%0 Journal Article
%T ProvidersĄ¯ Perspectives on Provision of Family Planning to HIV-Positive Individuals in HIV Care in Nyanza Province, Kenya
%A Sara J. Newmann
%A Kavita Mishra
%A Maricianah Onono
%A Elizabeth A. Bukusi
%A Craig R. Cohen
%A Olivia Gage
%A Rose Odeny
%A Katie D. Schwartz
%A Daniel Grossman
%J AIDS Research and Treatment
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/915923
%X Objective. To inform an intervention integrating family planning into HIV care, family planning (FP) knowledge, attitudes and practices, and perspectives on integrating FP into HIV care were assessed among healthcare providers in Nyanza Province, Kenya. Methods. Thirty-one mixed-method, structured interviews were conducted among a purposive sample of healthcare workers (HCWs) from 13 government HIV care facilities in Nyanza Province. Structured questions and case scenarios assessed contraceptive knowledge, training, and FP provision experience. Open-ended questions explored perspectives on integration. Data were analyzed descriptively and qualitatively. Results. Of the 31 HCWs interviewed, 45% reported previous FP training. Few providers thought long-acting methods were safe for HIV-positive women (19% viewed depot medroxyprogesterone acetate as safe and 36% viewed implants and intrauterine contraceptives as safe); fewer felt comfortable recommending them to HIV-positive women. Overall, providers supported HIV and family planning integration, yet several potential barriers were identified including misunderstandings about contraceptive safety, gendered power differentials relating to fertility decisions, staff shortages, lack of FP training, and contraceptive shortages. Conclusions. These findings suggest the importance of considering issues such as patient flow, provider burden, commodity supply, gender and cultural issues affecting FP use, and provider training in FP/HIV when designing integrated FP/HIV services in high HIV prevalence areas. 1. Introduction Unmet need for contraception and unintended pregnancy are prevalent among the estimated 13 million HIV-positive women in sub-Saharan Africa [1¨C3]. Unintended pregnancies account for 14¨C58% of all births in countries where the burden of HIV is the greatest [4]. In South Africa, a recent cohort study of women attending antiretroviral (ART) clinics found that 62% of pregnancies were unintended [5], while a cross-sectional study of pregnant women obtaining services for prevention of mother-to-child transmission (PMTCT) reported that 84% of pregnancies were unintended [6]. In a cohort of Ugandan women starting ART, 17% became pregnant over the two-year follow-up period, despite 93% not wanting or planning pregnancy [1]. Prevention of unintended pregnancy among HIV-positive women is one of the World Health OrganizationĄ¯s four cornerstones of preventing mother-to-child transmission of HIV (PMTCT) [7]. In many settings in sub-Saharan Africa, contraceptive services are provided in family planning (FP)
%U http://www.hindawi.com/journals/art/2013/915923/