Lifecycle considerations in FP/HIV integration Findings from a Facility-based Surveys of HIV Service Clients in Uganda

April 3, 2014 Alden Nouga, Senior Advisor for HIV and Integration

PATHFINDER INTERNATIONAL
Pathfinder Internationals mission is to ensure that people everywhere have the right and opportunity to live a healthy sexual and reproductive life. In more than 20 countries, Pathfinder provides women, men, and adolescents with a range of quality health servicesfrom contraception and maternal and neonatal health to HIV prevention and AIDS care and treatment.

ARISE
AriseEnhancing HIV Prevention Programs for At-Risk Populations aims to prevent new HIV infections among at-risk populations through innovative and cost-effective interventions. Through a six-project portfolio selected by PATH in consultation with an independent Technical Advisory Committee, and under a grant from Foreign Affairs, Trade and Development Canada (DFATD), the program aims to reach nearly one hundred thousand people in sub-Saharan Africa and India. Arise/Uganda looks at FP/HIV integration as an HIV prevention intervention (with emphasis on meeting contraceptive need).

PRESENTATION OUTLINE
Project Description Research Methods Findings Baseline Findings Endline Implementation Challenges Conclusions

PROJECT DESCRIPTION
Efforts to integrate family planning (FP) services into HIV services aim to increase access to contraception among HIV service clients who wish to space or limit pregnancies. Pathfinder partnered with the National Community of Women Living with HIV/AIDS. Arise/Uganda covered 10 districts (63 facility catchment areas) in post-conflict Northern and Eastern Uganda. Interventions included FP distribution, referrals, and counseling by community support agents; community group mobilization; facility staff training and ongoing onsite support/monitoring.

BOTTOM LINE UP FRONT

Baseline study indicated the wide range of FP needs among HIV clients: most young clients wanted a pregnancy many older clients had not been sexually active in the past 12 months Endline study indicated: significant increase in contraceptive use and reduction of unmet need for contraception High need for contraception among the youngest clients

RESEARCH METHODS
Conducted baseline (October 2011) and endline facilitybased surveys (March 2013) Representative samples of over 1,200 women aged 15-49 using ART or pre-ART services at participating facilities Conducted modeling of HIV prevention impact from reducing unintended pregnancies and increasing dual method use

FINDINGS - BASELINE
The baseline survey results included: 30% of women had not had sex in the past 12 months, as compared to 11% in the general population. 24% said they were not able to become pregnant because they were menopausal or sterilized Overall, 40% of the women seeking care were not at risk of pregnancy (some were both sexually inactive and unable to get pregnant) 61.6% of women without children expressed a desire for a pregnancy Unmarried women not living with partners had highest unmet need (29%)

FINDINGS - ENDLINE
Despite efforts of the project, still high unmet need (33% ) for FP among 15-19 year olds (compared to 15% 20-24 year olds) Unmet need for FP decreased from 12.8 to 9.0% among women who reported sex in the past year Dual method use increased from 17.0% to 28.3% (but condom use declined overall from 47% to 44%) Contraceptive use was significantly associated with: talking to a provider about FP (Adjusted OR 1.4, 95% CI: 1.0, 1.9) and hearing about services from a community group (Adjusted OR 1.9, 95% CI: 1.4, 2.5).

IMPLEMENTATION CHALLENGES
Endline results show modern contraceptive use increased from 38.4% to 54.2% The project staff had to make extra efforts to make contraceptives available in the ART room intrafacility referrals for FP services lost clients and ART rooms had stockouts even when the facility had supply.

CONCLUSIONS
Results indicate the value of a lifecycle approach to FP/HIV integration While there is general support for FP integration into HIV services, we cannot assume there are general FP service needs among HIV service clients To facilitate tailored, efficient FP counseling we recommend: screening HIV service clients for unmet need for contraception considering regular client/provider discussions of fertility intentions, and training providers in youth-friendly services.

ACKNOWLEDGEMENTS
Dr. Elizabeth Oliveras Dr. Margaret Waithaka Lucy Shillingi Caroline Nalwoga Arise Program at Path Canadian Government through Foreign Affairs, Trade and Development Arise/Uganda partners and staff

For more information contact Alden Nouga anouga@pathfinder.org twitter.com/PathfinderInt facebook.com/PathfinderInternational Youtube/user/PathfinderInt