Integration of Couples Voluntary HIV Counseling and Testing and Family Planning in Lusaka, Zambia

Prevention of unplanned pregnancy in HIV+ women, most of whom are married, is a cost-effective perinatal HIV-prevention strategy. Integrated Couples Voluntary Counseling and Testing (CVCT) and family planning can mutually leverage heterosexual and perinatal HIV prevention. From 2009-2010, the Zambia Emory HIV Research Project (ZEHRP) conducted a pilot study of IUD and implant in couples identified during CVCT in Lusaka, Zambia. Of 897 women/couples interviewed, 511 couples did not want more children (N=421) or wanted to wait at least 3 years (N=90), the serostatus distributions were: M-F+: 42%; M+F-: 33%; M-F-: 9%; M+F+: 16%. Following long-acting user-independent reversible contraceptives (LARC) counseling, 31% requested a method. Of LARC initiators, 20% had an IUD inserted; and, 80% received an implant. LARC initiation was associated with interview status (40% of couples vs. 28% of women interviewed alone, p=0.01), woman's HIV status (42% of HIV- women vs. 24% of HIV+, p=0.001), and reproductive intentions (29% of those who did not want more children vs. 43% who prefer to wait >3 years, p=0.01). Zambia's rate of economic growth cannot support rapid population increase and the strain that HIV/AIDS places on government resources exacerbates the problem. An estimated 70% of new HIV infections in urban Zambia are acquired from cohabiting partners in 'discordant couples' who do not realize that one partner is HIV+ and the other HIV-. As shown in this pilot study, integration of CVCT and family planning services jointly addresses both of these critical issues.