Title : Reduction in HIV spread in Abuja metropolis through Integrated HIV and Family planning services-A case for one-stop-shop model of care
Abstract:
Background: The NARHS-Plus 2013 and the NDHS 2013 showed that the current HIV prevalence among women aged 15-49 is 3.4% with male to female variation of 3.3% to 3.4% respectively. Mindful of the fact that Family planning preferences among HIV positives of reproductive age has been at the centre stage of prevention of mother-to-child transmission (PMTCT) of HIV/AIDS, there is need to investigate the relationship between HIIV prevalence rate and the reproductive Health contraceptive prevalence rate in Nigeria using a pilot study of Abuja metropolis. The current National Contraceptive Prevalence Rate (CPR) is 15% for any method and 10% for modern methods among women of child bearing age with fertility rate of 5.5%. These statistical coverage is abysmally low considering the National target of 38% by 2018 which around the corner. 16% of currently married women have an unmet need for family planning: 12% for spacing and 4% for limiting. Even though knowledge of any contraceptive method is 72 per cent of all women and 90 per cent of all men, only 24 per of all women and 33.2 per cent of all men ever used a modern method. Critical knowledge is that heterosexual behavior of HIV positives of reproductive age has been found to be crucial in increasing incidence of HIV among general population. In most centers in Nigeria, HIV services are offered independently from family planning. Studies have shown areas of intersection between HIV services and family planning services uptake which provides huge opportunity in stemming the tide of HIV spread among the general population.
Method: Data was collected using a structured questionnaire administered to 400 HIV positive men (18-64 year) and women of reproductive age (15-49 years) attending HIV clinics in four randomly selected hospitals in Abuja metropolis which included Kubwa, Maitama, Wuse, Nyanya between March 2012 – December 2012. Out of the 400 questionnaires distributed only 364 were retrieved and analyzed.
Results: While 63% of HIV positive women were attending FP clinic only 49.7% of them were on family planning with their sources of information varying from sex partner (17.1%), HCT counsellor (47%), media (12%) to self (15.6%). While 76.1% accepted that their clinics offered HIV and FP services, 75% of the facilities offered integrated HIV/FP services. Eighty one (81%) accepted that there was reduction in HIV spread in clinics that offer integrated HIV/FP services. Considering drivers of FP choices among the respondents, while 61.5% felt that their educational level affected their choice of family planning, 65.9% felt that their desire for children did not influence their choice of family planning and 70.9% felt that their spouse and sexual partner has no influence on their choice of family planning. Religion influenced 64% of family planning choices. While 64.4% were aware of various family planning methods, there were varied preferences where 42.7% preferred condom as their FP choice, 15.8% preferred pills and rhythm method was the least preferred at 2.1%.
Conclusion: A model of ‘one-stop-shop’ integrated HIV/FP services is recommended which will reduce the burden of poor human resources for health, improved confidentiality and reduce patients out of pocket spending due to referrals.
