Integration of HIV care and family planning: attitudes,challenges and opportunities in Lusaka,Zambia

Abstract

Policy recommendations from governments and international organisations alike now explicitly support the integration of HIV and reproductive health service delivery, particularly family planning. There is recognition that integration is needed to support women‘s and men‘s reproductive health needs, to push the HIV epidemic back, with the goal of achieving an HIV-free generation and to meet several of the Sustainable Development Goals (UNDP 2015). Despite the existence of invaluable efforts to make available integrated HIV/FP services by government and other stakeholders, evidence for clients’ attitude, challenges and opportunities towards these services in Zambia is limited. It is for this reason that this study was put up with the main objective to determine the attitudes, challenges and opportunities for providing integrated HIV care and Family Planning services in Lusaka, Zambia. This study used a non-experimental cross-sectional design, with a quota sampling approach to capture the targeted number of respondents for the quantitative component and purposive sampling for the qualitative component. The study was conducted in eight ART facilities in Lusaka, among 480 ART clients (adult women and men) aged 18-49 years and living with HIV. Additionally, sixteen health care providers and eight ART clients from the selected health facilities were subjected to in-depth interviews so as to gather insights around service provision and their general perceptions and attitudes around the integration of HIV care and family planning services. The study established that ART clients have the desire to access integrated services with support from the community, friends, partners or relatives, except that in most cases these services are provided in different standalone health facilities. Associations between demographic variables and the future intention to use integrated FP services were examined using Fisher's exact tests and permutation tests. Most participants (80%) indicated that they intended to use FP methods if made available. However, the majority of them (68%) indicated condoms as a preferred FP method for men, and 80% of them indicated that injectable were ideal for women. Factors associated with positive intentions to use integrated FP services were: marital status (p = 0.04), having talked to their spouse or partner about FP (p<0.001), perceived spouse or partner approval of FP (p<0.001), previous use of a FP method (p = 0.006), and satisfaction with the current clinical experience (p = 0.02). Additionally, more than 80% of the study participants agreed with the statement that FP services must be provided together and within the ART clinic. This therefore, implies that ART clients have no reservations when it comes to receiving integrated HIV care and FP services. The study further established that overburdened primary care facilities have limited the effectiveness of HIV and FP service linkage efforts which has been necessitated by lack of trained human resources to handle the ever increasing demand for various services. This situation coupled with evidence in the literature to-date, points to gaps in the continuity of care for HIV and FP clients, leading to missed opportunities for averting new HIV infections and unintended pregnancies. Therefore, scaling up human resources for health will be essential in the continued effort to combat the HIV epidemic and provide other necessary health care services including FP. This coupled with strengthened cross-referrals and service linkages with a robust and well-stipulated system would provide an appropriate environment to increase uptake of FP and HIV care services among current FP and ART clients as well as among their partners.