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

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

PATHFINDER INTERNATIONALPathfinder 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.

ARISEAriseEnhancing 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 OUTLINEProject DescriptionResearch MethodsFindings BaselineFindings EndlineImplementation ChallengesConclusions

PROJECT DESCRIPTIONEfforts 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 FRONTBaseline study indicated the wide range of FP needs among HIV clients: most young clients wanted a pregnancymany older clients had not been sexually active in the past 12 monthsEndline study indicated:significant increase in contraceptive use and reduction of unmet need for contraceptionHigh need for contraception among the youngest clients

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

FINDINGS - BASELINEThe 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 sterilizedOverall, 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 - ENDLINEDespite 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 yearDual 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 CHALLENGESEndline 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.

CONCLUSIONSResults indicate the value of a lifecycle approach to FP/HIV integrationWhile there is general support for FP integration into HIV services, we cannot assume there are general FP service needs among HIV service clientsTo facilitate tailored, efficient FP counseling we recommend: screening HIV service clients for unmet need for contraceptionconsidering regular client/provider discussions of fertility intentions, andtraining providers in youth-friendly services.

ACKNOWLEDGEMENTSDr. Elizabeth OliverasDr. Margaret WaithakaLucy ShillingiCaroline NalwogaArise Program at PathCanadian Government through Foreign Affairs, Trade and DevelopmentArise/Uganda partners and staff

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For more information contact Alden Nougaanouga@pathfinder.org

***Note for sexual activity being low that given the post-conflict and high HIV prevalence nature of the region, many female clients were older and widowed.

Important findings were surprising! ***Shows some of the weaknesses in data collection. First, it takes a data review to find this since HCs dont report FP from HIV services separately. Second, it isnt possible to know about the 39% (need for contraception). Also shows that condom only remains high and LARC is low.**