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Integrating Family Planning into HIV Programs:

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Tricia Petruney

on 21 April 2014

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Transcript of Integrating Family Planning into HIV Programs:

Improves HIV-related outcomes
Strengthens male involvement in family planning
Holds potential to reduce costs
From Roots to Results:
Evidence-Based Practices for Integrating Family Planning
into HIV Programs

Increases access to and uptake of contraception by people living with HIV who wish to prevent pregnancy
Meets client desires and demand
Reduces unmet need for family planning
Why is family planning and HIV integration important?
Consensus in the global health community affirms that
linking family planning and HIV
is essential for meeting international development goals, including achieving an HIV-free generation and ensuring access to reproductive health services.
Integrating family planning services into HIV programs
can increase access to contraception, or help ensure a safe and healthy pregnancy and delivery
for those who wish to have a child.
Family planning services can be integrated into
HIV health systems strengthening, prevention, counseling and testing, PMTCT, and care and treatment.
Different types of integration might be appropriate for different health care facilities or programs.
Barriers that reduce the effectiveness of integrated FP/HIV programs
Key facilitators of successful programs

Why should family planning and HIV be integrated?
What is the impact of integrating family planning and HIV services?
Like all women, men, and couples, people living with HIV have diverse fertility desires.

confirm that women living with HIV experience high rates of unmet need for family planning and unintended pregnancies.
Unintended pregnancy among women living with HIV carries significant risks for mothers and children.
Integrating family planning and HIV services is desirable for many clients and has important potential individual, program, and public health benefits.
Policy and financial support for integrating family planning and HIV services is robust and continues to grow.
Government engagement and leadership

Benefits of integration clearly articulated to key stakeholders

‘Levels’ of integrated services tailored to local context and facility capacities
Task-shifting for delivery of integrated services

Improved monitoring and evaluation

Strong referral systems
Functional supply chains and good commodity security measures

Services designed to attract and include men and youth

Collaboration with local community groups
Investment in pre- and in-service capacity building on family planning counseling and service delivery for HIV providers and supervisors
Meaningful involvement of people living with HIV, national and local-level government staff, program managers, service providers, and community leaders in the design and rollout of integrated services
Some of the countries where FP and HIV integration is underway - from situational analyses to national-level scale up
What measures can be taken to advance family planning and HIV integration?
Be strategic and pursue "smart", context-specific integration
Address constraints and introduce reinforcements at multiple levels of the health system, such as:
Government leadership, policy linkages, and coordinating bodies
Civil society and community engagement
Supply chain and commodity security
Training and other human resource considerations
Facility infrastructure and space considerations
Communication and demand generation, including dual-method promotion
Male involvement
Information systems and M&E
Ongoing research
In 2013, with support from USAID, FHI 360 reviewed 97 resources (including peer-reviewed articles as well as programmatic and technical materials) to identify evidence pertaining to: the rationale for integrating family planning (FP) and HIV services; facilitators of and barriers to successful integration; the impact of integrated FP/HIV services; and recommendations to advance effective delivery of integrated services.
What follows is a summary of the evidence.
For access to the full technical brief of this evidence synthesis, which includes descriptions of the specific research findings and data, a full bibliography, and suggestions for key tools and resources, please go to:

Data from diverse countries like these
Gives the client more control over his or her reproductive health and fertility
Allows for ongoing contraceptive management when clients come in for regular HIV-treatment services
Increases the promotion of dual-method use
Reduces new pediatric HIV infections, and the number of children needing HIV treatment, care and support
Supports gender equity
Two essential elements for training are:

Orienting providers to the SRH rights of people living with HIV - including key populations - and addressing provider biases
(e.g., that they should not bear children, are not sexually active, should only use condoms, or be sterilized)
Ensuring that providers are able to counsel on the full spectrum of fertility choices, including safer pregnancy and the range of safe and effective contraceptive methods for HIV-positive clients
What is family planning and HIV integration?
The integration of family planning (FP) and HIV services improves sexual and reproductive health outcomes by providing both services under one programmatic umbrella.
For example, levels of integration will vary per setting.

Some facilities may only have the capacity to offer
FP screening, information, condoms,

and referrals for methods
, while others may be able to provide
FP counseling and a

full range of contraceptive methods
Political, religious, or community opposition to FP
Lack of government support
Vertical funding for and national management of FP and HIV programs

Insufficient involvement of people living with HIV
Lack of youth-friendly services
Lack of community awareness and mobilization
Human resource constraints
Limited clinic space
Lack of supportive supervision
Provider biases and stigma
Lack of FP knowledge among providers
Fears about interactions between FP and ARV medications
Absent or weak referral systems between FP and HIV service delivery points
Contraceptive stockouts
Full transcript