UCSF has received a $1.15 million grant from the Bill & Melinda Gates Foundation to determine if integrating family planning into HIV treatment and care will increase contraceptive use and decrease unintended pregnancy among HIV-positive women. UCSF will partner with the Kenya Medical Research Institute and Ibis Reproductive Health to conduct the research.
"Two-thirds of the world's HIV-infected population lives in sub-Saharan Africa and 60 percent are estimated to be women. Recent evidence suggests high rates of unintended pregnancy among HIV-infected women. Family planning is the cornerstone for preventing mother-to-child transmission of HIV and can also reduce maternal mortality, but family planning services are not always accessible at many of the public health clinics providing HIV care and treatment," said the study's primary investigator, Craig R. Cohen, MD, MPH, professor of obstetrics, gynecology and reproductive sciences at UCSF.
The research will be conducted at 18 HIV care and treatment clinics in Nyanza Province, Kenya. With 15.3 percent of its population HIV-infected, Nyanza Province has the highest seroprevalence rate amongst provinces in Kenya. These clinics are supported by the Family AIDS Care and Education Services (FACES) Program, a collaboration between UCSF and the Kenya Medical Research Institute (KEMRI). At 12 randomly selected clinics, HIV-infected clients will receive the intervention package of integrated family planning and HIV care. At each of the six clinic control sites, HIV-infected clients will receive standard HIV care and a referral to a separate family planning clinic within the same facility for contraceptive services.
The study's first objective is to improve family planning clinical and counseling skills of clinicians and community health workers at all the FACES-supported HIV care and treatment clinics. A training curriculum on family planning counseling and method provision will be developed and implemented.
The second objective is to measure contraceptive use and unintended pregnancy along with interviews with female and male clients regarding knowledge, attitudes, and practices related to family planning along with the acceptability of family planning services received. In addition, clinic staff will be interviewed about the feasibility of increasing the integrated model of HIV care and family planning services provision.
"There is a large unmet need for family planning in Kenya--nearly 75 percent of HIV-infected women age 15-49 either do not want to have a child in the next two years or do not ever desire to do so. With a significant overlap between women needing family planning services and women who are HIV-infected needing treatment and care, delivering both together could help alleviate some of the challenges we face with a shortage of skilled staff paralleled with a great many needs for health care services," said the study's site principal investigator, Elizabeth Anne Bukusi, MBChB, M.Med (ObGyn), MPH, PhD, co-director, Research Care Training Program and chief research officer, Center for Microbiology Research, KEMRI.