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Research

Integrating HIV Voluntary Testing and Counseling and Family Planning Services

Family Health International (FHI) believes that the following research and programmatic findings, if more widely incorporated into policies and programs, could improve family planning and reproductive health services. FHI is committed to promoting more extensive use of these and related research findings. If you would like more information, or if you are interested in technical assistance on using these results, contact the Research to Practice team. This page is part of a larger guide on family planning research. To read other sections of the guide, click here.

  • Integrating voluntary counseling and testing (VCT) and family planning services has the potential to improve effectiveness of service delivery, to reach more people in need of these services, and to be more cost-efficient than separate delivery of these services.

      • U.S. Agency for International Development. Family Planning/HIV Integration: Technical Guidance for USAID-Supported Field Programs. Washington, DC: U.S. Agency for International Development, 2003. (full text [PDF, 252 KB])

    • Integrating family planning into VCT services is acceptable to providers, supervisors, and clients and is feasible if efforts are made to improve facilities and train providers. A 2006 study in Kenya showed that providers have the time to discuss family planning, believe the addition of family planning services improves VCT quality, and can distribute condoms for dual protection.

      • Reynolds H, Beaston-Blaakman A, Burke H, et al. Integrating Family Planning Services into Voluntary Counseling and Testing Centers in Kenya: Operations Research Results, 2006. Family Health International. (full text)
      • Reynolds H, Liku J, Maggwa NB. Assessment of voluntary counseling and testing centers in Kenya. Unpublished paper. Family Health International, 2003. (full text [PDF, 189 KB])

    • Operations research shows that integrating family planning into VCT services does not appear to decrease the quality of the VCT services.

      • Bradley H, Bedada A, Tsui A, et al. HIV and family planning service integration and voluntary HIV counselling and testing client composition in Ethiopia. AIDS Care 2008 Jan;20(1):61-71. (abstract)
      • Reynolds H, Beaston-Blaakman A, Burke H, et al. Integrating family planning into voluntary testing and counseling in Kenya: operations research results. Family Health International, July 2006. (full text [PDF, 441 KB])

    • Clients seeking VCT also likely require other reproductive health services. Clients of VCT are often sexually active, and so they need access to contraceptives to prevent unintended pregnancy and information about how HIV affects their contraceptive options. Integrating family planning and VCT services can potentially meet an unmet need for contraception and family planning information and services.

      • Hoffman IF, Martinson FE, Powers KA, et al. The Year-Long Effect of HIV-Positive Test Results on Pregnancy Intentions, Contraceptive Use, and Pregnancy Incidence Among Malawian Women. JAIDS 2008;47:477-83. (abstract)
      • Integrating Family Planning Services into Voluntary Counseling and Testing Centers in Kenya: Operations Research Results, 2006. Family Health International. (full text)
      • Reynolds H, Liku J, Maggwa NB. Assessment of voluntary counseling and testing centers in Kenya. Unpublished paper. Family Health International, 2003. (full text [PDF, 189 KB])

    • In Haiti, integrating family planning into VCT services resulted in 19 percent of VCT clients becoming new users of contraception.

      • Peck R, Fitzgerald D, Liautaud B. The feasibility, demand, and effect of integrating primary care services with HIV voluntary counseling and testing: evaluation of a 15-year experience in Haiti, 1985-2000. J Acquir Immune Defic Syndr 2003;33(4):470-75. (abstract)

  • Integrating family planning into VCT can require some changes to VCT service delivery.

    • Voluntary counseling and testing sites differ in the types of contraceptive methods they are equipped to provide. As a result, each facility should decide what level of family planning services it can offer. Sites that begin to offer family planning might need to adjust their procedures for making referrals, for keeping records, and for managing stocks of commodities.

      • Integrating Family Planning Services into Voluntary Counseling and Testing Centers in Kenya: Operations Research Results, 2006. Family Health International. (full text)
      • Reynolds H, Liku J, Maggwa NB. Assessment of voluntary counseling and testing centers in Kenya. Unpublished paper. Family Health International, 2003. (full text [PDF, 189 KB])

    • For integration of services to be successful, program managers might need to restructure the way they provide both family planning and VCT services, rather than simply inserting a new service into an existing one. Program managers should rethink the service site's overall goals, revise policy, retrain providers, and rewrite guidelines and manuals as needed.

      • Richey L. HIV/AIDS in the shadows of reproductive health interventions. Reprod Health Matters 2003;11(22):30-35. (abstract)

    • Where full-scale integration is not feasible, providers should refer VCT clients to family planning services and vice versa. However, research suggests that initial uptake of contraceptives among VCT clients increases when the desired methods are available on site.

      • Mark KE, Meinzen-Derr J, Stephenson R, et al. Contraception among HIV Concordant and Discordant Couples in Zambia: A Randomized Controlled Trial. J Women's Health. 2007;16(8):1200-1210. (abstract)
      • U.S. Agency for International Development. Family planning/HIV integration: technical guidance for USAID-supported field programs. Washington, DC: U.S. Agency for International Development. 2003. (full text [PDF, 252 KB])

  • More research is needed to determine the effectiveness of various models of service integration.

    • A large Cochrane review conducted in 2008 recommends evaluating whether integration of services results in improved health outcomes (such as unintended pregnancies averted and HIV infections averted) compared to offering each service separately.

      • [Sexual and Reproductive Health and HIV] Linkages: Evidence review and recommendations. Cochrane Database Syst Rev 2008 (forthcoming)

    • As programs continue to move toward integrating reproductive health and HIV services, research should assess whether integration is successful, replicable, sustainable, and cost-efficient.

      • Pruyn N, Cuca Y. Analysis of family planning/HIV/AIDS integration activities within the USAIDpopulation, health and nutrition center.Unpublished paper. Advance Africa and the CATALYST Consortium, 2002. (full text [PDF, 812 KB])

    • More research should be conducted on the effect service integration on the incidence and prevalence of sexually transmitted infections (STIs) and levels of unintended pregnancy.

      • Askew I, Maggwa NB. Integration of STI prevention and management with family planning and antenatal care in sub-Saharan Africa — what more do we need to know? Int Fam Plann Perspect 2002;28(2):77-86. (full text [PDF, 125 KB])

  • Once research demonstrated the feasibility of integrating family planning into VCT centers in Kenya, the Kenyan government quickly developed and began implementing a strategy for providing family planning services at all VCT centers in the country. Government leadership, an effective task force, and stakeholder commitment were key factors in putting research into practice and improving services for Kenyan clients.

      • Fischer S. Integrating family planning into HIV voluntary counseling and testing services in Kenya: Progress to date and lessons learned. Family Health International, 2006. (full text [PDF, 1 MB])


Additional Resources

Topical page: Integration of Family Planning and HIV/AIDS Services

Brief: Contraception and HIV (PDF, 159 KB)