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Member Research & Reports

Member Research & Reports

CUNY Faculty Promotes a Structural Intervention to Integrate Sexual and Reproductive Health into Public Sector HIV Care in South Africa

Dr. Elizabeth Kelvin, a Professor at the CUNY Graduate School of Public Health and Health Policy and colleagues worked to integrate sexual and reproductive health within HIV care services as a promising strategy for increasing access to family planning and sexually transmitted infection services and reducing unwanted pregnancies, perinatal HIV transmission and maternal and infant mortality among people living with HIV and their partners in Cape Town, South Africa. The findings were published in the journal AIDS and Behavior.

The research team conducted a Phase II randomized futility trial of a multi-level intervention to increase adherence to safer sex guidelines among those wishing to avoid pregnancy and adherence to safer conception guidelines among those seeking conception in newly-diagnosed HIV-positive persons in four public-sector HIV clinics in Cape Town. Clinics were pair-matched and the two clinics within each pair were randomized to either a three-session provider-delivered enhanced intervention (onsite contraceptive services and brief milieu intervention for staff) or standard-of-care provider-delivered intervention.

This is one of the first trials to assess an intervention that integrated both contraceptive and safer conception services into HIV care and treatment. Part of the goal of the research team was to test promising interventions that appropriately address fertility desires of HIV-positive individuals—both those who want to avoid or defer childbearing and those who want to conceive—within the context of real-world, overburdened and under-resourced, public-sector clinic settings. Such interventions are essential for determining their readiness for scale-up.

The futility analysis showed that we cannot rule out the possibility that the enhanced intervention has a 10 % point or greater success rate in improving adherence to safer sex/safer conception guidelines than does standard-of-care. Results from this trial suggest that the intervention has merit and should be more rigorously evaluated in a Phase III trial with biological endpoints in South Africa and other high HIV burden, resource-constrained settings in sub-Saharan Africa. This is all the more important as countries move toward universal treatment of HIV-positive people, irrespective of their CD4 count and HIV viral load.