New study shows “one-stop shop” family planning care more effective for women living with HIV


New study shows integrating HIV care and family planning services reduces pregnancy rate by nearly 30 percent and increases use of effective contraception among women living with HIV

Researchers at UC San Francisco (UCSF), in collaboration with the Kenya Medical Research Institute (KEMRI), have released the first study to show that integrating HIV care and family planning services reduces the pregnancy rate among HIV-positive women in Kenya—and increases their sustained use of more effective contraceptive methods. Previous research has shown that the majority of women living with HIV in Kenya want to avoid a pregnancy in the near future.

The study, published in PLOS ONE, analyzed contraceptive use and pregnancy rates for HIV-positive women over two years across 18 clinic sites in Kenya. Outcomes for women receiving care at integrated “one-stop shop” clinics were compared to those still receiving HIV care and family planning services separately.

In addition to proving that the “one-stop shop” model significantly improves family planning outcomes, this study also demonstrates that the model can be effectively implemented locally. A joint UCSF-KEMRI team led integration at the trial’s first 12 clinic sites, and then transitioned management of those sites—as well as the work of expanding to six more sites—to the Kenya Ministry of Health. Those locally led and managed facilities produced similarly positive and sustained outcomes.

“This study is the most comprehensive proof we have that when family planning services are easy to access, women living with HIV will use them—and do so effectively,” stated Craig Cohen, MD, MPH, the study’s lead researcher and director of Family AIDS Care & Education Services (FACES), a program of the UCSF Bixby Center for Global Reproductive Health and KEMRI. “Furthermore, we have demonstrated this model could be easily and locally replicated to reach all of the 16 million women living with HIV in sub-Saharan Africa.”

Unintended pregnancies can be damaging to any woman’s future, but they can be especially dangerous for women living with HIV. In addition to endangering their health, such pregnancies can also lead to mother-to-child-transmission of HIV and other adverse pregnancy outcomes.

The researchers hope these findings highlight the progress that may be endangered by United States policies that restrict or defund support for family planning abroad. “Policies like the Global Gag Rule at best inhibit integrated care—and, at worst, force women to use unsafe or ineffective methods to control their reproductive lives,” said Daniel Grossman, MD, a co-author of the study and director of Advancing New Standards in Reproductive Health (ANSIRH).

Other authors of the study include Cinthia Blat, Sara J. Newmann, Rachel Burger and Starley B. Shade, all of UCSF, Norah Bett, of the Kenya Ministry of Health, and Elizabeth A. Bukusi, of KEMRI. The study was sponsored by the Bill & Melinda Gates Foundation.

Read a BuzzFeed article about this study.