beliefs, fear of side effects, partnership dynamics, long wait times at clinics, and stockouts of contraceptive commodities [ 18 , 19 ].…”