Integrating Family Planning into HIV Care/ART Services in Uganda
The Ministry of Health in Uganda identified prevention of HIV infection and improvement of linkages between family planning (FP) services and HIV care and support as a priority for its national Quality of Care Initiative in HIV Care. Integration of FP and antiretroviral therapy (ART) services in Uganda had not previously been given proper attention in the push to expand ART services in the country. The only commonly used FP method was a condom, but even then, condoms were given for prevention of re-infection but not for family planning, although they are an important method of dual protection.
As part of a national improvement collaborative to improve ART and other aspects of HIV care and treatment, 10 teams participating in the collaborative volunteered to give a specific focus to improving the integration of family planning and HIV/AIDS services. Sites participating in the collaborative had reported increasing numbers of pregnancies among HIV-positive clients on ART and lacked FP services in the same clinics. Thus, a new emphasis on improving FP-HIV integration was added for a new group of teams that joined the collaborative in January 2007. While 13 teams originally asked to participate, another 2 teams later began monitoring progress in FP-HIV integration, for a total of 15 sites focusing on this process out of the 84 teams participating in the collaborative at that time.
New improvement indicators were added to monitor the percentage of HIV-positive clients of reproductive age who were counseled on FP methods, who were using at least one FP method, and, of those not using a method, who were referred elsewhere for FP services.
Results from the 15 sites show sustained improvement in counseling on FP methods and in FP use. The percentage of HIV-positive patients of reproductive age who were counseled on family planning at their last clinic visit increased from 42% in January 2007 to 98% by January 2008. The percentage of HIV-positive patients of reproductive age seen in the clinic who report they are currently using at least one family planning method rose from 51% to 81% in the same period.
Over the course of the year, providers at the pilot sites reported that they could see several advantages to integration, particularly making services more easily accessible for clients, who did not feel comfortable going to another clinic where they were not familiar with the health providers. Clients were happier that they were no longer inconvenienced to walk to separate FP clinics for the services.