Integration of contraception services in a HIV care clinic serving most at risk populations in Phnom Penh, Cambodia
ESC Congress Library. Delvaux T. 05/28/14; 50500; A-085
Dr. Thérèse Delvaux
Dr. Thérèse Delvaux
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Abstract
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 Objective: The main objective of the study was to assess rates of contraceptive uptake and method choice among women living with HIV who attended an HIV care clinic serving most at risk women in Phnom Penh Cambodia, before and after the introduction of integrated contraception/family planning (FP) services.   


Methods: A before -after design was used. Following a theoretical and on-site training on provision of FP, contraceptive methods (pills, injectables, implants, and IUDs) were made available at the HIV clinic from August 2011 onward. Baseline and endline assessments, using mixed-methods (quantitative and qualitative) including among clients and providers at the HIV care clinic were conducted before (June -July 2011) and after (June -July 2012) the introduction of FP services.


Results: A total of 250 and 249 women living with HIV were interviewed at baseline and endline assessments, respectively.  Twenty four percent of women reported selling sex for money during the last 6 months at baseline and 35% at endline. Awareness about contraceptive methods such as injectable, IUD, implant, male and female sterilization significantly increased among HIV positive clients at endline. Among sexually active women, the male condom remained the method of choice and the use of dual method (condom plus another method) was low (11% at baseline vs. 15% at endline (p=0.28). Condom use during the last six months did not change significantly (91% at endline versus 95.6% at baseline, p = 0.11). The primary reason women reported for not using non-condom FP methods was that the majority (79.5% at endline) thought that condom use was sufficient to prevent unintended pregnancy. The use of non-condom FP methods increased but not significantly (16% at endline vs. 13% compared to baseline, p=0.8). The use of implants, however, significantly increased at endline (p <0.05). Pills and female sterilization were the most frequently used non-condom methods both at baseline and endline.


Conclusion: Our results show that FP practices of HIV positive women attending an HIV care clinic for most at risk populations in Phnom Penh, Cambodia did not significantly change after introducing on-site provision of a wide range of non-condom FP methods.  Though some best practices for integrated services have emerged in generalized HIV epidemics, innovative strategies and further research is needed to better understand how to effectively promote non-condom and dual method contraceptive uptake among most at risk and HIV positive women in concentrated epidemics.

 Objective: The main objective of the study was to assess rates of contraceptive uptake and method choice among women living with HIV who attended an HIV care clinic serving most at risk women in Phnom Penh Cambodia, before and after the introduction of integrated contraception/family planning (FP) services.   


Methods: A before -after design was used. Following a theoretical and on-site training on provision of FP, contraceptive methods (pills, injectables, implants, and IUDs) were made available at the HIV clinic from August 2011 onward. Baseline and endline assessments, using mixed-methods (quantitative and qualitative) including among clients and providers at the HIV care clinic were conducted before (June -July 2011) and after (June -July 2012) the introduction of FP services.


Results: A total of 250 and 249 women living with HIV were interviewed at baseline and endline assessments, respectively.  Twenty four percent of women reported selling sex for money during the last 6 months at baseline and 35% at endline. Awareness about contraceptive methods such as injectable, IUD, implant, male and female sterilization significantly increased among HIV positive clients at endline. Among sexually active women, the male condom remained the method of choice and the use of dual method (condom plus another method) was low (11% at baseline vs. 15% at endline (p=0.28). Condom use during the last six months did not change significantly (91% at endline versus 95.6% at baseline, p = 0.11). The primary reason women reported for not using non-condom FP methods was that the majority (79.5% at endline) thought that condom use was sufficient to prevent unintended pregnancy. The use of non-condom FP methods increased but not significantly (16% at endline vs. 13% compared to baseline, p=0.8). The use of implants, however, significantly increased at endline (p <0.05). Pills and female sterilization were the most frequently used non-condom methods both at baseline and endline.


Conclusion: Our results show that FP practices of HIV positive women attending an HIV care clinic for most at risk populations in Phnom Penh, Cambodia did not significantly change after introducing on-site provision of a wide range of non-condom FP methods.  Though some best practices for integrated services have emerged in generalized HIV epidemics, innovative strategies and further research is needed to better understand how to effectively promote non-condom and dual method contraceptive uptake among most at risk and HIV positive women in concentrated epidemics.

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