Integrating contraceptive and HIV care and treatment services in Kenya: Evaluating an intervention to increase contraceptive uptake among HIV+ women with unmet need for contraception

Integrating contraceptive and HIV services is an increasingly popular intervention for promoting comprehensive sexual and reproductive health care and reducing mother-to-child transmission of HIV. However, evidence is still needed to determine if these interventions successfully increase contraceptive uptake among HIV-infected clients at risk of unintended pregnancy. This study evaluates an intervention integrating contraceptive and HIV care and treatment services in 16 facilities in Kenya's Coast and Rift Valley Provinces. We compared contraceptive outcomes one month before intervention implementation and again 9 months after baseline for a cohort of 240 female clients of reproductive age. Repeated, cross-sectional male client and provider interviews further investigated the intervention's impact on family planning attitudes and provision. Follow-up data collection is ongoing through early July 2009. Baseline data show that 11% of clients had an unmet need for contraception in the last 30 days. However, an additional 11% of women were not sexually active in the last 30 days, but had been sexually active within the last 6 months and wished to avoid a birth in the next two years, but were not currently using contraception. These women represent another potentially large group with unmet need, should they resume sexual activity. This research is an important contribution to the global evidence base for integrating contraception and HIV services and highlights patterns of contraceptive use and potential risk for unintended pregnancy among HIV+ clients.