Implementation and Operational Research: Integration of Family Planning Services in a Peer-Managed HIV Care Clinic Serving Most-at-Risk Populations in Phnom Penh, Cambodia.

Objective: To assess contraceptive uptake and method choice among women living with HIV (WLHIV) attending an HIV care clinic serving most-at-risk women in Phnom Penh, Cambodia, before and after the implementation of family planning (FP) services.
Methods: Semistructured questionnaires were administered to clients before (July, 2011) and after (July, 2012) FP service implementation with provision of contraceptive methods (pills, injectables, implants, and intrauterine device [IUD]).
Results: Among 250 and 249 clients interviewed before and after implementation respectively, 24.5% of women reported selling sex for money during the last 6 months before and 35.3% after implementation. Awareness about contraceptive methods significantly increased among clients postimplementation. Among sexually active women, male condom remained the contraceptive method of choice with an overall condom use during the last 6 months at 91% postimplementation vs. 95.6% preimplementation (P = 0.11). Although the use of noncondom FP methods increased but not significantly (16.4% after vs. 12.6% before implementation, P = 0.8), the use of dual method (condom plus another method) remained low and did not significantly increase after implementation (14.8% after vs. 11.0% before, P = 0.28).
Conclusions: Our results show that FP practices of WLHIV attending an HIV care clinic for most-at-risk populations did not significantly change after integration on-site provision of a wide range of FP methods. Innovative strategies and further research are needed to better understand how to promote the use of noncondom FP methods and prevent unwanted pregnancies and abortions among most-at-risk women and WLHIV.